Tagged Aging

Secret Repository Kept Well-Stocked In Case Of Bioterror Attack, Pandemic, Or Major Public Health Crisis

In the stockpile outside D.C. and in several other places across the country there are rows of antibiotics, including the powerful medication Ciprofloxacin, vaccines for smallpox and anthrax and antivirals for a deadly influenza pandemic. In other public health news: stem cell therapy, kidney disease, broken heart syndrome, rapid-aging disease, and more.

New Medicare Perk For Diabetes Prevention Stumbles At Rollout

Several weeks ago, Medicare launched an initiative to prevent seniors and people with serious disabilities from developing Type 2 diabetes, one of the most common and costly medical conditions in the U.S.

But the April 1 rollout of the Medicare Diabetes Prevention Program, a major new benefit that could help millions of people, is getting off to a rocky start, according to interviews with nearly a dozen experts.

In all but a few locations, experts said, Medicare’s new prevention program — a yearlong series of classes about healthy eating, physical activity and behavioral change for people at high risk of developing diabetes — isn’t up and running yet. And there’s no easy way (no phone number or website) to learn where it’s available.

A Medicare spokesman declined to indicate where the diabetes program is currently available, saying only that officials had approved three providers to date.

In a first for Medicare, community organizations such as YMCAs and senior centers will run the program, not doctors and hospitals. But many sites are struggling with Medicare’s contracting requirements and are hesitant to assume demanding administrative responsibilities, said Brenda Schmidt, acting president of the Council for Diabetes Prevention and chief executive officer of Solera Health, a company that assembles provider networks.

Medicare Advantage plans, an alternative to traditional Medicare run by private insurance companies, are now required to offer the Medicare Diabetes Prevention Program to millions of eligible members. But they aren’t doing active outreach because there are so few program sites available.

It’s “too early” to discuss how Medicare Advantage plans will handle implementation given uncertainty about the program’s accessibility, Cathryn Donaldson, director of communications for America’s Health Insurance Plans, said in an email.

Supporters urge patience. While Medicare’s embrace of diabetes prevention is “transformational,” building an infrastructure of community organizations to deliver these services “hasn’t been done before. It’s going to take time,” said Ann Albright, director of the Division of Diabetes Translation at the U.S. Centers for Disease Control and Prevention.

In a written comment, a spokesman for the Centers for Medicare & Medicaid Services said about 50 of more than 400 eligible programs are in the process of submitting applications. An online resource identifying approved programs is under development, and outreach to people with Medicare coverage is “planned for the coming months,” the statement said.

For those who want more timely information, here’s a look at the Medicare Diabetes Prevention Program and why it’s worth waiting for, even if takes awhile for a program to become available near you.

Diabetes and older adults. According to the CDC, at least 23 million people age 65 and older have “prediabetes” — elevated blood sugar levels that put them at heightened risk of developing Type 2 diabetes.

In five years, without intervention, up to one-third of this group will develop Type 2 diabetes — a leading cause of blindness, amputation and kidney disease in older adults, associated with a heightened risk of heart disease, stroke and dementia.

Program eligibility. The Medicare Diabetes Prevention Program is available to older adults and people with serious disabilities with Medicare Part B coverage who have prediabetes — and it’s free for those who qualify.

Once the program becomes available in your area, your doctor can refer you or you can sign up on your own, so long as you have a body mass index of at least 25 (or a BMI of 23, if you’re Asian), you haven’t been previously diagnosed with diabetes, and your blood sugar levels are consistent with prediabetes.

This benefit is available only once to each qualified Medicare beneficiary, so it behooves you to make sure you’re ready for the commitment it entails.

“The purpose of this should be to improve your health and quality of life, long term, not to lose vanity pounds,” said Marlayna Bollinger, executive director of San Diego’s Skinny Gene Project, which works with people at risk of developing diabetes.

Evidence of effectiveness. Medicare is tweaking the National Diabetes Prevention Program, launched by the CDC in 2010. In a much-cited 2002 study published in the New England Journal of Medicine, researchers found that participants in an early version of the CDC program were 58 percent less likely to develop diabetes than a placebo group. For people 60 and older, the reduced risk of developing diabetes was even more striking — 71 percent.

James Combs, 66, weighed 273 pounds when he enrolled in a program offered by Baptist Health in Lexington, Ky., in January 2016. Today, he weighs 210 pounds, no longer takes medication for high blood pressure, and reported “feeling fantastic.” (Combs enrolled before becoming eligible for Medicare, and his private insurance paid for the program.)

Medicare’s model. Small groups of about eight to 20 people meet weekly, for about an hour, 16 times over a six-month period, then once or twice a month for the next six months. Nutritionists, diabetes educators or other coaches use a structured CDC-approved curriculum and foster group discussion and problem-solving.

Participants check their weight at each session and keep daily logs of what they’re eating and their physical activity. The goal is to have participants lose at least 5 percent of their body weight and get 150 minutes of physical activity weekly.

“The objectives are very realistic and that increases the likelihood of success,” said Kathleen Stanley, Baptist Health’s coordinator for diabetes education and prevention.

A four-year pilot program involving nearly 8,000 seniors in 315 locations, sponsored by Medicare and coordinated by YMCA of the USA, found that savings were significant: an estimated $2,650 over the course of 15 months for each participant.

