Tagged Aging

Video Help Is On Way For Family Caregivers Who Must Draw Blood Or Give Injections

Renata Louwers has a hard time getting her blood drawn. The needle, the pinprick of pain, the viscous liquid flowing out of her arm — they make her queasy.

So, Louwers had to steel herself when her husband, Ahmad Khoshroo, developed metastatic bladder cancer four years ago at age 72.

Within months, as a tumor pressed on his spine, Khoshroo was taking heavy-duty opioids and Louwers was administering his medications. When he developed blood clots following a stay in intensive care, she injected a blood thinner into his belly.

Figuring out what to do as her husband’s eventually fatal disease progressed was a nightmare. Louwers remembers getting hastily delivered, easily forgotten instructions from hospital nurses and, later, limited assistance from a home health agency. “It wasn’t much, and it was incredibly hard,” she said.

Now, groups around the country are mobilizing to help family caregivers like Louwers manage medications, give injections, clean catheters, tend to wounds and perform other tasks typically handled in medical facilities by nurses or nursing assistants.

Judith GrahamNAVIGATING AGING

In December, 15 organizations joined a new national consortium, the Home Alone Alliance, devoted to providing better training and instructional materials for family caregivers. Founding members include the AARP Public Policy Institute, the Family Caregiver Alliance, the United Hospital Fund and the Betty Irene Moore School of Nursing at the University of California, Davis.

This week, the alliance released a series of 10 short videos (five each in English and Spanish) designed to help caregivers deal with seniors who use canes or walkers and need help getting up or down stairs, into a wheelchair, or in and out of a tub or a shower.

Two of the videos deal with falls — the most common cause of injury among older adults.

This summer, nine videos on wound care and topics will be added and include dealing with newly sutured wounds, bed sores, cellulitis and diabetic foot care, among other topics, and, by the end of the year, another 20 videos should be available.

Potential topics include nutrition, the use of specialized equipment such as nebulizers, feeding tubes and oxygen tanks, and a revised series on medication management — a topic profiled in a pilot project for the alliance.

Organizations across the country will be free to put the videos on their websites. The goal is to disseminate them as widely as possible and “bridge the gap between what family caregivers are expected to do and what we actually teach them to do,” said Susan Reinhard, director of AARP’s Public Policy Institute.

That gap was highlighted in 2012, when AARP and the United Hospital Fund’s Families and Health Care Project published a groundbreaking report on medical and nursing tasks undertaken by caregivers. It found that 46 percent helped patients who required specialized care, but few got adequate training.

After the study’s publication, AARP started compiling educational materials from around the country that addressed caregivers’ increasingly complex responsibilities. There wasn’t much available.

With the United Hospital Fund, AARP convened focus groups and asked people what would be helpful. Don’t overwhelm us with information; break the material into chunks focusing on concrete tasks, they said. And tell us a story that we can relate to, involving people like us — not doctors and nurses, they requested.

Ongoing research into what works, from family caregivers’ perspective, will be an integral part of the Home Alone Alliance. And while videos will be a core component of the consortium’s offering, they won’t be the only one.

“It may be that within certain Asian communities, a video isn’t the best approach — we may want to partner with Asian resource centers and do ‘train the trainer’ sessions about caregiving,” said Heather Young, founding dean and a professor at the Betty Irene Moore School of Nursing at UC Davis.

In African-American communities, churches are a pillar of caregiving support and the focus may be on “helping congregations build their capacity,” Young said. “You can equip one person at a time all you want, but if there isn’t a broader context of support, a net around them, it’s very difficult to sustain the caregiving.”

Meanwhile, alliance members are developing plans for disseminating materials. The Family Caregiver Alliance will incorporate them in a new online platform for caregivers, FCA CareJourney — a source of support and resources that is still under development.

FCA began producing videos for family caregivers about four years ago; its Caregiver College series and SafeAtHome series have been watched by about 500,000 people to date. “We’re going to a more visual information exchange society,” said Kathleen Kelly, FCA’s executive director.

The U.S. Department of Veterans Affairs partnered with AARP in producing the alliance’s video series on mobility. It plans to post the videos on the VA’s caregiver website and encourage their use by patients discharged from rehabilitation and those served through its home-based primary care program, said Meg Kabat, national director of the VA’s Caregiver Support program.

Recognizing the value of videos, the VA’s Office of Rural Health has created a 20-module series on caring for someone with dementia and a five-part series on managing challenging behaviors associated with dementia. An extensive compilation of materials on various health conditions, Veterans Health Library, is also online, and another valuable resource for caregivers.

What’s missing from the current offerings is advice on dealing with older adults who are frail and have multiple conditions. Catherine Yanda’s 91-year-old mother, Mary, is in this situation: She has end-stage dementia, sarcopenia, heart disease, incontinence, frequent skin tears and difficulty swallowing — a set of problems that Yanda has had to figure out how to manage, largely on her own.

