Tags Posts tagged with "Aging"

Aging

METRO photo

By Leah S. Dunaief

Leah Dunaief,
Publisher

For whatever reason, we, in America, have always had an age bias. We have even been said to worship youth. We buy clothes to make us look younger. We get injections, and we even submit to surgery in order to deceive the eye of the beholder and appear more youthful. Many people have complained about ageism in hiring practices. Women have even bemoaned that they become invisible after age 50. We do crossword puzzles to retain our cognitive abilities.

Is it any wonder, then, that age has recently burst into view concerning our upcoming presidential election? The likely contenders are 77 and 81. That means in January 2029, when the next president will replace one of them, they will be 82 and 86. Until now, Ronald Reagan was the oldest president, leaving office just short of 78.

Both men are being studied for signs that they are too old. Both have had memory lapses. But is memory what determines a person’s ability to perform in a leadership role? Even more crucial, for the rest of us, is memory failure the first sign of impactful cognitive decline and even of encroaching dementia?

According to Dr. Charan Ranganath, professor of psychology and neuroscience, Director of the Dynamic Memory Lab at the University of California, Davis, “As an expert in memory, I can assure you that everyone forgets. In fact, most of the details of our lives—the people we meet, the things we do and the places we go—will inevitably be reduced to memories that capture only a small fraction of those experiences.”

The professor goes on to say, in an Opinion Guest Essay for the New York Times this past Monday, that it is normal to be forgetful as we get older, starting in our 30s. He makes an interesting distinction, however, about memory omissions: There is forgetting and there is Forgetting. To understand the difference is to relax about an occasional lack of memory.

The first (with the small f) describes struggling for that word or name on the tip of our tongue that just cannot be remembered. The professional term for that is “retrieval failure,” and while the word or name is there, we can’t summon it immediately or at all. Those of us who watch “Jeopardy!” on television see examples of that nightly as each contestant struggles to call out the answer to the question first—or as the game works, to call out the proper question to match the answer. They may have the information in their heads but just can’t grab it in time.

Forgetting (with a capital F), however, is when a memory is lost or totally gone. The example of the first, that the professor offers from the political scene, is when the names of the leaders of two countries or people are conflated, as Biden did with Mexico and Egypt and Trump with Pelosi and Haley. An instance of the second is if the President didn’t remember meeting the leader of Egypt at all.

The prefrontal cortex is the brain area that is responsible for daily memory, and it changes somewhat as we age. I prefer to think of it as the Rolodex that becomes so full with thoughts and experiences as we live our lives, that it turns increasingly slowly when called upon to produce a particular memory, like a name or date. While it does turn, it may not retrieve the information until the middle of the next night, and whom can we call with the answer then?

We all want to be “super-agers” and retain our cognitive abilities. There is, according to the professor, a huge degree of variability in cognitive aging. While aging is associated with loss of memory, that should not be equated with cognitive decline.

The professor points out that Harrison Ford, Paul McCartney and Martin Scorsese are the same age as Biden, Jane Fonda is 86, and my mentor in the aging-and-functioning department, Warren Buffett, the head of Berkshire Hathaway, is 93.

So if you can’t come up right away with that name you’re intensely seeking, you’re in good company.

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Photo from Statepoint

September, which is World Alzheimer’s Month, is an excellent reminder to keep your mind and body healthy through the years. Experts say that doing so can reduce your risk for cognitive decline. Try taking on these new hobbies to keep your mind sharp as you age:

• Cooking: Not only can the development of a new complicated skill such as cooking improve cognitive functions like problem-solving and concentration, but having the ability to create your own nutritious meals at home has the added benefit of being good for brain health. From TikTok tutorials to online classes taught by master chefs, today, there are more avenues for picking up culinary know-how than ever before.

• Music: Learning to play a musical instrument has countless benefits for brain health, helping improve memory, hand-eye coordination and more. It’s also a mood booster, which is important, as depression is considered a risk factor for dementia. Check out instruments designed to build skills quickly. Whether you’re a total novice or taking up the piano after a long hiatus, Casiotone Keyboards, for example, are portable, easy to use and connect to an app that features lessons and more.

• Exercise: The mind-body connection is strong. For ultimate brain health, stay physically active; and if you can do so outdoors, all the better. Research suggests that connecting with nature is good for one’s mental well-being, reducing stress, anxiety and depression. Support your journey with tools that track your activity and inspire you to delve further into adventures, whether that be hiking, fishing or rock climbing. The watches in the Pro Trek line feature Quad Sensor technology to provide you with temperature and barometric pressure so you can keep your eye on the weather conditions while out and about, as well as sunrise and sunset times, an app for anglers and much more.