Medicare has also added a second year of monthly sessions, designed to reinforce lessons learned in the first year, for people who meet weight loss targets and regularly attend classes. (Those who don’t aren’t allowed to attend these sessions.)

Medicare will pay up to $670 per participant for the two-year period if programs meet performance standards relating to weight loss and attendance. If not, payments are lower.

For the moment, Medicare doesn’t plan to work with companies such as Omada Health Inc. or Canary Health that offer online versions of CDC’s Diabetes Prevention Program. But advocacy groups are pressing for this alternative to in-person classes.

“Virtual delivery of the diabetes prevention program would be a great option, particularly for seniors in underserved areas,” said Meghan Riley, vice president of federal government affairs for the American Diabetes Association.

Next steps. YMCA of the USA is among several organizations that plan to participate in the Medicare Diabetes Prevention program but are adopting a cautious approach.

“We’re still digging through Medicare rules and regulations and trying to make sure we understand the implications,” said Heather Hodges, the Y’s senior director of evidence-based health interventions.

She said 25 of the Y’s 840 associations were in the process of applying for Medicare certification and that as many as 50 might be offering the Medicare Diabetes Prevention Program by the end of the year. (Each Y association encompasses multiple locations.)

Albright said the CDC was asking state health departments and 10 national organizations, including the American Diabetes Association, the National Alliance for Hispanic Health and Black Women’s Health Imperative, to promote the new Medicare benefit. Once Medicare publishes a list of programs that its officials have approved, CDC will highlight this online, she said.

Angela Forfia, senior manager of prevention at the American Association of Diabetes Educators, suggested that older adults contact their local Area Agency on Aging, local health departments and senior centers in their area and express interest in the Medicare Diabetes Prevention Program.

“If Medicare recipients start to demand and ask for this, you’ll have more organizations step up and sign on to become Medicare suppliers,” she suggested.

Meanwhile, seniors might want to learn if they have prediabetes. (About 9 out of 10 people who do don’t know it.) “Take our risk test and see where you stand,” Albright advised (available at www.doihaveprediabetes.org). “It’s a good conversation starter with your health care professional, who may want to follow up by ordering a blood test.”

It Can Be ‘Next To Impossible’ To Find Nursing Facilities That Will Accept Patients Recovering From Opioid Addiction

Legal experts say that nursing facilities rejecting patients on addiction medication violates the Americans with Disabilities Act, yet an investigation finds that it’s a common practice. In more news on the crisis: medical groups are advocating for a new reimbursement model of physicians who treat opioid patients; researchers find that organ transplants from overdose victims fare as well as from traditional donors; West Virginia reaches a settlement with a pharmacy over its distributing practices; and more.

Más mujeres que hombres sufren ahora una “aterradora” enfermedad pulmonar

Joan Cousins ​​fue parte de una generación de mujeres jóvenes que escucharon, y aceptaron la idea, que fumar un cigarrillo era sofisticado, moderno e incluso liberador. Nadie sospechaba en aquel entonces que las haría más iguales a los hombres al sufrir una enfermedad pulmonar que asfixia y acorta la vida.

“Todos fumaban. Era estar en onda”, dijo Cousins, quien probó su primer cigarrillo hace 67 años, cuanto tenía 16.

Pero un día, Cousins ​​comenzó a toser y no pudo parar, o siquiera respirar profundamente. Fue a un hospital, en donde los médicos le dijeron que padecía una afección progresiva en los pulmones llamada enfermedad pulmonar obstructiva crónica (EPOC). “No poder respirar era tan aterrador… que nunca probé otro cigarrillo”, contó Cousins.

Tradicionalmente, la EPOC se consideraba una enfermedad masculina, pero ahora, en los Estados Unidos, mata a más mujeres que a hombres. Las mujeres representan el 58% de los 14,7 millones que viven en el país con esta enfermedad y el 53% de los que mueren a causa de ella, según la American Lung Association. Casi el 8% de las mujeres han informado un diagnóstico de EPOC, en comparación con poco menos del 6% de los hombres.

La ex primera dama Barbara Bush, de 92 años, padece esta enfermedad. El anuncio de un vocero de la familia el lunes 16 de abril informando que Bush ha decidido comenzar a recibir un “cuidado confortable” (comfort care en inglés), un tipo de cuidado hacia el final de la vida, encendió el debate sobre lo que significa dejar de tratar una enfermedad terminal.

“Es un gran problema de salud pública para las mujeres, que realmente no recibe suficiente atención”, dijo la doctora Meilan Han, profesora asociada de medicina en la Universidad de Michigan. “Este es uno de los principales asesinos de mujeres en el país”.

Debido a que la EPOC generalmente se asocia con hombres, con frecuencia a las mujeres se le diagnostica cuando la enfermedad ya está avanzada. Los síntomas incluyen tos crónica, sibilancia, endurecimiento del pecho y dificultad para respirar. No hay cura, pero su progresión se puede hacer más lenta. Lo más importante que un paciente puede hacer después de un diagnóstico de EPOC es dejar de fumar.

Los investigadores culpan en gran medida a la adopción gradual del hábito de fumar por parte de las mujeres por el aumento en las muertes por EPOC. Los hombres comenzaron a fumar masivamente a fines del siglo XIX, coincidiendo con la producción masiva de cigarrillos. En las décadas de 1920 y 1930, las compañías tabacaleras comenzaron a apuntar hacia las mujeres con anuncios que apelaban a su sentido de independencia y anhelo de atractivo social y sexual.