“I learn what to do as it happens,” said Yanda, who turns to FCA’s website for support and websites for nurses for information. “You go to whatever site helps you deal with the problem you’re trying to address. I’m lucky because I have the belief system that I can do it. But for some people, it’s just too much.”

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

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation and its coverage of aging and long-term care issues is supported by The SCAN Foundation.

Categories: Aging, Navigating Aging, Public Health

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Medicaid Caps Pitched By GOP Could Shrink Seniors’ Benefits

Before nursing home patient Carmencita Misa became bedridden, she was a veritable “dancing queen,” says her daughter, Charlotte Altieri.

“Even though she would work about 60 hours a week, she would make sure to go out dancing once a week — no matter what,” Altieri, 39, said. “She was the life-of-the-party kind of person, the central nervous system for all her friends.”

A massive stroke in March 2014 changed all that. It robbed Misa, 71, of her short-term memory, her eyesight and her mobility — and it left her dependent on a feeding tube for nourishment. Altieri, who has two small children, is unable to provide the 24-hour care her mother now gets at a Long Beach, Calif., nursing home three miles away — all of it paid by Medi-Cal, California’s version of the Medicaid program for low-income people.

But advocates for the elderly now worry that Misa and other low-income seniors who receive long-term care in facilities or at home could see their benefits shrink or disappear under Republican-proposed legislation to cap federal Medicaid contributions to states. The proposal is part of a broader GOP plan to repeal and replace former President Barack Obama’s Affordable Care Act.

“My mom is getting the basic of basic care,” Altieri said. “If they cut it, I don’t know what to do.”

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Nationwide, Medicaid provides long-term care and support to more than 2 million low-income seniors. The program, funded jointly by the federal government and the states, pays more than half of all long-term care in the country — “more than Medicare, private long-term care insurance and out-of-pocket spending combined,” said Matt Salo, executive director of the National Association of Medicaid Directors.

And, he said, it’s the only public program that offers such care on an ongoing basis. The Medicare program — for people 65 and older — provides only limited long-term care to those who need it after being hospitalized.

The GOP bill, scheduled for a vote on the floor of the House on Thursday, would transform Medicaid from an open-ended system, in which the federal government matches state spending, to one in which it provides a fixed amount to each state, either through a lump-sum payment or on a per-capita basis.

In an attempt to overcome opposition to the bill among some Republicans, GOP leaders agreed Monday to add the option of a lump-sum payment, known as a block grant.

They also amended the bill to allocate additional money for elderly and disabled people on Medicaid. But Eric Carlson, a directing attorney in the Los Angeles office of the nonprofit group Justice in Aging, said such an allocation would not offset the wide funding gap created by caps on federal spending.

“It doesn’t matter whether it’s a block grant or per-capita cap,” Carlson said. “Either way the federal government is setting a hard limit on federal funding available, and states are going to be forced to make due with whatever is sent to them, and it’s not going to be enough.”

Carlson is co-author of a paper released by Justice in Aging that says capping federal Medicaid spending, with either per-capita funding or block grants, would harm older Americans, in part by forcing states to cut services for them “to the bone.”

“Federal payment for Medicaid would drop sharply, resulting in fewer services for everyone who relies on Medicaid, including older adults who account for over 22 percent of all Medicaid spending,” the report predicted.

In 2015, Medicaid spending topped $552 billion nationwide, including more than $85 billion spent on Medi-Cal enrollees, according to the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

Under the GOP proposal, nursing care in a facility would remain a guaranteed Medicaid benefit, though states could reduce how much they spent on it if they were forced to economize. And Republicans might well attempt to loosen or undo federal program requirements with subsequent legislation that would give states more control.

Such a shift would “decimate Medicaid’s current guarantee of adequate and affordable care,” according to the Justice in Aging paper.

In the meantime, states could do away with benefits not guaranteed under federal law, which include at-home nursing, personal care — which Medi-Cal covers for qualified beneficiaries — and even inpatient and nursing care in mental health facilities for the elderly.

A report released last week by the nonpartisan Congressional Budget Office suggests states might cut provider payments or eliminate some of their optional services to fill the funding gap left by the restricted flow of federal money.

Oren Cass, a senior fellow with the Manhattan Institute who specializes in anti-poverty law, doesn’t believe that means the GOP plan would necessarily harm elderly Medicaid beneficiaries.

“A state that wants to continue the spending it does on the elderly can do that if it would rather make cuts elsewhere,” he said. “Or it can put up more of its own money.”

Cass said that having more flexibility might appeal to California legislators and health care leaders.