• Camaraderie: Having an active social life can improve brain function. Unfortunately, if you aren’t proactive about it, there are not always that many opportunities to make new friends in adulthood. Whether it’s a sewing circle or a bowling league, consider joining a club or team for camaraderie and fun.

• Fast fingers: Did you know that you can use your calculator to keep your mind engaged when there’s downtime or you’re on-the-go? Calculator games can build math skills, improve memory and keep your mind nimble.

Just as it is important to maintain physical fitness as you age, it’s also critical to exercise your mind. Stay mentally active by trying new hobbies, building new skills and seeking out new experiences.

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It is disconcerting when the medical community reverses course. They seem to do that every decade or so, as with the purported value of vitamin C, estrogen and so forth. The latest about face, in case you haven’t yet heard, is on the matter of taking baby aspirin. For years we have been urged to take a baby aspirin each day to ward off all sorts of ills: heart attacks, strokes, dementia, colorectal cancers and who knows what else. Those tiny pills that can dissolve in seconds against the roof of one’s mouth, or be popped into it, seemed capable of miracles.

Now, with a shot heard truly around the world, an Australian research team at Monash University in Melbourne concluded that not only may aspirin not help, it may in some cases actually harm. The results of their study, which included more than 19,000 people over 4.7 years, were published in three articles this past Sunday in the prestigious New England Journal of Medicine and summarized by The New York Times on Monday, and by just about all other major media.

The study included whites 70 and older, and blacks and Hispanics 65 and older. Each took 100 milligrams — slightly more than the 81 milligrams of a baby aspirin — or a placebo each day. While doing so did not lower their risks of diseases, it did increase “the risk of significant bleeding in the digestive tract, brain or other sites that required transfusions or admission to the hospital,” according to The Times.

So what does all that mean, especially for those already at risk for the conditions aspirin was supposed to protect against?

I am going to quote from The Times very carefully here because this can get confusing due to mixed messages. “Although there is good evidence that aspirin can help people who have already had heart attacks or strokes, or who have a high risk that they will occur, the drug’s value is actually not so clear for people with less risk, especially older ones,” wrote reporter Denise Grady.

So can aspirin prevent cardiovascular events in people with diabetes, for example, or is the benefit outweighed by the risk of major bleeding? Does dose matter in that heavier people might require more aspirin to be prophylactive?

Here’s what the study tells us: Healthy older people should not begin taking aspirin. This will no doubt disappoint Bayer, St. Joseph and others who manufacture the drug. But those who have already been using it regularly should not quit based on these findings, according to Dr. John McNeil, leader of the Australian study. Rather they should talk with their doctors first because the new findings do not apply to those who have already had heart attacks or strokes, which involve blood clots. Aspirin is known to inhibit clotting.

The name of this study is Aspree and it was funded by the National Institute on Aging, along with the National Cancer Institute, Monash University and the Australian government. Bayer supplied the aspirin and placebos but had no other role, according to The Times.

The study focuses on preventive medicine, especially how to keep older people healthy longer. It included 16,703 people from Australia and 2,411 from the United States, starting in 2010. Serious bleeding occurred in 3.8 percent of the aspirin group as opposed to 2.7 percent in the placebo group.

McNeil does suggest the possibility that aspirin’s protective effect against colorectal cancers might still exist but not show up for a longer time span than the study. The Times article does go on to say that the good doctor, who is 71 and specializes in epidemiology and preventive medicine, does not himself take aspirin.

Don’t know what to do? As they say in the commercials, consult your doctor.

If parts of the body could talk, I wonder what they’d say. To that end, I imagined the following dialogue among mostly facial features.

Teeth: Hey, look at me. Something’s changed. You’re going to like it.

Ears: What? You’re talking again? Seriously. Can’t you give it a rest, just for a few moments? Here’s a news flash: You don’t have to eat crunchy food all the time. How about eating something soft once in a while?

Teeth: Crunchy food tastes good.

Tongue: Yes, but the ears have a point. That crunchy stuff scratches me.

Eyes: Keep it down. I’m surfing the net and you’re distracting me.

Nose: Oh, how wonderful. You get to look for stuff all day long, while I’m sitting here waiting for Eileen to share perfume that smells like flowers.