Otra ola de campañas publicitarias a fines de la década de los 60 y principios de los 70 indujo a un gran número de mujeres y adolescentes a comenzar a fumar cigarrillos. Marcas como Virginia Slims capitalizaron el movimiento de liberación femenina con lemas pegadizos, entre ellos “Has recorrido, muchacha, un largo camino ya”.

“Los efectos de la EPOC se retrasan durante décadas y décadas”, dijo la doctora May-Lin Wilgus, profesora clínica asistente y neumóloga de UCLA Health. “Estamos viendo los efectos de las mujeres fumando en grandes cantidades, especialmente en los 60 y 70”.

Las diferencias de género también contribuyen al aumento del peligro de EPOC para las mujeres. La investigación muestra que las mujeres pueden ser más susceptibles a los efectos tóxicos del humo del cigarrillo que los hombres. La razón exacta no se conoce con certeza, pero los investigadores creen que un factor es que los pulmones de las mujeres son generalmente más pequeños. El estrógeno también puede empeorar el daño pulmonar causado por fumar.

Joan Cousins, quien fue diagnosticada con EPOC hace dos décadas, sostiene un collage que ella misma hizo con piezas de un rompecabezas y botones. Fumó durante 46 años antes de dejar el hábito. (Cortesía de Joan Cousins)

Cousins, quien dejó de fumar a los 62 años, dijo que ahora lleva un tanque de oxígeno a todos lados. Bromeando, lo llama “su mejor amigo”. Por la noche, duerme conectada a una máquina que ayuda a mantener sus vías respiratorias abiertas. A pesar de la respiración asistida, Cousins ​​dijo que a menudo siente como si alguien estuviera presionando su pecho. La mujer de 83 años, quien vive al sureste de San Francisco, aún puede cultivar y crear arte, entre sus especialidades está la decoración de madera quemada, pero describió la enfermedad como una “sofocación lenta”.

La EPOC es un término genérico utilizado para describir enfermedades pulmonares progresivas que incluyen bronquitis crónica, enfisema y otras afecciones que dificultan que las personas expulsen el aire de sus pulmones. Más allá de fumar, factores como la contaminación y la genética también pueden contribuir al desarrollo de la enfermedad.

Las mujeres tienen más probabilidades que los hombres de tener crisis respiratorias, que pueden ser causadas por infecciones o exposición a contaminantes. Las crisis frecuentes se asocian con una progresión más rápida de la enfermedad.

El tratamiento de la EPOC, que puede mejorar temporalmente los síntomas y la función pulmonar, incluye broncodilatadores para abrir las vías respiratorias, inhaladores y esteroides, dijo Han, quien también es vocera voluntaria de la American Lung Association. En los casos más severos, pueden necesitarse un trasplante de pulmón.

Los médicos y defensores dicen que muchas mujeres están viviendo la enfermedad sin saberlo porque no tienen conciencia o son reacias a buscar ayuda.

“Si tienen problemas para respirar cuando suben las escaleras, pueden decir ‘soy un poco mayor, estoy pesada, o fuera de forma’”, dijo Stephanie Williams, directora de programas comunitarios de la COPD Foundation, que recientemente realizó un seminario en internet sobre la enfermedad entre las mujeres. “Las mujeres posponen el tratamiento por más tiempo y ocultan sus síntomas”.

Inez Shakman, de 73 años, quien vive en Ventura, California, y es paciente de la doctora Wilgus, dijo que tuvo problemas para exhalar durante años, y los resfriados comunes tendían a asentarse en su pecho y duraban más de lo esperado. También le costaba hasta una breve caminata. Fue solo hace unos cuatro meses cuando supo que tenía EPOC. Nunca había oído hablar de la enfermedad. Ahora, con medicamentos, puede caminar por el parque sin detenerse o perder el aliento, contó.

Las escuelas de medicina han enseñado durante mucho tiempo sobre la EPOC, pero en libros que tienen dibujos de hombres que padecen la enfermedad, y los investigadores han detectado un sesgo de género en los diagnósticos médicos. En un estudio bien conocido, médicos a los que se les presentaron pacientes hipotéticos hicieron el diagnóstico correcto más a menudo en hombres que en mujeres.

Caroline Gainer, una maestra jubilada de 74 años, quien vive en Daniels, un pueblo rural de West Virginia, le contó a su médico más de una vez sobre sus síntomas, que incluían toser cada mañana y sensación de falta de aliento. “Pensó que tenía asma”, dijo.

Finalmente, le diagnosticaron EPOC y ahora necesita oxígeno para moverse. Fue cuando abandonó el cigarrillo con ayuda de un parche de nicotina, después de haber fumado por medio siglo. “Hago todo lo que se supone que debo hacer”, dijo Gainer. “Tal vez no pueda detener el avance de la enfermedad, pero puedo retrasarlo”, dijo.

Más mujeres que hombres sufren ahora una “aterradora” enfermedad pulmonar

Joan Cousins ​​fue parte de una generación de mujeres jóvenes que escucharon, y aceptaron la idea, que fumar un cigarrillo era sofisticado, moderno e incluso liberador. Nadie sospechaba en aquel entonces que las haría más iguales a los hombres al sufrir una enfermedad pulmonar que asfixia y acorta la vida.

