Too Many Open Browser Tabs

Whenever I find an interesting article, I leave it open on my browser because I just know it will form the basis of a spectacular blog post. I’ve always done this, but in the past I would finally just close everything and start over again because the web is, after all, an infinite source of riches. But since I challenged myself to write a blog post a day in 2015, I’ve been less eager to close all those tabs down. What if I face a day when I can’t think of anything to write about?

My browser has now become so bloated that I have to do something to make my system work faster. Instead of just closing all those tabs, I’m resorting to a collection of the very best ones here. Because I have lots of wide-ranging interests, this is quite an eclectic collection. But every one of these articles is worth attention. I guarantee it.

The Moral Bucket List

New York Times op-ed columnist David Brooks writes here about some special people:

ABOUT once a month I run across a person who radiates an inner light. These people can be in any walk of life. They seem deeply good. They listen well. They make you feel funny and valued. You often catch them looking after other people and as they do so their laugh is musical and their manner is infused with gratitude. They are not thinking about what wonderful work they are doing. They are not thinking about themselves at all.

Brooks distinguishes between two types of virtues, the résumé virtues and the eulogy virtues:

The résumé virtues are the skills you bring to the marketplace. The eulogy virtues are the ones that are talked about at your funeral — whether you were kind, brave, honest or faithful. Were you capable of deep love?

He goes on to say that a while back he set out “to discover how those deeply good people got that way.” In the rest of the article he describes what he found out.

It’s a good article, and I encourage you to read it. But I’ve left this browser tab open for a while now because this article reminded me of a former friend of mine. She could, at times, act caring and loving, but I always detected the tiniest disconnection between her inner workings and her outer behavior. For example, one day after she had spent a long time describing how each of her three children had recently hurt her feelings, she paused for a second while looking at me, then asked, “How’s your daughter?” During that second I could see the gears working inside her head: “I’ve talked about my kids, so I should now ask about hers.” I knew she wasn’t truly interested, so I said, “She’s fine” and left it at that. She visibly exhaled with relief.

This women always blamed other people for any problem in her own life. Everything was always the other person’s fault. She even developed a convoluted philosophy of life—it involved a person’s True Center of Pure Being (her caps)—that allowed her to avoid having to take responsibility for her own actions. When one of her children made her feel down on herself, she would explode and scream at me, trying to make me feel just as bad about myself as she felt about herself. When I told her, several times, how hurtful her behavior was to me, she said that I should understand that she was under a lot of pressure. “I’m not what I do,” she said.

This woman is the opposite of the people David Brooks describes. One can’t simply invoke one’s True Center of Pure Being. She is what she does. We all define ourselves by what we do and say. And this is why she’s a former friend, not a current one.

Sex, Dementia and a Husband on Trial at Age 78

This article brings up one of those issues that’s so complex and deeply personal that I have trouble figuring out what I think about it. In Iowa, Henry Rayhons, age 78, has been arrested for having sex with his 78-year-old wife, who had severe dementia, in a nursing home. The couple was married in 2007 after each had been widowed.

The top-level issue is whether Mrs. Rayhons was capable of giving consent for sex. But the lower-level issue is the question of who gets to decide whether Mrs. Rayhons was capable of giving consent: her husband, nursing home administrators, her doctor, her children?

This case suggests that someone must take the initiative in setting guidelines:

Sex is one of the most ambiguous areas in the scientific understanding of Alzheimer’s. While there are established methods of measuring memory, reasoning and the ability to dress, bathe and balance checkbooks, no widely used method exists for assessing the ability to consent to intimate relations.

Furthermore, dementia symptoms fluctuate. What may be appropriate on one day may not be appropriate on another day. Even more confusing, what may be appropriate in the morning may not be appropriate in the afternoon of the same day.

I’m glad I’m not sitting on the jury for this case.

Parsing Ronald Reagan’s Words for Early Signs of Alzheimer’s

Lawrence K. Altman, M.D., reports:

Now a clever new analysis has found that during his two terms in office, subtle changes in Mr. Reagan’s speaking patterns linked to the onset of dementia were apparent years before doctors diagnosed his Alzheimer’s disease in 1994.

The findings of the study by Arizona State University researchers were published in The Journal of Alzheimer’s Disease. Altman points out that these findings “do not prove that Mr. Reagan exhibited signs of dementia that would have adversely affected his judgment and ability to make decisions in office.”

But the findings do suggest that alteration in speech may one day be used to predict the development of Alzheimer’s and other neurological conditions long before clinical symptoms appear. Earlier detection could lead to earlier treatment, which in turn could help reduce or at least slow damage to the brain.