“If you ask California today whether it would rather have Donald Trump run its Medicaid program or run it itself, I think most people there, especially liberal people, would say they would rather have the state making the rules,” he said.

For now, however, the debate over the GOP bill is largely speculative, since there may be enough Republicans with serious concerns about the legislation to sink or significantly amend it.

The CBO report shows the bill would reduce federal budget deficits by a cumulative $337 billion over a decade. The CBO also projected that the bill, if passed, would leave 14 million more people uninsured next year than under current law and 24 million more by 2026.

The cost savings may not be enough to overcome the reluctance of many conservative Congress members who call the bill “Obamacare Lite” because it retains some of the most popular features of the Affordable Care Act.

As the debate heats up in Washington, Charlotte Altieri of Long Beach remains hopeful that her mother’s nursing home care will be spared any cuts.

“We’re not at some grandiose nursing home right now,” she said, “Where are we going to find one that costs less than this one?”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Categories: Aging, Repeal And Replace Watch, The Health Law

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Viewpoints: Planned Parenthood’s Popularity; FDA’s Retreating Oversight Of Supplements

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

Los Angeles Times: Why Is Planned Parenthood Popular? And If It’s Defunded, Could Any Other Organization Fill The Gap?
Congressional Republicans, President Trump and Vice President Mike Pence are united in support of “defunding” Planned Parenthood. Indeed, a provision in the GOP’s American Health Care Act would end its eligibility as a Medicaid provider, meaning patients covered by the low-income insurance program could no longer choose Planned Parenthood clinics for care. … Before unraveling Planned Parenthood, though, Republicans should look at why it’s so popular among Medicaid recipients — and whether any other organization is well-positioned to fill the gap. (Elizabeth Nolan Brown, 3/21)

Los Angeles Times: Bitter Pill To Swallow: Less FDA Oversight Of Supplements Seems Likely
The Food and Drug Administration last week shut shut down several Colorado dietary-supplement companies that it said were selling “misbranded and adulterated” products that wrongly purported to treat “high cholesterol, hypertension, diabetes, depression and muscle pain. ”The agency said violations such as these “put consumers’ health in jeopardy.” If President Trump has his way with the federal budget, it’s almost a sure thing that people increasingly will be at greater risk when it comes to the safety and effectiveness of over-the-counter supplements. (David Lazarus, 3/21)

The Des Moines Register: Right-To-Try Gives Little Hope To Sick Iowans
Every so often, a bill comes before the Iowa Legislature that no single lawmaker would dare vote against. Enter Senate File 404. The legislation gives terminally ill Iowans the “right to try” drugs and devices not yet approved by the U.S. Food and Drug Administration by permitting manufacturers to legally provide them. … “This gives patients hope,” said Sen. Rick Bertrand, R-Sioux City, who proposed the legislation in response to a friend’s battle with a degenerative illness. But that hope may be false. (3/20)

St. Louis Post-Dispatch: Missourians Deserve Affordable In-Home Care
Home care workers provide valuable care for Missouri families, but it often goes unnoticed, behind closed doors. I take care of Ms. Linda, who has been in my care for five years. I prepare her food and medications, dress and help her get to doctor’s visits — everything she needs to stay happy and healthy in her own house, instead of a nursing home. I love my job because it gives me the opportunity to work with my clients one-on-one, which provides an unmatched quality of care that you don’t get in a nursing home. The work is hard but rewarding. … But right now, the proposed $113 million budget cut from Gov. Eric Greitens threatens the care of Missourians like Ms. Linda. (Elinor Simmons, 3/21)

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

Congress May Delete Requirement That Businesses Track Worker Injuries

Also in public health news, the traditionally high U.S. infant death rate is making a promising decline and a new study highlights a connection between global warming and diabetes rates. Media outlets also report on a range of other developments, including ketamine being used to treat severely depressed patients and insurers weighing a simple treatment for artery disease.

NPR: Congress May Undo A Key Worker Safety Rule
Safety advocates are worried that lawmakers are getting ready to make it harder to penalize companies that don’t keep track of workers’ injuries. Since 1971, the Occupational Safety and Health Administration has required many employers to keep careful records of any worker injuries or illnesses. (Greenfieldboyce, 3/20)

Stat: Infant Deaths, Stubbornly High In The US, Continue A Promising Decline
In the US, a rising number of babies are living to see their first birthday, according to a study released Tuesday by the Centers for Disease Control and Prevention. The data show that infant mortality has declined by 15 percent over the last decade, with the biggest gains concentrated in the south and east of the country. That’s good news given that the US has persistently had a higher rate of infant deaths than other wealthy nations. (Swetlitz, 3/21)