“Todos fumaban. Era estar en onda”, dijo Cousins, quien probó su primer cigarrillo hace 67 años, cuanto tenía 16.

Pero un día, Cousins ​​comenzó a toser y no pudo parar, o siquiera respirar profundamente. Fue a un hospital, en donde los médicos le dijeron que padecía una afección progresiva en los pulmones llamada enfermedad pulmonar obstructiva crónica (EPOC). “No poder respirar era tan aterrador… que nunca probé otro cigarrillo”, contó Cousins.

Tradicionalmente, la EPOC se consideraba una enfermedad masculina, pero ahora, en los Estados Unidos, mata a más mujeres que a hombres. Las mujeres representan el 58% de los 14,7 millones que viven en el país con esta enfermedad y el 53% de los que mueren a causa de ella, según la American Lung Association. Casi el 8% de las mujeres han informado un diagnóstico de EPOC, en comparación con poco menos del 6% de los hombres.

La ex primera dama Barbara Bush, de 92 años, padece esta enfermedad. El anuncio de un vocero de la familia el lunes 16 de abril informando que Bush ha decidido comenzar a recibir un “cuidado paliativo” (comfort care en inglés), un tipo de cuidado hacia el final de la vida, encendió el debate sobre lo que significa dejar de tratar una enfermedad terminal.

“Es un gran problema de salud pública para las mujeres, que realmente no recibe suficiente atención”, dijo la doctora Meilan Han, profesora asociada de medicina en la Universidad de Michigan. “Este es uno de los principales asesinos de mujeres en el país”.

Debido a que la EPOC generalmente se asocia con hombres, con frecuencia a las mujeres se le diagnostica cuando la enfermedad ya está avanzada. Los síntomas incluyen tos crónica, sibilancia, endurecimiento del pecho y dificultad para respirar. No hay cura, pero su progresión se puede hacer más lenta. Lo más importante que un paciente puede hacer después de un diagnóstico de EPOC es dejar de fumar.

Los investigadores culpan en gran medida a la adopción gradual del hábito de fumar por parte de las mujeres por el aumento en las muertes por EPOC. Los hombres comenzaron a fumar masivamente a fines del siglo XIX, coincidiendo con la producción masiva de cigarrillos. En las décadas de 1920 y 1930, las compañías tabacaleras comenzaron a apuntar hacia las mujeres con anuncios que apelaban a su sentido de independencia y anhelo de atractivo social y sexual.

Otra ola de campañas publicitarias a fines de la década de los 60 y principios de los 70 indujo a un gran número de mujeres y adolescentes a comenzar a fumar cigarrillos. Marcas como Virginia Slims capitalizaron el movimiento de liberación femenina con lemas pegadizos, entre ellos “Has recorrido, muchacha, un largo camino ya”.

“Los efectos de la EPOC se retrasan durante décadas y décadas”, dijo la doctora May-Lin Wilgus, profesora clínica asistente y neumóloga de UCLA Health. “Estamos viendo los efectos de las mujeres fumando en grandes cantidades, especialmente en los 60 y 70”.

Las diferencias de género también contribuyen al aumento del peligro de EPOC para las mujeres. La investigación muestra que las mujeres pueden ser más susceptibles a los efectos tóxicos del humo del cigarrillo que los hombres. La razón exacta no se conoce con certeza, pero los investigadores creen que un factor es que los pulmones de las mujeres son generalmente más pequeños. El estrógeno también puede empeorar el daño pulmonar causado por fumar.

Joan Cousins, quien fue diagnosticada con EPOC hace dos décadas, sostiene un collage que ella misma hizo con piezas de un rompecabezas y botones. Fumó durante 46 años antes de dejar el hábito. (Cortesía de Joan Cousins)

Cousins, quien dejó de fumar a los 62 años, dijo que ahora lleva un tanque de oxígeno a todos lados. Bromeando, lo llama “su mejor amigo”. Por la noche, duerme conectada a una máquina que ayuda a mantener sus vías respiratorias abiertas. A pesar de la respiración asistida, Cousins ​​dijo que a menudo siente como si alguien estuviera presionando su pecho. La mujer de 83 años, quien vive al sureste de San Francisco, aún puede cultivar y crear arte, entre sus especialidades está la decoración de madera quemada, pero describió la enfermedad como una “sofocación lenta”.

La EPOC es un término genérico utilizado para describir enfermedades pulmonares progresivas que incluyen bronquitis crónica, enfisema y otras afecciones que dificultan que las personas expulsen el aire de sus pulmones. Más allá de fumar, factores como la contaminación y la genética también pueden contribuir al desarrollo de la enfermedad.

Las mujeres tienen más probabilidades que los hombres de tener crisis respiratorias, que pueden ser causadas por infecciones o exposición a contaminantes. Las crisis frecuentes se asocian con una progresión más rápida de la enfermedad.

El tratamiento de la EPOC, que puede mejorar temporalmente los síntomas y la función pulmonar, incluye broncodilatadores para abrir las vías respiratorias, inhaladores y esteroides, dijo Han, quien también es vocera voluntaria de la American Lung Association. En los casos más severos, pueden necesitarse un trasplante de pulmón.