This research used the same computer algorithm that other researchers have used to analyze changes in writing by novelists, which I have written about here:

Canadian researchers have reported that analyses of syntax in novels by Iris Murdoch and Agatha Christie indicated early signs of dementia (Ms. Murdoch died of Alzheimer’s; Ms. Christie is suspected to have had it.) The same analysis applied to the healthy P. D. James, who died at 94 last year, did not find signs of dementia.

Scientists not involved in this study caution that much more research is necessary before analyses such as this can confidently be used in examining for Alzheimer’s disease.

Diabetes Prevention That Works

It’s Week 5 of the Diabetes Prevention Program, and however commonplace the conversation, the results can be impressive. In 2002, a large national clinical trial showed that among adults at risk for Type 2 diabetes, this “lifestyle modification program” and resulting weight loss reduced the incidence of the disease by 58 percent in 1,000 subjects participating in the program, compared with those who did not — and by an even more substantial 71 percent in those over age 60.

So the Centers for Disease Control and Prevention began rolling out the National Diabetes Prevention Program in 2012. Now, 527 organizations around the country — health care providers, community groups, employers, colleges, churches — offer it in every state, often at multiple sites. Several providers are experimenting with online versions. The Y.M.C.A., the largest single organization involved, enrolls 40 percent of participants nationally.

via Diabetes Prevention That Works – NYTimes.com.

Did you know that nearly 26% of people over age 65 have Type 2 (sometimes referred to as adult-onset) diabetes? Here’s news about a program aimed at helping us make lifestyle changes to decrease our likelihood of developing the disease.

Many YMCAs across the country are offering this program. There’s a link here to help you find out if your local Y is among them.

Coverage for End-of-Life Talks Gaining Ground – NYTimes.com

Five years after it exploded into a political conflagration over “death panels,” the issue of paying doctors to talk to patients about end-of-life care is making a comeback, and such sessions may be covered for the 50 million Americans on Medicare as early as next year.

via Coverage for End-of-Life Talks Gaining Ground – NYTimes.com.

This article offers balanced information on the question of whether doctors should be reimbursed for discussing end-of-life directives with patients. These discussions not only help doctors fulfill patients’ wishes but also relieve families of having to make crucial medical decisions in emotional, stressful situations.

Some private insurers already cover the cost of end-of-life discussions, so it’s important to check your coverage if you have supplemental insurance.

Hospital Charges Surge for Common Ailments, Data Shows – NYTimes.com

Charges for some of the most common inpatient procedures surged at hospitals across the country in 2012 from a year earlier, some at more than four times the national rate of inflation, according to data released by Medicare officials on Monday.

While it has long been known that hospitals bill Medicare widely varying amounts — sometimes many multiples of what Medicare typically reimburses — for the same procedure, an analysis of the data by The New York Times shows how much the price of some procedures rose in just one year’s time.

via Hospital Charges Surge for Common Ailments, Data Shows – NYTimes.com.

Film Review: “Still Mine”

‘Still Mine’ Adds to Movies on Aging

Paula Span reviews this new film:

Not long ago, I could name the really excellent recent movies about aging on one hand. Now I’m running short of fingers, which I hope reflects filmmakers’ dawning recognition of the way this global demographic shift affects all our lives. The latest entry, a Canadian movie called “Still Mine,” opened in New York, Washington, Phoenix and several other cities last month and will arrive in Denver, Atlanta, Seattle, Charlotte and more locations today.

And, just as rain is the standard symbol for Seattle, dementia has become a standard trope for aging:

Interesting, isn’t it, how many of the best films about aging zero in on dementia? On my personal favorites list (adding “Still Mine” to “Amour,” “The Iron Lady,” “Iris,” “The Savages,” “Away from Her” and “About Schmidt”), all but the last incorporate a central character suffering from this disease. Screenwriters, and novelists like Walter Mosley and Alice LaPlante, can’t seem to resist its intrinsic here-but-not-here drama.

“Still Mine” is clear-eyed about this phase, not nearly as brutal as the masterful “Amour,” but more grounded than “The Best Exotic Marigold Hotel” and “Quartet,” both of which featured charming British actors in fluffy screenplays that carefully evaded most realities of advanced age.

This film doesn’t, but it is gentle, more gentle than life can be.

 

A Dark View of Assisted Living

A Dark View of Assisted Living – NYTimes.com

the hourlong “Frontline” documentary “Life and Death in Assisted Living,” airing Tuesday night on PBS stations across the country, doesn’t really break new ground on the subject. But it is important nonetheless.One reason is that families, who make most of the decisions about assisted living, don’t pore over gerontology journals or state regulations as they are looking for a place that is not a nursing home.