NPR: Ketamine For Severe Depression Gains Popularity Among Doctors
Gerard Sanacora, a professor of psychiatry at Yale University, has treated hundreds of severely depressed patients with low doses of ketamine, an anesthetic and popular club drug that isn’t approved for depression. This sort of “off-label” prescribing is legal. But Sanacora says other doctors sometimes ask him, “How can you be offering this to patients based on the limited amount of information that’s out there and not knowing the potential long-term risk?” Sanacora has a simple answer. (Hamilton, 3/20)

Stat: Insurers Weigh A Simpler Treatment For Artery Disease: Supervised Workouts
When Char Zinda’s doctors discovered that she had had a couple of small, undiagnosed heart attacks, their instructions were to start walking. She was game. She tried going to the local university’s indoor walking track near her house. But she couldn’t even walk two-tenths of a mile. “The bottoms of my feet just felt like somebody had taken a sharp pencil and was poking it in,” said the 64-year-old, who lives in Morris, Minn. The pain was so bad it made her cry. (Boodman, 3/20)

Stateline: With A Daily Dial, Police Reach Out To Seniors
Living alone can be tough for seniors. Some don’t have family nearby to check on them, and they worry that if they fall or suffer a medical emergency and can’t get to the phone to seek help, no one will know. That’s why hundreds of police agencies in small towns, suburbs and rural areas across the country are checking in on seniors who live alone by offering them a free automated phone call every day. (Bergal, 3/21)

The New York Times: Popular Prostate Cancer Therapy Is Short, Intense And Unproven
After learning he had early stage prostate cancer, Paul Kolnik knew he wanted that cancer destroyed immediately and with as little disruption as possible to his busy life as the New York City Ballet’s photographer. So Mr. Kolnik, 65, chose a type of radiation treatment that is raising some eyebrows in the prostate cancer field. It is more intense than standard radiation and takes much less time — five sessions over two weeks instead of 40 sessions over about two months or 28 sessions over five to six weeks. (Kolata, 3/20)

The Washington Post: This Woman’s Labored Breathing Alarmed Her Friends. Doctors Were Startled To Find The Cause.
“What’s wrong with you?” Dianne Hull remembered her friend Vicky Weinstein asking, alarm evident in her voice. The two women had just finished lunch in December 2012, and Hull breathed heavily as she walked across the kitchen of her friend’s home. Hull’s audible breathing — and increasing breathlessness — had been shoved aside in her constellation of pressing concerns. For months, Hull had been focused on a medical crisis affecting her young son. But now Weinstein — a nurse — was delivering a forceful reminder: It was past time for Hull, then 38, to pay attention to her own health. (Boodman, 3/20)

Stat: Craig Venter Wants $1,400 To Sequence A Genome. Is It Worth It?
The genomics pioneer who sequenced the human genome carved out a new niche just over a year ago, selling exhaustive $25,000 medical workups to apparently healthy people. Now Craig Venter’s trying to take one small piece of that business to a much wider audience — and to prove it’s worthwhile. (Robbins, 3/21)

Sacramento Bee: How To Wean Yourself From Your Gadget Addiction 
Many people find the constant dings, rings, buzzes and beeps that come from their computers and cell phones impossible to ignore. Experts say its a sign of our dependency on technology, which validates and entertains us while also cutting into our productivity and altering our attention span for the worse. (Caiola, 3/20)

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

Viewpoints: For Opioids, The Drug War Misses The Target; In Defense Of Meals On Wheels

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

Chicago Tribune: Opioid Epidemic: Another Drug War Failure
Illicit drug use is an old phenomenon, and Jeff Sessions has an old solution: Take off the gloves. “We have too much of a tolerance for drug use,” the attorney general complained to an audience of law enforcement officials Wednesday, promising more aggressive policing. … in his prepared remarks, Sessions insisted that cannabis is “only slightly less awful” than heroin. Oh, please. The nation is in the midst of an epidemic of overdose deaths involving heroin and other opioids. In 2015, 32,000 Americans died of such overdoses. Compare that with the number of people who died from ingesting an excess of marijuana: zero. (Steve Chapman, 3/17)

RealClear Health: Gottlieb Promises To Accelerate Drug Approvals; Surrogate Endpoints Can Help
President Trump’s FDA appointee Scott Gottlieb wants to speed up the drug approval process to give patients quicker access to life-saving drugs. Luckily for him, President Obama gave him the tools he’ll need to do so. In the waning days of his presidency, President Obama signed into law the bipartisan 21st Century Cures Act. The legislation permits the FDA to approve more drugs based on “surrogate endpoints.” This move will speed up the drug approval process and improve millions of Americans’ chances of beating cancer. (Sandip Shah and Vidya Ramesh, 3/20)