Los médicos y defensores dicen que muchas mujeres están viviendo la enfermedad sin saberlo porque no tienen conciencia o son reacias a buscar ayuda.

“Si tienen problemas para respirar cuando suben las escaleras, pueden decir ‘soy un poco mayor, estoy pesada, o fuera de forma’”, dijo Stephanie Williams, directora de programas comunitarios de la COPD Foundation, que recientemente realizó un seminario en internet sobre la enfermedad entre las mujeres. “Las mujeres posponen el tratamiento por más tiempo y ocultan sus síntomas”.

Inez Shakman, de 73 años, quien vive en Ventura, California, y es paciente de la doctora Wilgus, dijo que tuvo problemas para exhalar durante años, y los resfriados comunes tendían a asentarse en su pecho y duraban más de lo esperado. También le costaba hasta una breve caminata. Fue solo hace unos cuatro meses cuando supo que tenía EPOC. Nunca había oído hablar de la enfermedad. Ahora, con medicamentos, puede caminar por el parque sin detenerse o perder el aliento, contó.

Las escuelas de medicina han enseñado durante mucho tiempo sobre la EPOC, pero en libros que tienen dibujos de hombres que padecen la enfermedad, y los investigadores han detectado un sesgo de género en los diagnósticos médicos. En un estudio bien conocido, médicos a los que se les presentaron pacientes hipotéticos hicieron el diagnóstico correcto más a menudo en hombres que en mujeres.

Caroline Gainer, una maestra jubilada de 74 años, quien vive en Daniels, un pueblo rural de West Virginia, le contó a su médico más de una vez sobre sus síntomas, que incluían toser cada mañana y sensación de falta de aliento. “Pensó que tenía asma”, dijo.

Finalmente, le diagnosticaron EPOC y ahora necesita oxígeno para moverse. Fue cuando abandonó el cigarrillo con ayuda de un parche de nicotina, después de haber fumado por medio siglo. “Hago todo lo que se supone que debo hacer”, dijo Gainer. “Tal vez no pueda detener el avance de la enfermedad, pero puedo retrasarlo”, dijo.

Barbara Bush’s End-Of-Life Decision Stirs Debate Over ‘Comfort Care’

As she nears death at age 92, former first lady Barbara Bush’s announcement that she is seeking “comfort care” is shining a light — and stirring debate — on what it means to stop trying to fight terminal illness.

Bush, the wife of former President George H.W. Bush, has been suffering from congestive heart failure and chronic obstructive pulmonary disease, according to family spokesman Jim McGrath.

In a public statement Sunday, the family announced she has decided “not to seek additional medical treatment and will focus on comfort care.”

The announcement comes amid a national effort to define and document patients’ wishes, and consider alternatives, before they are placed on what has been described as a “conveyor belt” of costly medical interventions aimed at prolonging life.

Ellen Goodman, co-founder of the Conversation Project, which encourages families to discuss and document their end-of-life preferences, applauded the Bush family announcement.

“It sounds like this forthright, outspoken woman has made her wishes known and the family is standing by her,” Goodman said.

“It makes perfectly good sense at her age, with her failing health, that she would say at some point, ‘Life’s been good, and while you always want more, it’s enough,’” said Dr. Joanne Lynn, director of the program to improve elder care at Altarum Institute.

Lynn worked with Barbara Bush years ago, when she was a congressional spouse volunteering at the Washington Home for chronically ill patients. Bush helped with the founding of the hospice program there.

“We have so few examples in visible leadership positions” of public figures promoting palliative care, she said.

“It’s a personal decision that she didn’t have to share, but hopefully it will encourage others to think about their choices, talk about their choices, document their choices and have those choices honored,” said Nathan Kottkamp, founder and chair of National Healthcare Decisions Day.

Thousands were expected to focus on their end-of-life preferences Monday, which has been designated as National Health Care Decisions Day since 2008.

Dr. Haider Warraich, a fellow in cardiovascular medicine at Duke University Medical Center and author of the book “Modern Death,” also applauded the Bush family for putting the phrase “comfort care” into the public sphere so that other people can consider it “a viable option at the end of life.”

But he said the family statement also creates confusion about the meaning of “comfort care,” by suggesting that it entails stopping medical treatment. On twitter, palliative care experts vigorously refuted that mischaracterization.

“Comfort care” usually refers to palliative care, which focuses on managing patients’ symptoms to keep them comfortable and retain their dignity, Warraich said.

“One of the common myths about palliative care is that they are being denied medical help,” Warraich said.

For heart failure patients, he said, “comfort care” usually means opting not to use a breathing machine or CPR. But patients do continue to receive medical treatment, including morphine to ease shortness of breath, and diuretics to remove excess fluid from their lungs, he said.

Heart failure patients, he said, often receive “escalating medical treatments until days before the end of life.” Their transition to comfort care can be abrupt, “like falling off a cliff,” he said.

“By bringing this into the sphere of discussion,” Warraich said, “we can start thinking about comfort and palliation long before they are in the clutches of death.”

Barbara Bush’s End-Of-Life Decision Stirs Debate Over ‘Comfort Care’

As she nears death at age 92, former first lady Barbara Bush’s announcement that she is seeking “comfort care” is shining a light — and stirring debate — on what it means to stop trying to fight terminal illness.

