Tagged Aging

Thoughts On Medicaid: What To Do? Save It? Transform It? Protect Its Beneficiaries?

Opinion writers examine how plans to overhaul Medicaid impact those who rely on it — especially vulnerable populations.

St. Louis Post-Dispatch: Saving Medicaid, Saving Our Future
The parents of a 3-year-old are silent as they sit in their pediatrician’s office in Potosi. They have just learned their son has leukemia. The treatment will be long and hard, but at least it is a type of leukemia that usually has a good outcome. Yet they are also frightened because, between the two of them, they are working five part-time jobs just to keep their family’s heads above water. So they are relieved to hear that Medicaid will cover the bulk of the enormous cost of their child’s treatments. (Robert W. Wilmott and Gary A. Silverman, 6/27)

Bloomberg: Senate’s Health Bill’s Pain Doesn’t End At Medicaid
The AHCA has less-generous tax credits tied only to age. The BCRA, meanwhile, keeps the basic ACA structure, which makes it seem friendlier to patients and to health-care providers. But a closer look reveals warts. In 2020, the income range for tax credits shifts down to 0 to 350 percent of the poverty level. That may help low-income people in states that didn’t take the ACA’s Medicaid expansion. That’s arguably a positive for hospitals and insurers. But other aspects of BCRA erase that benefit. Cost-sharing subsidies will end in 2019. And tax credits will be far less generous. (Max Nisen, 6/27)

Detroit Free Press: Why Health Care Bills Leave Poor, Sick Behind
In many ways, calling the U.S. House of Representatives’ passed American Health Care Act (AHCA) or the Senate-proposed Better Care Reconciliation Act (BCRA) a “repeal and replacement” of the Affordable Care Act (ACA) is a misnomer. Neither bill fully repeals the ACA nor do their changes focus solely on replacing the ACA’s key provisions. At the most fundamental level, both bills have different goals than the Affordable Care Act. (Marianne Udow-Phillips, 6/27)

Los Angeles Times: The GOP Healthcare Plan Will Devastate Los Angeles
Congressional Republican proposals to “repeal and replace” Obamacare would slash Medicaid, the nation’s health insurance program for the poor. In so doing, they would devastate Los Angeles in ways that may not yet be fully appreciated. One in 20 of the nation’s Medicaid recipients lives in L.A. County and relies on the program for their healthcare. About 4 million strong, they make up about 40% of the county’s population. Many would be at grave risk of losing their health coverage, and consequently all but emergency medical treatment, under the Republicans’ program. Current programs to provide housing and treatment to thousands of people living on the streets, or heading there after their discharge from hospitals or release from jails and prisons, would be seriously curtailed. (6/27)

The Wall Street Journal: Health Bill Draws Fiscal Fault Line Between Old And Poor—And The Poor Are Losing
The health-care overhaul that Senate leaders floated this past week does more than roll back an entitlement Republicans have loathed since the day it was enacted in 2010. It portends a deeper struggle over the safety net that pits the elderly against the poor. The federal government is often called an insurance company with an army. Thanks to aging and health-care inflation, the cost of that insurance is rising relentlessly. Social Security, Medicare and Medicaid now swallow 58% of tax revenue, and are on track to take 80% by 2047. (Greg Ip, 6/28)

The Des Moines Register: Allow Iowans To Buy Into Medicaid
You can see the train wreck coming. Iowans who do not receive health insurance through an employer may not be able to buy it next year on a state-based exchange created by Obamacare. Only one insurer has applied to offer individual coverage here in 2018. That company, Medica, is proposing steep rate increases and may still pull out of the market. Iowans cannot purchase insurance if no one will sell it to them. What are they going to do? (6/26)

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

Seniors Miss Out On Clinical Trials

More than 60 percent of cancer patients are older adults — and that will rise to 70 percent by 2040.  Yet seniors continue to be underrepresented in clinical trials, making it difficult to assess how treatments are likely to help or harm them.

The newest evidence of the problem comes from a Food and Drug Administration analysis, which found that only 25 percent of patients participating in cancer clinical trials were 65 and older. The analysis, which has not yet been published, was presented at the American Society of Clinical Oncology’s annual meeting in June.

Clinical trials investigate the safety and effectiveness of new drugs and therapies, as well as ways to prevent illness and detect conditions early. Their discoveries help guide medical practice.

Yet, older adults are often not included in research studies to any significant extent. This is especially true for cancer patients in their 70s and 80s, according to the FDA’s data:

  • While 19 percent of breast cancer patients are 75 or older, only 4 percent of breast cancer clinical trial participants are of this age.
  • Although 33 percent of colon cancer patients are in the 75-and-up group, a mere 8 percent of patients studied by researchers fell in that age group.
  • While 37 percent of lung cancer patients are 75 or older, only 9 percent of people of that age are represented in lung cancer clinical trials.

The sobering conclusion: “It’s difficult to practice evidence-based medicine in an older population because the data isn’t there,” said Dr. Stuart Lichtman, professor of medicine at Weill Cornell Medical College in New York City and president of the International Society of Geriatric .

And it’s not just cancer. Across medical conditions that disproportionately affect seniors, people 65 and older have a poor showing in clinical trials.

“There’s often an assumption that drugs only need to be tested in younger people and results can be extrapolated,” said Dr. Consuelo Wilkins, an associate professor of medicine at Vanderbilt University Medical Center who, with colleagues, is overseeing a major grant to help bring more seniors,  blacks, Hispanics and other groups into clinical trials. “But we know that how older adults respond to medications and interventions and their risk for adverse events is different based on their physiology.”

Difficulties enrolling older people in research studies extend to Alzheimer’s disease. With National Institutes of Health research funding now at nearly $1.4 billion a year, “we’re going to be seeing more and more clinical trials, but it’s already difficult to get enough people to participate,” said Keith Fargo, director of scientific programs at the Alzheimer’s Association.

Fewer than one-third of people diagnosed with Alzheimer’s are eligible to join clinical trials, he said.

Judith GrahamNAVIGATING AGING

Researchers often find older adults unsuitable for trials for multiple reasons:  Seniors may have multiple illnesses — diabetes and hypertension, as well as cancer or Alzheimer’s disease — that could complicate the study’s results, or they may be taking several medications already that could interact with therapies being examined.