Morning Consult: Why Drug Importation Is Flawed Policy
With the issue of prescription drug importation being debated on Capitol Hill again, mark me in the skeptical camp. As a matter of safety and practical policymaking, drug importation simply doesn’t work. It is not by happenstance that our country has the world’s safest drug supply. Counterfeit medicines are proliferating around the world and the people who do this are brilliant at making these products look just like the real deal. (Mike Leavitt, 3/20)

The New York Times: The Cost Can Be Debated, But Meals On Wheels Gets Results
Meals on Wheels has been delivering food to older people in the United States since the 1950s. Last year it served 2.4 million people. This week, after President Trump released his budget proposal, a furor erupted over the program’s future and effectiveness. Let’s look at the evidence. (Aaron E. Carroll, 3/17)

Miami Herald: Trump’s Budget Makes The Unkindest Cuts Of All
Sadder still, is that so many of these cuts will do damage to so many of the people he persuaded to vote for him: the low-income, the unemployed, the chronically sick and under-housed. Though the president’s increases for training programs for disabled Americans deserve praise, his cutbacks in job training programs for seniors, perhaps unable to retire, but thrust into the job market; disadvantaged youth — and they don’t all live in inner cities, but in rural areas, too; and the out-of-work are headscratchers. Who’s going to fill all those jobs he’s promised to restore? And independent studies show Meals on Wheels, also on the chopping block, is extremely effective at providing isolated seniors nutrition and socialization. (3/18)

The New York Times: Why Cystic Fibrosis Patients In Canada Outlive Those In The U.S.
Cystic fibrosis is an inherited disorder that affects the lungs, pancreas, intestines and other organs. A genetic mutation leads to secretory glands that don’t work well; lungs can get clogged with thick mucus; the pancreas can become plugged up; and the gut can fail to absorb enough nutrients. Cystic fibrosis has no cure. Over the last few decades, though, we have developed medications, diets and treatments for depredations of the disease. Care has improved so much that people with cystic fibrosis are living on average into their 40s in the United States. In Canada, however, they are living into their 50s. (Aaron E. Carroll, 3/20)

The Kansas City Star: Prospect Of Guns In State Mental Hospitals Means It’s Time For Lawmakers To Act
Common sense dictates that Kansas doesn’t want guns in its mental hospitals. But the state is headed precisely in that direction unless lawmakers can rally in the days ahead and agree on exemptions to a gun law passed in 2013. That law gave mental hospitals, other hospitals and the state’s college campuses four years to prepare for the day when firearms would be allowed in their buildings. (3/18)

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

‘It’s A Real Crisis’: Ohio’s Low Nursing Home Ratings Raise Care Concerns

The Cleveland Plan Dealer reports on its review of inspection reports, finding dozens of nursing home deaths involving patient care questions.

Cleveland Plain Dealer: Federal Rating System Is Flawed, Nursing Homes Say: A Critical Choice
The federal government’s Nursing Home Compare system is the only way to evaluate nursing homes nationally, but there’s a lively debate over whether it’s good enough for families to rely on. Critics, including administrators of some of the lowest-rated nursing homes in Northeast Ohio, say the system is flawed. They noted it penalizes homes for problems that may have occurred years ago, and say it punishes facilities that take in the most seriously ill residents. (Caniglia and Corrigan, 3/19)

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

As Medical Marijuana Industry Booms, The Question Becomes Where To Put The Shops

Some end up tucked away on the edges of town, while others are out in the open.

Boston Globe: Where In Town Would You Put A Marijuana Facility? 
A medical marijuana dispensary plans to open in Hanover this summer next to Friendly’s on busy Route 53, allowing customers to — if they so choose — move quickly from a menu featuring THC-infused chocolate bars to one heavy on children’s meals and ice-cream sundaes. Meanwhile in neighboring Norwell, another medical marijuana outlet is breaking ground soon in a far less visible location — tucked into the far reaches of an industrial park at the edge of town. (Seltz, 3/17)

Meanwhile in California —

The New York Times: Marijuana Industry Presses Ahead In California’s Wine Country
In the heart of Northern California’s wine country, a civil engineer turned marijuana entrepreneur is adding a new dimension to the art of matching fine wines with gourmet food: cannabis and wine pairing dinners. Sam Edwards, co-founder of the Sonoma Cannabis Company, charges diners $100 to $150 for a meal that experiments with everything from marijuana-leaf pesto sauce to sniffs of cannabis flowers paired with sips of a crisp Russian River chardonnay. (Fuller, 3/18)

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

Once Nearly Buried By Medical Bills, Farmer Braces For Insurance Drought

Darvin Bentlage’s health insurance plan used to be the same as all the other cattle farmers in Barton County, Mo., he said: to stay healthy until he turned 65, then get on Medicare. But when he turned 50, things did not go according to plan.

“Well, I had a couple of issues,” he said.

That’s putting it mildly.