Bush, the wife of former President George H.W. Bush, has been suffering from congestive heart failure and chronic obstructive pulmonary disease, according to family spokesman Jim McGrath.

In a public statement Sunday, the family announced she has decided “not to seek additional medical treatment and will focus on comfort care.”

The announcement comes amid a national effort to define and document patients’ wishes, and consider alternatives, before they are placed on what has been described as a “conveyor belt” of costly medical interventions aimed at prolonging life.

Ellen Goodman, co-founder of the Conversation Project, which encourages families to discuss and document their end-of-life preferences, applauded the Bush family announcement.

“It sounds like this forthright, outspoken woman has made her wishes known and the family is standing by her,” Goodman said.

“It makes perfectly good sense at her age, with her failing health, that she would say at some point, ‘Life’s been good, and while you always want more, it’s enough,’” said Dr. Joanne Lynn, director of the program to improve elder care at Altarum Institute.

Lynn worked with Barbara Bush years ago, when she was a congressional spouse volunteering at the Washington Home for chronically ill patients. Bush helped with the founding of the hospice program there.

“We have so few examples in visible leadership positions” of public figures promoting palliative care, she said.

“It’s a personal decision that she didn’t have to share, but hopefully it will encourage others to think about their choices, talk about their choices, document their choices and have those choices honored,” said Nathan Kottkamp, founder and chair of National Healthcare Decisions Day.

Thousands were expected to focus on their end-of-life preferences Monday, which has been designated as National Health Care Decisions Day since 2008.

Dr. Haider Warraich, a fellow in cardiovascular medicine at Duke University Medical Center and author of the book “Modern Death,” also applauded the Bush family for putting the phrase “comfort care” into the public sphere so that other people can consider it “a viable option at the end of life.”

But he said the family statement also creates confusion about the meaning of “comfort care,” by suggesting that it entails stopping medical treatment. On twitter, palliative care experts vigorously refuted that mischaracterization.

“Comfort care” usually refers to palliative care, which focuses on managing patients’ symptoms to keep them comfortable and retain their dignity, Warraich said.

“One of the common myths about palliative care is that they are being denied medical help,” Warraich said.

For heart failure patients, he said, “comfort care” usually means opting not to use a breathing machine or CPR. But patients do continue to receive medical treatment, including morphine to ease shortness of breath, and diuretics to remove excess fluid from their lungs, he said.

Heart failure patients, he said, often receive “escalating medical treatments until days before the end of life.” Their transition to comfort care can be abrupt, “like falling off a cliff,” he said.

“By bringing this into the sphere of discussion,” Warraich said, “we can start thinking about comfort and palliation long before they are in the clutches of death.”

Older Americans Without Adult Children Need To Be Proactive In Creating Aging Plans, Experts Say

There’s a growing population of older adults without children having to navigate getting older and the pitfalls that come with it. But it can be done successfully, experts say. In other aging news: the financial toll of dementia, older patients who have been living with HIV, positive perceptions about aging, and more.

Older Americans Without Adult Children Need To Be Proactive In Creating Aging Plans, Experts Say

There’s a growing population of older adults without children having to navigate getting older and the pitfalls that come with it. But it can be done successfully, experts say. In other aging news: the financial toll of dementia, older patients who have been living with HIV, positive perceptions about aging, and more.

Genetic Testing Is A Hot New Benefit For Employees, But Researchers Say It Might Do More Harm Than Good

Experts caution that extending use of the tests to the broader population may lead some people of average risk to forgo recommended screenings or, on the flip side, lead to unnecessary and extreme medical procedures. In other public health news: a smart gun, drug-resistant typhoid, viruses, hypertension, the dangers of sitting, bright lights for hospital patients, and more.

Genetic Testing Is A Hot New Benefit For Employees, But Researchers Say It Might Do More Harm Than Good

Experts caution that extending use of the tests to the broader population may lead some people of average risk to forgo recommended screenings or, on the flip side, lead to unnecessary and extreme medical procedures. In other public health news: a smart gun, drug-resistant typhoid, viruses, hypertension, the dangers of sitting, bright lights for hospital patients, and more.

‘Scary’ Lung Disease Now Afflicts More Women Than Men In U.S.

Joan Cousins was among a generation of young women who heard — and bought into the idea — that puffing on a cigarette was sophisticated, modern, even liberating. No one suspected it would make them more than equal to men in suffering a choking, life-shortening lung disease.

“Everybody smoked. It was the cool thing to do,” said Cousins, who smoked her first cigarette 67 years ago at age 16.

But one day, Cousins started coughing and could not stop — or take a deep breath. She drove to a hospital, where doctors told her she had a progressive lung disease called chronic obstructive pulmonary disease (COPD). “Not breathing was so scary … that I never had another cigarette,” Cousins said.

COPD traditionally was considered a man’s disease, but it now kills more women in the United States than men. Women account for 58 percent of the 14.7 million people in the U.S. living with the disease and 53 percent of those who die from it, according to the American Lung Association. Nearly 8 percent of women in the U.S. have reported a COPD diagnosis, compared with just under 6 percent of men.

(Story continues below.)

“It’s a huge public health problem for women that doesn’t really get enough attention,” said Dr. Meilan Han, associate professor of medicine at the University of Michigan. “This is one of the top killers of women in the country.”