Also, older adults may live alone, and not have someone who can accompany them to the study site for tests and procedures — a significant concern for Alzheimer’s trials, which typically require a caregiver to provide input about the patient’s condition and progress. Or, seniors can’t get around easily. Or they’re frail.

Responsibility falls to a large extent on physicians, said Dr. Richard Schilsky, chief medical officer for ASCO, noting “they don’t ask older adults whether they want to participate or not. It’s a combination of concern that older patients might be unable to comply with a trial’s requirements, which are usually quite rigorous, and concern that specified therapies might be too toxic.”

Two years ago, ASCO issued new recommendations calling for older adults to be included in more clinical trials. But progress has been slow, acknowledged Dr. Hyman Muss, director of geriatric oncology at the Lineberger Comprehensive Cancer Center at the University of North Carolina-Chapel Hill.

“My view is that every patient I see, if they’re eligible for a clinical trial I’ll tell them about it,” he said.

Don’t assume your doctor will be equally forthcoming. “Absolutely, you should take the initiative and ask,” Schilsky recommended. And don’t assume you need to have run out of options before doing so. “Clinical trials aren’t just for people who have no treatment options left — that’s a common misconception,” Schilsky said.

Debbie Earp, 67, joined a trial at the Lineberger this year, after getting a diagnosis of stage 2 breast cancer in early January. Her responsibilities over the four-month study: wearing a Fitbit, tracking how much exercise she was getting on a daily basis, and filling out a questionnaire about how she was feeling each time she got chemotherapy.

Earp said she agreed to participate because “I’ve always exercised and I felt, from a physical and psychological point of view, anything that was going to motivate me during treatment to exercise more would be a good idea.” The goal of the trial was to examine how physical activity affects older breast cancer patients’  response to chemotherapy.

Of course, clinical trials aren’t for everyone. Some older adults are reluctant to consider them because they’re skeptical of unproven therapies. Others may choose to focus on their quality of life instead of aggressive treatments.

There are good resources about clinical trials on the internet, if you know where to look. The National Institute on Aging has prepared materials for older adults, including a list of questions that seniors should ask before deciding whether to join a trial. The FDA has a patient-oriented site that delves into issues such as informed consent — making sure you’re fully informed about the potential benefits and harms of a research study, among other essential information.

For those who want to look for trials on their own, the NIH sponsors ClinicalTrials.gov, a database of studies across the world, searchable by disease and geography. Trials Today is an effort to make the NIH site more consumer-friendly, created at Vanderbilt University. ResearchMatch is another Vanderbilt effort where people who want to participate in studies can sign up and be matched with clinical trial sponsors. And TrialMatch is a one-stop-shop for clinical trials for people with Alzheimer’s disease, their caregivers, and people interested in preventing dementia, currently listing nearly more than 250 scientific studies.

Make sure you run whatever prospects you find by your doctor. “Very few patients have the expertise to understand if a clinical trial is appropriate for them,” Schilsky said. “You really need an expert opinion to help you understand what you find.”

Categories: Aging, Navigating Aging, Pharmaceuticals

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Take Our Quiz To Test Your Wits On Aging

As we get older, it helps to tickle the noggin’ with trivia. Here’s a pop quiz to see what you have learned as a regular reader of Kaiser Health News.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Aging, Health Industry, Insurance, Medicaid, Medicare, Multimedia, Pharmaceuticals

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Research Roundup: AHCA’s Impact On Medicaid; Hearing Aids In Free Clinics

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Urban Institute: The Impact Of The AHCA On Federal And State Medicaid Spending And Medicaid Coverage: An Update 
This paper examines the coverage and financing impacts of the Medicaid provisions of the American Health Care Act (AHCA), including the reduction in the federal matching rates for ACA and pre-ACA expansion populations and per capita caps. Estimates for three scenarios of state responses to the bill’s changes are provided… The first scenario would reduce federal spending by $373.6 billion from 2019 to 2028, the second by $803.2 billion, and the third by $938.3. (Holahan et al., 6/16)

JAMA: Income Disparities in Cardiovascular Risk Factors in the United States
Are there socioeconomic disparities in 10-year predicted absolute cardiovascular disease risk and individual risk factors (systolic blood pressure, smoking, diabetes, and total cholesterol) among U.S. adults? A cross-sectional analysis using data on adults 40 to 79 years of age without established cardiovascular disease … showed the percentage of adults with diabetes and the mean total cholesterol level did not vary by income. The authors concluded that adults in each socioeconomic stratum have not benefited equally from efforts to control cardiovascular risk factors. (Odutayo, Gill, Shepherd, et al, 6/7)

JAMA Psychiatry: Efficacy Of A Maternal Depression Prevention Strategy In Head Start
In this randomized clinical trial of 230 Head Start mothers, those receiving problem-solving education experienced a 60% incident rate of depressive symptom episodes compared with those not receiving it. Among the subpopulation with low symptom levels at baseline, those receiving problem-solving education experienced a 39% incident rate. The efficacy of problem-solving education demonstrates the promise of embedding maternal depression prevention programs in Head Start; additional effectiveness studies are necessary to develop meaningful public health programs. (Silverstein et al., 6/14)

JAMA Otolaryngology–Head & Neck Surgery: Comprehensive Hearing Aid Intervention At A Free Subspecialty Clinic
Is it possible to provide free, comprehensive audiologic services to indigent patients? In this observational cohort study at a preexisting free clinic, 34 patients were identified as eligible for a free hearing aid and 20 of these patients (59%) received hearing aids. The value of services provided was estimated to be $2260 per patient. It is feasible to provide free, comprehensive audiologic care, including hearing aids and fitting, in a well-established, free clinic model. (Wertz et al., 6/15)

New England Journal of Medicine: Changes In Hospital Quality Associated With Hospital Value-Based Purchasing 
The Patient Protection and Affordable Care Act (ACA) established value-based purchasing programs throughout Medicare, including the Hospital Value-Based Purchasing (HVBP) program… Our estimates of the effect of HVBP on clinical process, patient experience, and mortality were small, not consistent with one another in the direction of the association, and generally nonsignificant. The significant reduction in 30-day risk-standardized mortality among patients who were admitted to the hospital for pneumonia was driven by an increase in mortality in the matched sample of Critical Access Hospitals. (Ryan et al. 6/15)

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

In The End, Even The Middle Class Would Feel GOP Cuts To Nursing Home Care

ORANGE, Va. — Alice Jacobs, 90, once owned a factory and horses. She raised four children and buried two husbands.