Over two years, he dealt with hepatitis C and diverticulitis. That was on top of his persistent kidney stones, diabetes and other health problems.

“I had to go back and refinance the farm,” he said. “By the time the two years was up, I had run up between $70,000 and $100,000 in hospital bills.”

He does not want to end up in that situation again, so he is paying close attention to what Republican health care bill working its way through Congress might mean for him.

He racked up those medical bills in 2007. Bentlage said that given his preexisting conditions, health insurance became impossibly expensive — a problem because he needed more health care. So when the Affordable Care Act exchanges opened in 2013, he said, “I was probably one of the first ones to get online with it and walk through it.”

About a quarter of the people on the exchanges are between 55 and 64, and they have more health problems than younger people do. So they have a lot on the line if the Affordable Care Act gets replaced. Under the GOP plan, older people’s insurance cost could rise dramatically, but the subsidies would be capped at $4,000. That’s less than half of what Bentlage is getting now under the ACA.

“And my estimated income is less than $20,000. So I’d have to go back to Plan A and hope I make it to 65, you know?” he chuckled.

Insurance premiums tend to be higher in rural areas where the population tends to be older, poorer and sicker than elsewhere. And Maggie Elehwany of the National Rural Health Association said there’s another issue: 80 rural hospitals have closed across the country since 2010.

“We’ve got an access crisis going on,” she said. “What this House bill does is nothing — nothing to address the rural hospital closure crisis. You’ve got to understand that so much of that is linked to not only the health, but to the economic vitality of the community. If a hospital closes in a rural area, it closes for good.”

One reason for these hospital closures is that 19 states, including Missouri, chose not to expand Medicaid, which left poor rural patients uninsured. The GOP proposal would cut Medicaid more over time.

Bentlage said his county recently increased property taxes to keep its hospital open.

“It falls on the farmers,” he said. “My property tax on the hospital went from about $80 to about $400. And it’s still in trouble.”

Missouri’s Republican congressional delegation has said Obamacare has failed. And Bentlage, whose positive experience with the health law once was featured in a healthcare.gov video, said the ACA does need work.

“There’s problems with it,” he said, “but I don’t think it’s worth scrapping.” All you need to do, he said, is look at how it’s helped him.

This story is part of a partnership that includes Side Effects Public Media, NPR and Kaiser Health News.

Categories: Aging, Cost and Quality, Public Radio Partnership, Repeal And Replace Watch, The Health Law

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After 3 Discussions With Trump, Rep. Cummings Says Drug Prices Are A Top Priority For President

However, the director of the Office of Management and Budget plays down the possibility of allowing Medicare to negotiate the cost of drugs. Also, the Columbus Dispatch examines the difficulties that seniors face in enrolling and navigating Medicare. And hospitals must now give Medicare patients official notice if they haven’t been admitted to the hospital and are instead in observation care.

ABC News: Democrat: Trump ‘Enthusiastic’ About Call For Medicare To Negotiate Drug Prices
Democratic Rep. Elijah Cummings said President Trump in recent meetings was “enthusiastic” about proposals to lower drug prices by having Medicare negotiate with pharmaceutical companies and by importing less costly medicines from Canada or other foreign countries. Cummings said he met three times over the past week with the president about drug prices. (Scanlan, 3/12)

Columbus Dispatch: Many Have Trouble Navigating Medicare’s Complexities
More than 57 million seniors and disabled adults depend on Medicare, but too many people struggle to enroll and navigate the complexities of the federal health-insurance program, a national advocacy group says. And with half of all people on Medicare living on annual incomes of $24,150 or less, many can’t afford the co-payments, co-insurance and deductibles associated with their coverage. (Pyle, 3/12)

Kaiser Health News: By Law, Hospitals Now Must Tell Medicare Patients When Care Is ‘Observation’ Only
Under a new federal law, hospitals across the country must now alert Medicare patients when they are getting observation care and why they were not admitted — even if they stay in the hospital a few nights. For years, seniors often found out only when they got surprise bills for the services Medicare doesn’t cover for observation patients, including some drugs and expensive nursing home care.The notice may cushion the shock but probably not settle the issue. (Jaffe, 3/13)

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

By Law, Hospitals Now Must Tell Medicare Patients When Care Is ‘Observation’ Only

Under a new federal law, hospitals across the country must now alert Medicare patients when they are getting observation care and why they were not admitted — even if they stay in the hospital a few nights. For years, seniors often found out only when they got surprise bills for the services Medicare doesn’t cover for observation patients, including some drugs and expensive nursing home care.

The notice may cushion the shock but probably not settle the issue.

When patients are too sick to go home but not sick enough to be admitted, observation care gives doctors time to figure out what’s wrong. It is considered an outpatient service, like a doctor’s visit. Unless their care falls under a new Medicare bundled-payment category, observation patients pay a share of the cost of each test, treatment or other services.