So they don’t always realize that these reassuring-looking residences may have no nurse on the premises most of the time, that health care in assisted living frequently consists of a 911 call, that the average length of stay — according to the Assisted Living Federation of America — is less than two years.

Managing chronic pain in older people

Managing chronic pain in older people

Pain management needs to be tailored for older people. The British Pain Society and British Geriatric Society produced guidelines specifically for this client group

This link is to a page summarizing an article from the professional journal Nursing Times. The article lists five key points:

  1. Pain is a risk factor for falls in older people
  2. It is thought that 50% of older adults living in the community, and 80% of those living in care homes, experience chronic pain
  3. Few studies look at the effects of pharmacological interventions specifically on older people
  4. Combination therapy using different classes of analgesics may be more effective with fewer side-effects, compared with higher doses of a single medicine
  5. Further research is needed on psychological treatments for pain in older people

You can see the entire two-page article by clicking on the link for the PDF file under “Related Files” in the middle of the page.

In the Doctor’s Office, a Neglected Resource

In the Doctor’s Office, a Neglected Resource – NYTimes.com

When it comes to providing health care for an aging nation, the bad news is no longer news. We already lack sufficient numbers of geriatricians and other professionals — nurses, social workers, pharmacists, aides — trained to care for the elderly, and the shortage is projected to increase.

The good news, confirmed by a study in the Journal of the American Geriatrics Society, is that nurse practitioners can markedly improve the quality of care for older patients.

This article in The New York Times‘s health section “The New Old Age” reports on a recent study revealing that nurse practitioners can, in many cases, dramatically improve the quality of patient care.

Researchers from UCLA examined medical visits involving four common conditions among older patients: urinary incontinence, falls, depression and dementia:

When it came to treating depression, patients seeing a doctor and a nurse practitioner received about the same care as those treated by doctors alone. In both groups, patients received 60 percent to 63 percent of recommended care.

But when patients showed up with one of the other three conditions, the addition of nurse practitioners meant much higher scores. Patients who saw a nurse practitioner along with a doctor received 80 percent of the recommended assessments and treatments for falls (compared with 34 percent for those who only saw a doctor), 59 percent for dementia (versus 38 percent) and 66 percent for incontinence (versus a particularly dismal 19 percent).

Dr. David Reuben, director of geriatrics at the University of California, Los Angeles and lead author of the study, explains the benefits of a team approach to medical management that uses both doctors and nurse practitioners:

“There are certain things doctors do well, certain things they don’t do well, certain things nurse practitioners do better,” he said. He added that he sympathized with primary care doctors working with elderly patients who have many chronic conditions: “The job is too big. It’s too complicated. There’s too much to do.”

 

Dementia’s Signs May Come Early – NYTimes.com

Dementia’s Signs May Come Early – NYTimes.com

Studies presented Wednesday at an Alzheimer’s Association conference in Boston showed that people with some types of cognitive concerns were more likely to have Alzheimer’s pathology in their brains, and to develop dementia later. Research presented by Dr. Amariglio, for example, found that people with more concerns about memory and organizing ability were more likely to have amyloid, a key Alzheimer’s-related protein, in their brains.

And, in a significant shift highlighted at the conference, leading Alzheimer’s researchers are identifying a new category called “subjective cognitive decline,” which is people’s own sense that their memory and thinking skills are slipping even before others have noticed.

This article reports on a new interest in Alzheimer’s research, the subjective reports of aging patients, known as “the worried well,” who sense their cognitive abilities changing before standard testing procedures reveal definite signs of dementia:

leading Alzheimer’s researchers are identifying a new category called “subjective cognitive decline,” which is people’s own sense that their memory and thinking skills are slipping even before others have noticed.

However, it’s important to note that:

Some memory decline reflects normal aging, they say, and some concerns reflect psychological angst. People who forget what they wanted in the kitchen or the names of relatively unfamiliar people are probably aging normally. People who forget important details of recent events, get lost in familiar places or lose track of book or television plots may not be, especially if they have more problems than others their age.

European studies find dementia rate down sharply | Nation & World | The Seattle Times

Finally, a bit of good news:

European studies find dementia rate down sharply | Nation & World | The Seattle Times

A new study has found dementia rates among people 65 and older in England and Wales have plummeted by 25 percent over the past two decades, to 6.2 percent from 8.3 percent, a trend researchers say is likely occurring across developed countries and that could have major social and economic implications for families and societies.Another recent study, in Denmark, found that people in their 90s who were given a standard test of mental ability in 2010 scored substantially better than people who reached their 90s a decade earlier.