But years in an assisted living facility drained her savings, and now she relies on Medicaid to pay for her care at Dogwood Village, a nonprofit, county-owned nursing home here.

“You think you’ve got enough money to last all your life, and here I am,” Jacobs said.

Medicaid pays for about two-thirds of the 1.4 million elderly people in nursing homes, like Jacobs. It covers 20 percent of all Americans, and 40 percent of poor adults.

On Thursday, Senate Republicans joined their House colleagues in proposing steep cuts to Medicaid, part of the effort to repeal the Affordable Care Act. Conservatives hope to roll back what they see as an expanding and costly health care entitlement. But little has been said about what would happen to older Americans in nursing homes if these cuts took effect.

Under federal law, state Medicaid programs are required to cover nursing home care. But state officials decide how much to pay facilities, and states under budgetary pressure could decrease the amount they are willing to pay or restrict eligibility for coverage.

“The states are going to make it harder to qualify medically for needing nursing home care,” predicted Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy. “They’d have to be more disabled before they qualify for Medicaid assistance.”

States might allow nursing homes to require residents’ families to pay for a portion of their care, she added. Officials could also limit the types of services and days of nursing home care they pay for, as Medicare already does.

The 150 residents of Dogwood Village include former teachers, farmers, doctors, lawyers, homemakers and health aides — a cross section of this rural county a half-hour northeast of Charlottesville. Many entered old age solidly middle-class but turned to Medicaid, once thought of as a government program exclusively for the poor, after exhausting their insurance and assets.

A combination of longer life spans and spiraling health care costs has left an estimated 64 percent of the Americans in nursing homes dependent on Medicaid. In Alaska, Mississippi and West Virginia, Medicaid was the primary payer for three-quarters or more of nursing home residents in 2015, according to the Kaiser Family Foundation. (KHN is an editorially independent project of the foundation.)

“People are simply outliving their relatives and their resources, and fortunately, Medicaid has been there,” said Mark Parkinson, president of the American Health Care Association, a national nursing home industry group.

With more than 70 million people enrolled in Medicaid at an annual cost of more than $500 billion, the program certainly faces long-term financial challenges. Federal Medicaid spending is projected to grow by 6 percent a year on average, rising to $650 billion in 2027 from $389 billion this year, according to the Congressional Budget Office.

Even if Congress does not repeal the Affordable Care Act, Medicaid will remain a target for cuts, experts say.

“The Medicaid pieces of the House bill could be incorporated into other pieces of legislation that are moving this year,” said Edwin Park, a vice president at the Center on Budget and Policy Priorities, a Washington nonprofit that focuses on how government budgets affect low-income people. “Certainly, nursing homes would be part of those cuts, not only in reimbursement rates but in reductions in eligibility for nursing home care.”

While most Medicaid enrollees are children, pregnant women and non-elderly adults, long-term services such as nursing homes account for 42 percent of all Medicaid spending — even though only 6 percent of Medicaid enrollees use them.

Alice Jacobs in her room at Dogwood Village. Her fellow residents include former teachers, farmers, doctors, lawyers and health aides. (Khue Bui for The New York Times)

“Moms and kids aren’t where the money is,” said Damon Terzaghi, a senior director at the National Association of States United for Aging and Disabilities, a group that represents state agencies that manage programs for these populations or advocate for them. “If you’re going to cut that much money out, it’s going to be coming from older people and people with disabilities.”

The House health care bill targets nursing home coverage directly by requiring every state to count home equity above $560,000 in determining Medicaid eligibility. That would make eligibility rules tougher in 10 states — mostly ones with expensive real estate markets, including California, Massachusetts and New York — as well as in the District of Columbia, according to an analysis by the Center for Budget and Policy Priorities.

Dogwood Village receives about half of its $13 million annual operating costs from Medicaid, with rates from $168 to $170 a day. Some residents who come to the facility after a hospital stay are initially covered by Medicare, but if they stay longer than 100 days, that benefit ends, and those without savings move to Medicaid.

“You have patients who have spent their life savings, and they come here,” said Kristen Smith, the admissions coordinator. Smith said patients now were older and sicker than they used to be, frequently arriving directly from a hospital.

“It used to be hips and knee” surgeries, she said. “And now a lot of those patients are going home. What we’re seeing is more complex, sicker patients.”

With cinder-block walls brightened by pictures of horses that evoke this equestrian county, the nursing home offers crafts, bingo and other activities.

Mary Ann Mohrmann is 85, the average age of Dogwood Village residents. An elementary school teacher for 25 years, she has Charcot-Marie-Tooth disease, a neurological disorder that has weakened her legs, feet and thumbs and compromised her fine motor skills.

Two of her children have it, too, she said. None of them can take care of her at home. “I’ve been here years,” she said. “I don’t know how many.”

Mary Ann Mohrmann, 85, was an elementary school teacher for 25 years. She now suffers from a neurological disorder and lives at Dogwood Village of Orange County Health and Rehabilitation. (Jeff Poole/Orange County Review)

Medicaid helps pay for care for people with disabilities, like Nancy Huffstickler, 64, who has been here four years and regards herself as “a medical disaster.”

She listed her ailments: spinal cancer in remission, restless legs syndrome, high blood pressure and multiple ulcers. She has had spinal reconstructive surgery and a hip replacement. She is undergoing physical therapy with the hope that, one day, she will be able to leave her wheelchair and use a walker.

Huffstickler is fearful of Republicans’ health care changes. “It may save the federal government money, but what about us?” she asked.

Major Medicaid cuts would compel the facility to cut staff, supplies and amenities — changes that would affect the quality of care for all residents, not just those on Medicaid.