And if they need nursing home care to recover their strength, Medicare won’t pay for it because that coverage requires a prior hospital admission of at least three consecutive days. Observation time doesn’t count.

“Letting you know would help, that’s for sure,” said Suzanne Mitchell, of Walnut Creek, Calif. When her 94-year-old husband fell and was taken to a hospital last September, she was told he would be admitted. It was only after seven days of hospitalization that she learned he had been an observation patient. He was due to leave the next day and enter a nursing home, which Medicare would not cover. She still doesn’t know why.

“If I had known [he was in observation care], I would have been on it like a tiger because I knew the consequences by then, and I would have done everything I could to insist that they change that outpatient/inpatient,” said Mitchell, a retired respiratory therapist. “I have never, to this day, been able to have anybody give me the written policy the hospital goes by to decide.” Her husband was hospitalized two more times and died in December. His nursing home sent a bill for nearly $7,000 that she has not yet paid.

The notice is — as of last Wednesday — one of the conditions hospitals must meet in order to get paid for treating Medicare beneficiaries, who typically account for about 42 percent of hospital patients. But the most controversial aspect of observation care hasn’t changed.

“The observation care notice is a step in the right direction, but it doesn’t fix the conundrum some people find themselves in when they need nursing home care following an observation stay,” said Stacy Sanders, federal policy director at the Medicare Rights Center, a consumer advocacy group.

Medicare officials have wrestled for years with complaints about observation care from patients, members of Congress, doctors and hospitals. In 2013, officials issued the “two-midnight” rule. With some exceptions, when doctors expect patients to stay in the hospital for more than two-midnights, they should be admitted, although doctors can still opt for observation.

But the rule has not reduced observation visits, the Health and Human Services inspector general reported in December. “An increased number of beneficiaries in outpatient stays pay more and have limited access to [nursing home] services than they would as inpatients,” the IG found.

The new notice drafted by Medicare officials must be provided after the patient has received observation care for 24 hours and no later than 36 hours. Although there’s a space for patients or their representatives to sign it “to show you received and understand this notice,” the instructions for providers say signing is optional.

Some hospitals already notify observation patients, either voluntarily or in more than half a dozen states that require it, including California and New York.

Doctors and hospital representatives still have questions about how to fill out the new observation care form, including why the patient has not been admitted. During a conference call Feb. 28, they repeatedly asked Medicare officials if the reason must be a clinical one specific for each patient or a generic explanation, such as the individual did not meet admission criteria. The officials said it must be a specific clinical reason, according to hospital representatives who were on the call.

Atlanta’s Emory University hospital system added a list of reasons to the form that its doctors can check off, “to minimize confusion and improve clarity,” said Michael Ross, medical director of observation medicine and a professor of emergency medicine at Emory. Emory also set up a special help line for patients and their families who want more information, he said.

The form also explains that observation care is covered under Medicare’s Part B benefit, and patients “generally pay a copayment for each outpatient hospital service” and the amounts can vary. But Ross said “this wording may be antiquated.” Medicare revised some billing codes last year to combine several observation services into one category. That means beneficiaries are responsible for one copayment if the observation stay meets certain criteria.

The new payment package also includes coverage for some prescription drugs to treat the emergency condition that brought the observation patient to the hospital, said Debby Rogers, the California Hospital Association’s vice president of clinical performance and transformation. Other drugs for that condition will be billed under Part B with separate copayments, she said.

But patients will have to pay out-of-pocket for any medications the hospital provides for preexisting chronic conditions such as high cholesterol, and then seek some reimbursement from their Medicare Part D drug plans for any covered drugs.

Yet, Ross said, most observation visits are less expensive for beneficiaries than a hospital admission if they stay a short time, which the inspector general’s report also concluded. Doctors should “front load” tests and treatment so that the decision to admit or send the patient home can be made quickly. “If you get them out within a day, they are more likely to go back to independent living as opposed to needing nursing home care,” he said.

Last summer, Judy Ehnert’s 88-year-old mother had a bad fall and broke her wrist. Following surgery, and additional complications, hospital officials told the family she would be kept for observation but she would need to go to a nursing home to recover. When the family learned what observation care meant, said Ehnert, a retired bookkeeper who lives in West Fargo, N.D., “that’s when we blew a cork.”

Then, after a few days in observation, Enhert’s mother contracted an infection and she was admitted to the hospital. “Her care was totally the same, in the same room, with the same doctor, the same nurse.” And Medicare covered her nursing home care.

“That’s what I expected at her age,” Enhert said. “I always thought that’s what Medicare was for.”

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation and its coverage of aging and long-term care issues is supported by The SCAN Foundation.