Because COPD is often associated with men, women are frequently diagnosed after the disease is already advanced. Symptoms of COPD include a chronic cough, wheezing, tightening of the chest and shortness of breath. There is no cure for COPD, but its progression can be slowed. The most important thing a patient can do after a COPD diagnosis is to stop smoking.

Researchers largely blame women’s gradual adoption of smoking for the modern-day rise in COPD deaths among women. Men started smoking in large numbers in the late 1800s, coinciding with the mass production of cigarettes. In the 1920s and 1930s, tobacco companies began targeting women with ads that appealed to their sense of independence and yearning for social and sexual desirability.

Another wave of ad campaigns in the late 1960s and early 1970s induced large numbers of women, and teenage girls, to start smoking cigarettes. Brands such as Virginia Slims capitalized on the women’s liberation movement with catchy slogans, including “You’ve come a long way, baby.”

“The effects of COPD are delayed for decades and decades,” said Dr. May-Lin Wilgus, assistant clinical professor and pulmonologist at UCLA Health. “We are seeing the effects of women smoking in large numbers, especially in the 1960s and ’70s.”

Gender differences also contribute to the increased danger of COPD for women. Research shows women may be more susceptible to the toxic effects of cigarette smoke than are men. The exact reason is not certain, but researchers believe one factor is that women’s lungs are generally smaller. Estrogen can also worsen the lung damage caused by smoking.

Joan Cousins, who was diagnosed with COPD about two decades ago, holds a “story collage” made from puzzle pieces, fabric and buttons. The Union City, Calif., woman smoked for 46 years before quitting. (Courtesy of Joan Cousins)

Cousins, who stopped smoking at age 62, said she now takes an oxygen tank everywhere she goes. She half-jokingly calls it her “best friend.” At night, she sleeps hooked up to a machine that helps keep her airways open. Despite the assisted breathing, Cousins said she often feels as if someone is pushing down on her chest. The 83-year-old, who lives southeast of San Francisco, is still able to garden and create art — among her specialties is wood-burned décor — but she described the disease as “slow suffocation.”

COPD is an umbrella term used to describe progressive lung diseases including chronic bronchitis, emphysema and other conditions that make it difficult for people to push air out of their lungs. Beyond smoking, factors such as pollution and genetics can contribute to developing the disease.

Women are more likely than men to have flare-ups, or exacerbations, which can be caused by infections or exposure to pollutants. Frequent exacerbations are associated with a faster progression of the disease.

Helena Bravi of Lawrence, Kan., said she has repeatedly gone to the ER since her COPD diagnosis four years ago, even though she is on medication and oxygen. When her COPD flares up, Bravi said, the pressure builds in her chest and she gets anxious. She tries to avoid triggers such as smoke and aerosols.

“It’s really scary,” she said. “The goal is to get through the day without an exacerbation.”

COPD treatment, which can temporarily improve symptoms and lung function, may include bronchodilators to open the airways, inhalers and steroids, said Han, who is a volunteer spokeswoman for the American Lung Association. In the most severe cases, lung transplants might be needed.

Doctors and advocates say many women are unknowingly living with the disease because they lack of awareness or are reluctant to seek help.

“If they have trouble breathing when they are going up stairs, they may say ‘I’m just a little older or heavier or out of shape,’” said Stephanie Williams, director of community programs for the COPD Foundation, which recently held a webinar about the disease among women. “Women put off treatment longer and they mask their symptoms.”

Inez Shakman, 73, who lives in Ventura, Calif., and sees Dr. Wilgus, said she had problems exhaling for years, and common colds tended to settle in her chest and last longer than expected. She also found it physically straining sometimes to walk in the park. It was only about four months ago that she learned she had COPD. She’d never heard of the disease. Now, with medication, she can walk around the park without stopping or gasping for air, she said.

Medical schools have long taught about COPD with a textbook that features images of two men, and researchers have detected gender bias in doctors’ diagnoses of the disease. In one well-known study, physicians who were presented with hypothetical patients made the correct diagnosis more often for men than for women.

Caroline Gainer, a 74-year-old retired teacher who lives in Daniels, a rural town in West Virginia, told her doctor more than once about her symptoms, which included coughing every morning and regularly feeling short of breath. “He thought I had asthma,” she said. “I don’t think I ever got the message across about how bad it was.”

Finally, Gainer was diagnosed with COPD, and now she needs oxygen to get around. She gave up her 50-year smoking habit with the help of a nicotine patch, takes her medications and exercises regularly. “I do everything I am supposed to do,” Gainer said. “I can maybe not halt the progress but I can slow it down.”

‘Scary’ Lung Disease Now Afflicts More Women Than Men In U.S.

Joan Cousins was among a generation of young women who heard — and bought into the idea — that puffing on a cigarette was sophisticated, modern, even liberating. No one suspected it would make them more than equal to men in suffering a choking, life-shortening lung disease.

“Everybody smoked. It was the cool thing to do,” said Cousins, who smoked her first cigarette 67 years ago at age 16.

But one day, Cousins started coughing and could not stop — or take a deep breath. She drove to a hospital, where doctors told her she had a progressive lung disease called chronic obstructive pulmonary disease (COPD). “Not breathing was so scary … that I never had another cigarette,” Cousins said.