If that does not save enough money, the facility might have to reduce the number of Medicaid residents, said Vernon Baker, who resigned as administrator in April. “It’s not like our toilet paper or paper towels are like the Ritz-Carlton’s,” he said.

Some residents do not even know they are on government insurance; administrators often complete the paperwork to start Medicaid once other insurance expires. Others are embarrassed that they are dependent on a program that still carries stigma.

They should not be, said Jennifer Harper, the assistant director of nursing. Relying on Medicaid for nursing home care has become the new normal.

“These folks have worked their whole lives, some with pretty strenuous jobs, and paid into the system,” she said. But with changes looming, she said, “it may be a system that fails them.”

KHN’s coverage of aging and long-term care issues is supported by The SCAN Foundation.

Categories: Aging, Health Industry, Medicaid, The Health Law

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‘No One Wants To Be Old’: How To Put The ‘Non-Age’ in Nonagenerian

Wilhelmina Delco learned to swim at 80. Harold Berman is in his 67th year practicing law. Mildred Walston spent 76 years on the job at a candy company. And brothers Joe and Warren Barger are finding new spots in their respective homes for the gold medals they’ve just earned in track-and-field events at the National Senior Games.

These octogenarians and nonagenarians may not be widely known outside their local communities, but just as their more famous peers — think Carl Reiner, Betty White, Dr. Ruth (Westheimer) or Tony Bennett — the thread that binds them is not the year on their birth certificate but the way they live.

“Age shouldn’t be a reason to slow down,” said Joe Barger, 91, of Austin, Texas.

It never hurts to have longevity in your genes and few chronic health problems, but mindset plays a role in how people age, experts say. Some older adults have been termed “superagers” for mental acuity despite their years because the typical age-related decline in brain volume is much slower.

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However, for most active elders who aren’t among these elite agers, staying vital when others around you aren’t may be about more than physical or mental agility. Researchers find that society’s focus on youth culture and negative stereotypes about aging prompts older adults’ memory loss and stress. These days, older adults who want to dispel notions of growing feeble now have growing ranks to emulate.

Joe Barger and brother Warren, 95, of Chattanooga, Tenn., just wrapped up two weeks of competition in Birmingham, Ala., where Warren earned five gold medals and set a new national high-jump record in his 95-99 age bracket. In badminton, where Warren played singles, doubles and mixed doubles, he had to compete in the younger 85- to 89-year-old bracket because there weren’t competitors in his age group.

Joe Barger, 91, of Austin, Texas, runs the 1500-meter race at the National Senior Games in Birmingham, Ala. He won gold in that competition, as well as in the 800-meter and 5-kilometer distances in his age bracket (91-94). (Photo courtesy of Cindy Rosier)

“My secret of life is to wake up every morning with something to do,” Warren said. “Some people I feel are old because they allow themselves to get old. When people ask me how I’m able to do what I can do, I say I never did quit trying.”

A former insurance salesman and church music director, Warren plays golf and pickleball once a week and badminton twice a week. He mows his lawn, volunteers weekly at his church and sings in the senior choir.

In a study published last year, David Weiss, an assistant professor of sociomedical sciences and psychology at the Columbia Aging Center at Columbia University in New York, found that those who don’t fall for the inevitability of aging can “counteract the detrimental and self-fulfilling consequences of negative age stereotypes.”

“My research looks at why no one wants to be old,” Weiss said.

“They want to set themselves apart from this negatively viewed age group. They just want to distance themselves from stereotypes. ‘l’m not like the stereotype. I’m different,’ ” he said. “Adults who believe age is just a number showed better memory performance, but adults who believed aging is set in stone and fixed had a decrease in memory performance and a stronger stress reaction.”

Social psychologist Becca Levy of the Yale School of Public Health in New Haven, Conn., said her studies found an increase in negative age stereotypes over the past two centuries.

“Part of it is due to media and marketing,” she said. “An ageist culture produces many more negative stereotypes.”

Such notions do have an impact. Research by Sarah Barber, an assistant professor of psychology at San Francisco State University, published earlier this year found that people blamed “everyday forgetting” on their age as in a “senior moment” because popular wisdom reinforces stereotypes of age-related memory decline. The negative stereotypes about aging made older adults “over-attribute everyday memory losses we all have to age,” she said.

Seniors, Seize The Moment

To stay vital, Westheimer advises older people to “do as many things that are enjoyable to them as possible — participating in activities at a senior center, going to the theater and movies and not just sitting home and saying ‘I’m too old to be out there.’ ”

The younger Barger, a retired mechanical engineer, lives by that creed. He competed in seven track events at the games and took gold in three, including the 800-meter, 1500-meter and 5-kilometer distances.

“I hate to see people slowing down when you know they can do more than what they’re doing,” he said. “Most friends I have are much younger than me.”

Reiner, the 95-year-old iconic writer, comedian, director and creator of the 1960s-era “The Dick Van Dyke Show,” is way too busy to slow down.  He and his longtime friend (since 1950) Mel Brooks, who turns 91 on Wednesday, have dinner at Reiner’s house  most evenings unless the comedic genius behind such classics as “Blazing Saddles” and “The Producers” is away on business, Reiner said in a phone interview from his Beverly Hills home.

(Photo courtesy of HBO)

Reiner, 95, is the narrator of a documentary airing this month on HBO exploring why some people continue to blossom in their later years and others wither.

Reiner’s latest book — his 22nd, “Too Busy to Die,” published June 1 — is one of five books he’s written since turning 90. He’s now working on two more books, expected out at Thanksgiving.

“Very, very often, I think of an idea and then I get up and put it on a pad,” he said, though he spends a good part of his day working at his computer.

Reiner also serves as a narrator in the new documentary “If You’re Not in the Obit, Eat Breakfast,” which airs on HBO throughout June. The film, which includes a bevy of the famous and not-so-famous in their 90s and beyond, aims to explore why some thrive and others don’t in their later years.

“I tweet every night before bed,” Reiner said. He has 175,000 Twitter followers.

Resetting Your Mindset

Westheimer, 89, a sex therapist who dishes out advice in a heavy German accent, also tweets, sometimes several times a day.