Ears: So, you like Eileen?

Nose: No, but she smells a lot better than we do. Our armpits leave something to be desired at the end of the day. It’s amazing we’re still married.

Armpit: You wouldn’t smell so great either if you got damp every time the stress level started to rise. Besides, with all that running, nose, I’d think you’d be in better shape.

Nose: Is that supposed to be funny?

Armpit: I’m sorry. I know it’s not your fault. Maybe my stress would be lower if the eyes didn’t spend so much time reading about politics.

Teeth: Wait, guys. Come on, I want to tell you something. You’re going to like it.

Ears: Oh, please. Are you going to tell us that you have a few more thoughts you’d like to share about a way to smile so we look better in selfies? Forget it. Haven’t you heard? Your daughter said you’re incapable of taking a good selfie. She’s probably right. Selfie’s were made for people much younger than we are. They’re a tool to even out the generational power struggle.

Cheeks: We’re as young as we feel, right?

Eyes: Have you looked in the mirror lately? Cheeks, you’re showing our age.

Cheeks: Wait, what’s wrong with me?

Eyes: Nothing’s wrong. It’s just that gravity seems to have caught up with you.

Chin: Gravity, that’s funny.

Eyes: You haven’t looked in the mirror either, have you chin?

Chin: Why?

Eyes: Are you trying to clone yourself?

Nose: Ignore them, cheeks and chin. They’re just jealous.

Eyes: Jealous? What? Let’s just say that the new hairs coming out of you, my little nose friend, aren’t winning admirers.

Nose: Hairs? Where?

Ears: Can we keep it down? I’m trying to enjoy the few moments of silence before the phone rings or
someone else has to share thoughts about a better way to do something.

Eyes: We noticed the extra hairs growing on you, too, ears.

Ears: You’re in a bad mood today, eyes. What’s wrong?

Eyes: Nothing.

Teeth: No, you can tell us.

Eyes: I need to wear close glasses for the computer and distance glasses for driving. I hate having two pairs and it takes me a minute to adjust.

Nose: Tell me about it. The computer glasses are pinching me.

Ears: Yeah, and they’re irritating me, too.

Teeth: Come on. I have something to say.

Ears; Of course you do. That’s all you do. Blah, blah, blah. Would it hurt you to listen?

Teeth: I am part of the mouth, you know. That’s what I do.

Ears: Yes, but silence can be good for all of us, you know?

Eyes: OK, tell us this important news that you’re so eager to share.

Teeth: After all these years, my teeth are straight. See? My smile isn’t crooked anymore.

Eyes: Let me see.

Teeth: Aah.

Eyes: Hmm, they are straighter. What do you know? Now, what can you do about your breath?

Aging isn’t for sissies. We’ve all heard that line before and it also applies to our pets, our cats and dogs, our horses and so forth. Teddy is our only pet, a golden retriever with a square head, a pug nose, expressive brown eyes and an affable disposition. He has lived with us since he was 8 weeks, and in June he will turn 12.

It’s hard for us to see him getting old. He is totally deaf now and only knows we are there when we touch him. Then he will be startled as he whips his head around to see us and slowly wags his tail as if to say, “Oh, I know you, I’m safe with you.” He has serious cataracts that interfere with his vision, and he is beginning to bump into the corners of furniture. He’s gone white around his muzzle, although the changeover from light blond isn’t so dramatic. And while he still can find his way back to the front door after he’s gone out, he occasionally wanders aimlessly inside the house. Sometimes he just sits and stares at a wall. Yet most of the time, he is his usual self, putting his head in each of our laps in turn as we sit in the living room and nuzzling us with love.

Worst of all, for no reason we can discern, he will begin a chorus of howling. It’s a curious chain of sounds, starting at a high pitch and dropping down until it is wolverine, coming from deep in his throat. He throws his head back when he howls, much like the wolves I saw in the Oregon Zoo in Portland. Maybe it’s the equivalent of a primordial scream, or maybe he is communing with his ancestors, telling them he is on his way. It brings us to tears.

My sons tell me we should have cataract surgery for him on one eye to enable him at least to see better.

“You’d be howling, too, if you couldn’t see or hear,” they argue. Of course they have a point. But I am afraid, afraid of what Teddy’s reaction to the anesthetic might be, afraid to send him to a place of unfamiliarity, afraid to subject him to invasive procedure.