Categories: Aging, Health Industry, Medicare, Syndicate

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A Playbook For Managing Problems In The Last Chapter Of Your Life

CHICAGO — At least once a day, Dr. Lee Ann Lindquist gets an urgent phone call.

“Mom fell and is in the hospital,” a concerned middle-aged son might report.

“Dad got lost with the car, and we need to stop him from driving,” a distraught middle-aged daughter may explain.

“We don’t know what to do.”

Lindquist, chief of geriatrics at Northwestern University’s Feinberg School of Medicine, wondered if people could become better prepared for such emergencies, and so she designed a research project to find out.

The result is a unique website, www.planyourlifespan.org, which helps older adults plan for predictable problems during what Lindquist calls the “last quarter of life” — roughly, from age 75 on.

“Many people plan for retirement,” the energetic physician explained in her office close to Lake Michigan. “They complete a will, assign powers of attorney, pick out a funeral home, and they think they’re done.”

What doesn’t get addressed is how older adults will continue living at home if health-related concerns compromise their independence.

Judith GrahamNAVIGATING AGING

“People don’t want to think about the last 10 or 15 years of their life, and how they’re going to manage,” Lindquist said.

This isn’t end-of-life planning; it’s planning for the period before the end, when health problems become more common.

Lindquist and collaborators began their research by convening focus groups of 68 seniors — mostly women with an average age of 74. Nearly $2 million in funding came from the Patient-Centered Outcomes Research Institute, created under the Affordable Care Act.

Investigators wanted to know which events might make it difficult for people to remain at home. Seniors named five: being hospitalized, falling, developing dementia, having a spouse fall ill or die, and not being able to keep up their homes.

Yet most participants hadn’t planned for these kinds of events. Investigators asked why.

Among the reasons seniors offered: I don’t know what to do, I’m uncomfortable asking for help, I’m not at immediate risk of something bad happening, my children will take care of whatever I need, and I’m worried I won’t have enough money, according to a research report published last year.

Developing the website came next. Lindquist and her team decided to focus on three issues the focus groups had raised — hospitalizations, falling and developing dementia — and to include sections on communicating with family members and managing finances.

A group of senior advisers rejected the first version: the typeface was too small; the design, too cluttered; and the content, too complex. They didn’t want to be overwhelmed with information; they wanted the material on the site to be practical and concrete.

The final version “forces people to sit down and think about their future in a very helpful and non-threatening way,” said Phyllis Mitzen, 74, who worked on the project and is president of Skyline Village in downtown Chicago, a community organization with about 100 older adult members.

A website hosted by Northwestern University’s Feinberg School of Medicine helps users plan for the last stage of life. (Screenshot)

An individual going through the material is asked to consider a series of questions after examining explanatory information and watching short videos of seniors illustrating the issues being discussed. For instance, which rehabilitation facility would you like to go to if you need intensive therapy after a hospitalization?

Who will take care of your pets, mow your lawn or shovel the snow from your sidewalk while you’re away? Who can collect your mail, check on bills to be paid and get medications for you when you return home?

If you begin having memory problems, who can help you manage your bills and finances? Are you willing to wear a medical alert bracelet if you start getting lost? Would you be willing to have a friend or relative check on your driving or have a formal driving evaluation?

If you require more assistance, are you open to having someone come in to help at home? Would you prefer to live with somebody — if so, whom? Would you be willing to move into a senior community?

The goal is to jump-start conversations about these issues, Lindquist said, just as seniors are encouraged to have conversations about end-of-life preferences.

Those looking for deep dives into topics highlighted on the site will have to look elsewhere. Resources listed are spare and some of the material presented — for instance, how Medicare might cover various services — is overly simplified, noted Carol Levine, director of the United Hospital Fund’s Families and Health Care Project in New York City.

Her project has prepared a much more detailed, comprehensive set of guides for family caregivers about issues such as home care, doctors’ visits, emergency room care, rehabilitation and what to expect during and after a hospitalization. Those materials are full of useful advice and can flesh out issues raised on the Northwestern website.

Those wanting to know more about falls can consult materials prepared by the U.S. Centers for Disease Control and Prevention and the National Institutes of Health.

For dementia, the Alzheimer’s Association and the NIH are good places to start.

As for next steps, Lindquist contemplates disseminating PlanYourLifespan more widely, translating it into Spanish if funding can be secured and possibly expanding it to include more topics.

The point is to “give seniors a voice,” she said. Now, if an older woman breaks a hip and is rushed to surgery, “loved ones run around and usually make decisions without her input — she’s usually too out of it to really weigh in. That doesn’t have to happen, if only people would consider the reality of growing older and plan ahead.”

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

Categories: Aging, Navigating Aging, Syndicate

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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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