“I’m very busy. I’m teaching at Columbia. I’m coming out in 2018 with three new books. A movie is being made about me,” Westheimer said in a phone interview from her New York City apartment.

Westheimer is out six nights a week. She visits with friends and family — especially her grandchildren — and she serves on several boards.

Delco, who will be 88 next month, is trying to get a bit less involved with the half-dozen or so boards she’s been serving in Austin. Traffic congestion and travel time to attend board meetings have made this former state lawmaker (1974-94) less inclined to participate, she said.

Delco has been involved in public service since 1968, when she was elected to the school board.

“I still do a lot of public speaking,” she said. “I do not charge fees or anything like that, but the one thing they have to do if you want me to speak is come pick me up and take me home.”

Five days a week, Delco starts her mornings at the neighborhood Y, where her days of swimming laps ended because of arthritis. Now, she exercises with barbells in the pool to maintain strength and agility.

Wilhelmina Delco, a former Texas state lawmaker, turns 88 in July. (Sharon Jayson for KHN)

Walston, who turns 95 in September, has also turned her attention to exercise and staying fit.

“It seems to me like it’s boring to sit around if you don’t do anything,” she said. “Where I’m living, there’s something to do all the time. I’m signed up for everything I can.”

Walston worked at Lammes Candies, an Austin family-owned business that opened in 1885, since she graduated from high school in 1940.

“I wasn’t going to retire at all, but I lost my sight,” she said. “I woke up on June 8th of last year and I couldn’t see, so I couldn’t work anymore.”

Walston is legally blind but has enough sight to keep active.

Berman, 91, an attorney in Dallas, says he never thought about retiring.

“I made a pact with myself not to retire as long as I’m able to do it,” he said.

He’s at his desk at 8:30 a.m., takes a break and tends to stop work around 4:30 p.m.

Berman, a World War II veteran who in May participated in an Honor Flight, is at the gym at 5:30 a.m. three days a week.

“I used to go five times a week,” he said. “I have breakfast with the guys after we exercise.”

Although Berman has been a leader in various national organizations and is active in some local organizations, he said he is traveling less and definitely working less.

“My [law] practice used to be 20 hours a day, with the phone ringing and a lot of trial work,” he said. “I’m having to slow down. It’s not by choice. If I had my way, I’d be running all the time.”

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

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How Can You Avoid Dementia? Experts Say Control Blood Pressure And Stay Active

Other tips include targeted brain-training, but overall a U.S. panel of 17 experts finds few effective strategies for preventing Alzheimer’s and age-related dementia.

USA Today: These Few Things May Help Stave Off Dementia, Scientists Say
Scientists think there may be a few things you can do to keep dementia at bay: train your brain, keep your blood pressure under control and stay active. According to a report published Thursday by the National Academies of Sciences, Engineering and Medicine (NASEM), there is promising evidence that cognitive training, managing your blood pressure if you have hypertension and increasing your physical activity may help prevent age-related cognitive decline and dementia. (Toy, 6/22)

Los Angeles Times: To Preserve Mental Acuity Into Old Age, Experts Suggest Focusing On These Three Things
In drawing its qualified conclusions, the panel cited research released last summer suggesting that a program of highly targeted brain-training reduced the risk of cognitive decline or dementia by nearly half over 10 years. It cited a wide range of findings that link dementia to conditions — such as hypertension, diabetes and stroke — in which the health of blood vessels large and small is compromised. And it touted a welter of research that has linked sedentary lifestyles to a wide range of ills, and higher levels of physical fitness with better physical, cognitive and mental health. (Healy, 6/22)

Stat: Few Strategies Work To Prevent Dementia, Experts Say
To anyone who’s aware that efforts to develop Alzheimer’s drug treatments have met failure after failure, and to have therefore decided that prevention is the only hope, a U.S. panel of experts issued a sobering message on Thursday: Don’t count on it. From physical activity to avoiding high blood pressure to brain training, a 17-member committee assembled by the National Academies of Sciences concluded, no interventions are “supported by high-strength evidence.” Instead, some high-quality studies found that one or another intervention worked, but other equally rigorous studies found they didn’t. (Begley, 6/22)

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

Viewpoints: The Impact Of Artificial Intelligence On Health Care; Chronic Disease Rates ‘A Wake-Up Call’ For Policymakers

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

Fortune: Where Artificial Intelligence Will Pay Off Most In Health Care
Of all the places where artificial intelligence is gaining a foothold, nowhere is the impact likely to be as great — at least in the near term — as in healthcare. A new report from Accenture Consulting, entitled Artificial Intelligence: Healthcare’s New Nervous System, projects the market for health-related AI to grow at a compound annual growth rate of 40% through 2021—to $6.6 billion, from around $600 million in 2014. (Clifton Leaf, 6/19)

RealClear Health: Rising Chronic Disease Rates Portend Unsustainable Costs
12 percent of Americans suffer from five or more chronic conditions, such as high blood pressure, heart disease, and diabetes. This fraction of the population accounts for 41 percent of total health care spending. That ought to serve as a wake-up call for policymakers. If we don’t do more to prevent people from acquiring chronic disease, the resulting health care bills could blow a gaping hole in the federal budget. (Kenneth Thorpe, 6/20)

RealClear Health: Even Though Genetic Information Is Available, Doctors May Be Ignoring Important Clinical Clues
With the availability of home genetic testing kits from companies such as “23andMe” and “Ancestry DNA,” more people will be getting information about their genetic lineage and what races and ethnicities of the world are included in their DNA. … But there’s a problem, a recent study from the National Institutes of Health found. Many physicians and other providers are uncomfortable discussing race with their patients, and also reticent to connect race or ethnicity to genetics and clinical decision-making, the study suggested. (Greg Hall, 6/19)

Los Angeles Times: Trump’s Answer To The Obesity Epidemic: Here, Have A Cookie
The most attention-getting news out of the food industry last week was Amazon’s announcement Friday that it’s buying Whole Foods for nearly $14 billion. But that wasn’t the most important news. The most important news was a largely overlooked announcement from the Trump administration that it’s bowing to the wishes of food companies — and ignoring the pleas of scientific and medical experts — by giving industry players more time to push sugary treats on an increasingly blubbery nation. (David Lazarus, 6/20)