To further complicate the picture, he has had a seizure. We saw the whole thing. It happened only 10 minutes after the last of our dinner company had left a few weeks ago. He was laying down on his side in his familiar station near the front door when suddenly his legs started flailing at the air, he began panting and saliva started to bubble from his mouth. All we could do was look on in horror for the short time that it lasted. When it was over he became uncharacteristically aggressive for a couple of minutes. Then his breathing slowly returned to normal, and he started walking from room to room. After perhaps 15 more minutes, while we watched with concern, he sauntered over to his food bowl as if nothing had happened and began eating all his dinner, finishing up with a noisy slug of water. Finally he spun around, plopped down and looked at us as if to say, “Why are you following me?”

We called the vet, who seemed much more sanguine than we were and assured us that this sometimes happens to pets, although it had not happened to any of our preceding three dogs. She put him on meds to prevent another seizure.

What followed was a trial-and-error course of medication that alternately left Teddy so wobbly that he could barely step off the porch and caused him to sleep constantly, or wound him up so that he howled intermittently through the night, needing reassurance each time that we were there. It was like having a newborn baby in the house demanding multiple feedings.

We’ve finally gotten the right medicines to the right level and life is almost back to normal, but the questions remain: What to do next, and when to do it?

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By Nancy Burner, ESQ.

For most of us, if a time comes when we need assistance, the preferred option would be to remain at home and receive whatever care services we needed in our familiar setting surrounded by family. For many, the Community-Based Long-Term Care Program, commonly referred to as Community Medicaid, makes that an affordable and therefore viable option.

Oftentimes we meet with families who are under the impression that they will not qualify for these services through the Medicaid program due to their income and assets. In most cases, that is not the case. Although an applicant for Community Medicaid must meet the necessary income and assets levels, oftentimes with planning we are able to assist in making an individual eligible with little wait.

An individual who is applying for homecare Medicaid may have no more than $14,850 in nonretirement liquid assets. Retirement assets will not be counted as a resource as long as the applicant is receiving monthly distributions from the account. An irrevocable prepaid burial fund is also permitted as an exempt resource. The primary residence is an exempt asset during the lifetime of the Medicaid recipient. However, when the applicant owns a home, it is advisable to consider additional estate planning to ensure that the home will be protected once the Medicaid recipient passes away. 

Although the home is considered an exempt resource as long as the Medicaid recipient is living in it, once the applicant passes, Medicaid can assert a lien on the home if it passes through the probate estate. One way to avoid this is to ensure that at the time of the death of the applicant no assets pass through the probate estate; this can be achieved by transferring the home to a trust. Once this is done, the home will pass to the intended beneficiaries without a probate proceeding and without an opportunity for Medicaid to seek recovery against the home. 

With respect to income, an applicant for Medicaid is permitted to keep $825 per month in income plus a $20 disregard. However, where the applicant has income that exceeds that $845 threshold, a Pooled Income Trust can be established to preserve the applicant’s excess income and direct it to a fund where it can be used to pay his or her household bills.  It is important to note that there is no “look back” for Community Medicaid. This means that for most people, with minimal planning, both the income and asset requirements can be met with a minimal waiting period allowing families to mitigate the cost of caring for their loved ones at home, in many cases making aging in place an option.   

Individuals looking for coverage for the cost of a home health aide must be able to show that they require assistance with their activities of daily living. Some examples of activities of daily living include dressing, bathing, toileting, ambulating and feeding.

Community Medicaid will not provide care services where the only need is supervisory; therefore, it is important to establish an assistive need with the tasks listed above. Once this need is established, the amount of hours awarded will depend upon the frequency with which assistance with the tasks are necessary. 

For example, an individual who only needs help dressing and bathing may receive minimal coverage during the scheduled times, maybe two hours in the morning and two hours in the evening. Contrast that with an individual who requires assistance with ambulating and toileting. Because these tasks are considered “unscheduled,” the hours awarded will be maximized.

In fact, where the need is established, the Medicaid program can provide care for up to 24 hours per day, seven days per week. Once approved, the individual may be enrolled in a managed long-term care company. The MLTC may also cover adult day health care programs, transportation to and from nonemergency medical appointments and medical supplies such as diapers, pull-ups, chux and durable medical equipment.

The Community-Based Medicaid Program is invaluable for many seniors who wish to age in place but are unable to do so without some level of assistance.

Nancy Burner, Esq. has practiced elder law and estate planning for 25 years.