COPD traditionally was considered a man’s disease, but it now kills more women in the United States than men. Women account for 58 percent of the 14.7 million people in the U.S. living with the disease and 53 percent of those who die from it, according to the American Lung Association. Nearly 8 percent of women in the U.S. have reported a COPD diagnosis, compared with just under 6 percent of men.

(Story continues below.)

“It’s a huge public health problem for women that doesn’t really get enough attention,” said Dr. Meilan Han, associate professor of medicine at the University of Michigan. “This is one of the top killers of women in the country.”

Because COPD is often associated with men, women are frequently diagnosed after the disease is already advanced. Symptoms of COPD include a chronic cough, wheezing, tightening of the chest and shortness of breath. There is no cure for COPD, but its progression can be slowed. The most important thing a patient can do after a COPD diagnosis is to stop smoking.

Researchers largely blame women’s gradual adoption of smoking for the modern-day rise in COPD deaths among women. Men started smoking in large numbers in the late 1800s, coinciding with the mass production of cigarettes. In the 1920s and 1930s, tobacco companies began targeting women with ads that appealed to their sense of independence and yearning for social and sexual desirability.

Another wave of ad campaigns in the late 1960s and early 1970s induced large numbers of women, and teenage girls, to start smoking cigarettes. Brands such as Virginia Slims capitalized on the women’s liberation movement with catchy slogans, including “You’ve come a long way, baby.”

“The effects of COPD are delayed for decades and decades,” said Dr. May-Lin Wilgus, assistant clinical professor and pulmonologist at UCLA Health. “We are seeing the effects of women smoking in large numbers, especially in the 1960s and ’70s.”

Gender differences also contribute to the increased danger of COPD for women. Research shows women may be more susceptible to the toxic effects of cigarette smoke than are men. The exact reason is not certain, but researchers believe one factor is that women’s lungs are generally smaller. Estrogen can also worsen the lung damage caused by smoking.

Joan Cousins, who was diagnosed with COPD about two decades ago, holds a “story collage” made from puzzle pieces, fabric and buttons. The Union City, Calif., woman smoked for 46 years before quitting. (Courtesy of Joan Cousins)

Cousins, who stopped smoking at age 62, said she now takes an oxygen tank everywhere she goes. She half-jokingly calls it her “best friend.” At night, she sleeps hooked up to a machine that helps keep her airways open. Despite the assisted breathing, Cousins said she often feels as if someone is pushing down on her chest. The 83-year-old, who lives southeast of San Francisco, is still able to garden and create art — among her specialties is wood-burned décor — but she described the disease as “slow suffocation.”

COPD is an umbrella term used to describe progressive lung diseases including chronic bronchitis, emphysema and other conditions that make it difficult for people to push air out of their lungs. Beyond smoking, factors such as pollution and genetics can contribute to developing the disease.

Women are more likely than men to have flare-ups, or exacerbations, which can be caused by infections or exposure to pollutants. Frequent exacerbations are associated with a faster progression of the disease.

Helena Bravi of Lawrence, Kan., said she has repeatedly gone to the ER since her COPD diagnosis four years ago, even though she is on medication and oxygen. When her COPD flares up, Bravi said, the pressure builds in her chest and she gets anxious. She tries to avoid triggers such as smoke and aerosols.

“It’s really scary,” she said. “The goal is to get through the day without an exacerbation.”

COPD treatment, which can temporarily improve symptoms and lung function, may include bronchodilators to open the airways, inhalers and steroids, said Han, who is a volunteer spokeswoman for the American Lung Association. In the most severe cases, lung transplants might be needed.

Doctors and advocates say many women are unknowingly living with the disease because they lack of awareness or are reluctant to seek help.

“If they have trouble breathing when they are going up stairs, they may say ‘I’m just a little older or heavier or out of shape,’” said Stephanie Williams, director of community programs for the COPD Foundation, which recently held a webinar about the disease among women. “Women put off treatment longer and they mask their symptoms.”

Inez Shakman, 73, who lives in Ventura, Calif., and sees Dr. Wilgus, said she had problems exhaling for years, and common colds tended to settle in her chest and last longer than expected. She also found it physically straining sometimes to walk in the park. It was only about four months ago that she learned she had COPD. She’d never heard of the disease. Now, with medication, she can walk around the park without stopping or gasping for air, she said.

Medical schools have long taught about COPD with a textbook that features images of two men, and researchers have detected gender bias in doctors’ diagnoses of the disease. In one well-known study, physicians who were presented with hypothetical patients made the correct diagnosis more often for men than for women.

Caroline Gainer, a 74-year-old retired teacher who lives in Daniels, a rural town in West Virginia, told her doctor more than once about her symptoms, which included coughing every morning and regularly feeling short of breath. “He thought I had asthma,” she said. “I don’t think I ever got the message across about how bad it was.”

Finally, Gainer was diagnosed with COPD, and now she needs oxygen to get around. She gave up her 50-year smoking habit with the help of a nicotine patch, takes her medications and exercises regularly. “I do everything I am supposed to do,” Gainer said. “I can maybe not halt the progress but I can slow it down.”

Dementia Patients Hold On to Love Through Shared Stories

Photo

Credit Paul Rogers

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Photo

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

Photo

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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