Forbes: If You Need Long-Term Care, It Matters Where You Live
If you or a loved one needs long-term care, where you live matters … a lot. A new report by AARP shows wide variation in the quality of supports and services among states—whether delivered at home or in a nursing facility. While it found important improvements across states, it also identified significant shortcomings, even in the highest-rated states. (Howard Gleckman, 6/16)

The Washington Post: Law Makes VA Treat Some Family Caregivers Better Than Others
The last time Dennis Joyner walked, he was on patrol in Vietnam’s Mekong Delta on June 26, 1969. That’s when he tripped a 105-pound booby trap bomb. He lost both legs above the knees and his left arm below the elbow. “I have been confined to a one arm drive wheelchair for 48 years,” said the 68-year-old Longwood, Fla., resident. “As a former high school athlete, my life changed drastically in how I have to live with the combat injuries I suffered in Vietnam.” He gets lots of help from his wife Donna, “my day-to-day caregiver.” (Joe Davidson, 6/19)

Stat: Bedside Drug Production Will Truly Enable Personalized Medicine
Making medicines tailored to the needs and characteristics of individual patients is the dream for many scientists. This kind of personalized medicine approach would provide treatment with the highest possible effectiveness and safety, and would also save money. But it requires rethinking how we make medications. (Huub Schellekens, 6/19)

St. Louis Post-Dispatch: Roe V. Wade Saves Lives
An abortion is a terrible thing. No woman wants to have an abortion. Nevertheless, sometimes abortion can be the necessary choice of two excruciatingly painful options. Before 1973 when the Supreme Court legitimized abortion in the landmark Roe v. Wade decision, the procedure was illegal in most states; desperate women without means had to undergo illegal operations to end an untenable pregnancy. As a result, many were rendered sterile and some died. (Dr. Richard Gulick and Carol Shepley, 6/20)

The Kansas City Star: Is The Ghost Of Anti-Abortion Crusader Phill Kline Going To Haunt Missouri?
Are you ready for the return of Phill Kline? That’s exactly what Missouri could get should the House this week pass a sweeping abortion measure that would, among other things, require annual health inspections of clinics. The bill is the focus of the year’s second special session called by Gov. Eric Greitens. This unnecessary bill does something else, too: The measure carves out a special exception for this one issue when it comes to law enforcement. The legislation gives the attorney general, now Josh Hawley, an ardent abortion opponent who is said to have higher political aspirations, the power to prosecute violations of abortion laws. He could step in whenever local prosecutors opt not to act. (6/19)

The New York Times: Where Are The Rape-Kit Nurses?
If you are an adult victim of sexual assault in Las Vegas, there is only one hospital where you can go to have a rape kit completed. Only two nurses in that hospital have specialized training to do the exam. In a metropolitan area of two million people, in a state with consistently high rates of domestic violence, the limited number of resources for sexual assault survivors seeking to prosecute, although troubling, is not unique. (Brittany Bronson, 6/20)

The Health Care Blog: Trump’s Brain: What’s Going On?
In late May the science and health news site STAT ran a provocative article titled: “Trump wasn’t always so linguistically challenged. What could explain the change?” Not surprisingly, the piece went viral. After all, aren’t most of us wondering whether something is up with the President’s—how shall I say it—state of mind, psychological status, character, personality, and yes, mental health? (Steven Findlay, 6/19)

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Feds To Collect More Than $53M From Genesis HealthCare To Settle False Medicare Claim Charges

The nursing home operator strikes a settlement with the Justice Department to end six federal lawsuits and investigations of allegations that the company submitted false claims to Medicare and Medicaid for medically unnecessary therapy, hospice service and substandard care.

The Associated Press: Genesis HealthCare To Pay $53.6M To Settle US Probes
Genesis HealthCare has agreed to pay $53.6 million to settle allegations that it submitted false claims to the federal government for unnecessary therapy and substandard nursing care, the Justice Department said Friday. The settlement resolves six federal lawsuits and investigations alleging Genesis HealthCare companies and facilities violated federal statutes by submitting false claims to Medicare and Medicaid for medically unnecessary therapy, hospice service and substandard nursing care. (Balsamo, 6/16)

The Philadelphia Inquirer/Philly.com: Genesis Healthcare Finalizes $53.6M Federal Settlement
The U.S. Justice Department said Friday that Genesis Health Inc., a major nursing home operator based in Kennett Square, will pay $53.6 million to settle six federal lawsuits and investigations alleging that companies and facilities acquired by Genesis billed the government for “medically unnecessary therapy and hospice services, and grossly substandard nursing care.” The final settlement is slightly larger than the $52.7 million Genesis estimated last summer, when the company disclosed an agreement in principal to settle the allegations, some of which date back to 2003. (Brubaker, 6/16)

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State Highlights: Minn. Nurses Union Helps Pay Patients’ Medical Debts; Head Of Colo.’s State Mental Hospital Resigns

Media outlets report on health-related news from Minnesota, Colorado, Georgia, Texas, Massachusetts, New Jersey and California.

The Star Tribune: Minnesota Nurses Raise Money To Pay Off Medical Debts Of 1,800 Patients
Roughly 1,800 patients will see $2.6 million in medical debts disappear because of charitable payments by the Minnesota Nurses Association, the union that represents hospital nurses throughout the state. The union announced on Thursday that it would pay off the patients’ debts in conjunction with the anniversary of a strike by its nurses against five Allina Health hospitals in the Twin Cities. (Olson, 6/15)

Denver Post: Head Of Colorado State Mental Hospital Resigns As Hospital Is Placed On “Termination Track” 
The head of Colorado’s state mental institution has resigned in the midst of a staffing shortage that resulted in federal regulators determining the Pueblo hospital poses an “immediate and serious threat to the health and safety” of its 449 patients. Officials at the Colorado Department of Human Services, which oversees the hospital, would not say whether the resignation of Superintendent Ron Hale is related to the hospital’s numerous deficiencies, described in two recent federal reviews. He will stay until July 9, to “ensure a smooth transition,” state officials said. (Brown, 6/15)

Georgia Health News: State Agency To Monitor Blue Cross Rule On ER Use
Blue Cross recently told policyholders that starting in July, it will stop covering ER visits it considers to have been unnecessary. The health insurer, Georgia’s largest, said it’s pursuing the move, involving its coverage of individual policies, due to the costs of routine primary care being administered in an ER setting. (Miller, 6/15)

Houston Chronicle: Six Pregnant Women In Harris County Test Positive For Zika 
Six pregnant women in Harris County have tested positive for Zika, the first cases of the mosquito-borne disease to be reported locally in 2017. All of the women have since delivered their babies, but it is not yet known if any of the children were born with the birth defects that can be caused by the virus, said a spokesman for Legacy Community Health, a southeast Texas network of clinics where the women were initially tested. (Ackerman, 6/15)

Boston Globe: These Startups Want To Save You A Trip To The Drugstore 
Since the company was founded in 2013, it has raised about $118 million in funding, built a highly automated pharmacy in Manchester, N.H., and grown to more than 500 employees. Along with another Boston startup, ZappRx, it hopes to eliminate the familiar headache of driving to the drugstore and standing in line, only to find that someone forgot to do something, and the crinkly white bag isn’t there waiting for you. (Kirsner, 6/16)

The Philadelphia Inquirer: Troubled Mount Laurel Nursing Home Closing Next Month
Mount Laurel Center for Rehabilitation & Healthcare, a South Jersey nursing home that has been on a list of the nation’s most troubled facilities for 19 months without showing improvement, said it has lost its Medicare and Medicaid certifications and will close next month…Patient transfers are expected to be completed by July 16, when Medicare and Medicaid payments will stop for patients admitted before Friday. No federal payments will be made for patients admitted after Friday. (Brubaker, 6/15)

Austin American-Statesman: Austin City Council Places Julie Oliver On Central Health Board
The council voted to approve the appointment of Julie Oliver in a 6-5 vote after a closed session discussion. Council Members Ora Houston, Jimmy Flannigan, Ann Kitchen, Delia Garza, Kathie Tovo and Ellen Troxclair voted for the appointment. Her appointment had raised some eyebrows due to her position as division controller at St. David’s HealthCare, a competitor of Seton Healthcare Family, which partners with Central Health, Travis County’s hospital district. (Goldenstein, 6/15)

San Francisco Chronicle: Most Bay Area Beaches Are Free From Harmful Bacteria, Report Says 
The bathing-suit-and-bikini set can splash around happily knowing they are unlikely to get sick frolicking in the water at Bay Area beaches, all but one of which are free of harmful bacteria and pollution, according to a statewide beach report card released Thursday. But the one that didn’t make the grade — Marina Lagoon, in the Lakeshore Park area of San Mateo County — is pretty icky, getting an F for water quality and a No. 4 spot on the environmental group Heal the Bay’s Top 10 Beach Bummer list for California. (Fimrite, 6/25)

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Public Health Roundup: Conjoined Twins; A Shot For Incontinence; And Home Health Care For Seniors

Also in the news: a tool to detetct Parkinson’s, transgender talk and salt caves as the new health trend.

The Washington Post: Doctors Just Separated Twin Girls Joined At The Head In One Of The World’S Rarest Surgeries
For the first time, conjoined twins Abby and Erin Delaney can sleep in separate beds. The 10-month-old girls from North Carolina were born connected at the head, an extremely rare condition. Following months of planning and preparation, the pair underwent a successful 11-hour separation surgery last week at Children’s Hospital of Philadelphia in southeastern Pennsylvania, according to the hospital. (Bever, 6/14)

The Philadelphia Inquirer: The O-Shot: Incontinence Fix Or Empty Promise?
Urinary incontinence is a common condition in women. Approximately 25 percent of young women, around half of middle-aged and postmenopausal women, and three-fourths of older women experience some involuntary urine loss, according to the American Congress of Obstetricians and Gynecologists. The group estimates that $19.5 billion a year is spent on treatments, which run the gamut from behavior modification to surgery. Then there’s the O-Shot, meant for the 15 percent of women who have stress incontinence — leakage associated with a strain such as sneezing or lifting. Rush, 6/14)

Kaiser Health News: Some Seniors Just Want To Be Left Alone, Which Can Lead To Problems
The 84-year-old man who had suffered a mini-stroke was insistent as he spoke to a social worker about being discharged from the hospital: He didn’t want anyone coming into his home, and he didn’t think he needed any help. So the social worker canceled an order for home health care services. And the patient went back to his apartment without plans for follow-up care in place. (Graham, 6/15)

The Star Tribune: 10 Things You Should Ask Your Doctor On Your Next Visit 
Getting in to see a doctor takes time. Getting the most out of your doctor’s time takes something more: an inquisitive approach. Armed with the right questions before you sit on the exam table, you, too, can become an empowered patient ready to make informed decisions about your health. (Shah, 6/15)

KCUR: Lenexa Teen’s Tech Tool Could Identify Early Symptoms Of Parkinson’s 
Erin Smith doesn’t watch a lot of TV. Instead, the 17-year-old spends her evenings perfecting an online tool she created. The tool, called FacePrint, can detect Parkinson’s disease years before current diagnosis methods by recording your facial reactions with a webcam at home. Smith, a senior at Shawnee Mission West High School, has traveled to Twitter and Google headquarters, won a $10,000 prize from the #BuiltByGirls Future Founder competition to continue her research, and has been recognized by the Michael J. Fox Foundation. (Marleah Campbell, 6/14)

The New York Times: A New Lure For Spa Customers? A Salt Cave
Two young women in white chamois robes exited the Himalayan salt sauna at Premier57, a spa in Midtown Manhattan, looking rosy and happily spent. The salt sauna, lined with burnt orange and yellow blocks of sodium chloride, is a popular destination at the spa, where a day pass is $75 and the tagline urges guests to “immerse, indulge, intrigue.” Options include an infrared lounge, a meditation room, an igloo room, a gold sauna and a clay sauna, “but we have a lot of guests who just come here for the salt room, especially if they have arthritis,” said the spa’s general manager, Ellis Kim. “It’s very good for arthritis and for regulating blood pressure.” (Kaufman, 6/14)

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Some Seniors Just Want To Be Left Alone, Which Can Lead To Problems

The 84-year-old man who had suffered a mini-stroke was insistent as he spoke to a social worker about being discharged from the hospital: He didn’t want anyone coming into his home, and he didn’t think he needed any help.

So the social worker canceled an order for home health care services. And the patient went back to his apartment without plans for follow-up care in place.

When his daughter, Lisa Winstel, found out what had happened she was furious. She’d spent a lot of time trying to convince her father that a few weeks of help at home was a good idea. And she’d asked the social worker to be in touch if there were any problems.

Similar scenarios occur surprisingly often: As many as 28 percent of patients offered home health care when they’re being discharged from a hospital — mostly older adults — say “no” to those services, according to a new report.

Understanding why this happens and what can be done about it is important — part of getting smarter about getting older.

Judith GrahamNAVIGATING AGING

Refusing home health care after a hospitalization puts patients at risk of a difficult, incomplete or slower-than-anticipated recovery. Without these services, older adults’ odds of being readmitted to the hospital within 30 or 60 days double, according to one study.

Why, then, do seniors, resist getting this assistance?

“There are a lot of misperceptions about what home health care is,” said Carol Levine, director of the United Hospital Fund’s Families and Health Care Project, a sponsor of the new report.

Under Medicare, home health care services are available to older adults who are homebound and need intermittent skilled care from a nurse, a physical therapist or a speech therapist, among other medical providers.

Typically, these services last four to six weeks after a hospitalization, with a nurse visiting several times a week. Some patients receive them for much longer.

Many seniors and caregivers confuse home health care with “home care” delivered by aides who help people shower or get dressed or who cook, clean and serve as a companion. The two types of services are not the same: Home health care is delivered by medical professionals; home care is not. Nor is home care covered by Medicare, for the most part.

This was the mistake Winstel’s father made. He thought he was being offered an aide who would come to his apartment every day for several hours. “I don’t want a babysitter,” he complained to Winstel, chief operating officer of the Caregiver Action Network.

Like many other seniors, this older man was proud of living on his own and didn’t want to become dependent on anyone.

“Older adults are quite concerned about their independence, and they worry that this might be the first step in someone trying to take that away,” said Dr. Leslie Kernisan, a San Francisco geriatrician and creator of the website Better Health While Aging.

Other reasons for refusals: Seniors see their homes as sanctums, and they don’t want strangers invading their privacy. They think they’ve been getting along just fine and have unrealistic expectations of what recovering from a hospitalization will entail.

Or there are circumstances at home — perhaps hoarding, perhaps physical neglect — that an older adult doesn’t want someone to see. Or the patient’s cognition is compromised and he doesn’t understand his needs or limitations. Or cost is a concern.

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Robert Rosati, vice president of research and quality at Visiting Nurse Association Health Group, New Jersey’s largest private home health care provider, said about 6 percent of seniors who’ve agreed to receive home health care from his organization after a hospitalization end up refusing services.

Often, a breakdown in communication is responsible. Patients haven’t been told, in clear and concrete terms, which services would be provided, by whom, for how long, how much it would cost and what the expected benefit would be. So, they don’t understand what they’re getting into, prompting resistance, Rosati said.

Kathy Bowles, director of the Center for Home Care Policy & Research at the Visiting Nurse Service of New York, suggests a plain-language, positive way to convey this information. For example: “A nurse will check your medications and make sure they’re all in order. She’ll assess if you need physical therapy to help you regain your strength. And she’ll teach you and family members how to care for you once home care is over.”

“A lot of resistance arises from pride,” said Bowles, also a professor of nursing excellence at the University of Pennsylvania. “The conversation has to change from ‘Look, we think you really need help,’ to ‘We want to help you take care of yourself.’ ”

Emphasizing that a physician has recommended home health care can also be helpful. “In my experience, if a doctor says ‘I’d like a nurse to come see you and check that you’re feeling better,’ people are fairly responsive,” Kernisan said.

Instead of arguing with an older adult who says “I don’t want any assistance,” try to follow up by asking “Tell me more. What are you concerned about?” Kernisan suggested. “People really want to feel listened to and validated, not lectured to.”

This isn’t to suggest that persuading an older adult to accept unwanted help is easy. It’s not.

Last year, Winstel’s father had a medical device implanted in his spine to relieve pain from spinal stenosis — an outpatient procedure. Once again, he declined postoperative help.

Two days later, Winstel got a phone call from her dad, who had collapsed and couldn’t get up from the floor. Winstel said she’d call 911. “No, I don’t want someone coming in and finding me like this,” her father insisted. “You have to come.”

Later, at the hospital, doctors diagnosed an adverse reaction to medication and a surgical site infection on her father’s back. “He lives alone. He can’t reach back there. He wasn’t caring for the wound properly,” Winstel explained.

Extensive, heated conversations followed, during which her father insisted he was never going to change. “For him, living independently carries risks, and he’s willing to accept those risks,” Winstel said.

She hopes the new report on seniors refusing home health care will jump-start a conversation about how to bring caregivers into the process and how recommendations should be conveyed. “As the daughter of someone who has refused care, understanding that this is something lots of people go through makes me feel a little less crazy,” Winstel said.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

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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

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Credit Kim Murton

What kind of hot flasher are you?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Talking to Younger Men About Growing Old

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

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

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

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

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

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

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

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

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

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

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

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

Downward Facing Dog and High Heels

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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After Cataract Surgery, Hoping to Toss the Glasses

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How the World Looks With Cataracts

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

By CLINIC COMPARE on Publish Date May 4, 2016.

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

She decided it was time for cataract surgery.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Aging in Place

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Credit Paul Rogers

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Credit Stuart Bradford/The New York Times

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Retirement May Be Good for You

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

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

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

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

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

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

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

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

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

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Reinventing Yourself

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Credit Paul Rogers

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Using the Arts to Promote Healthy Aging

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Credit Paul Rogers

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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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