Recreation-of-Martin-Luther-Kings-Cell-in-Birmingham-Jail-National-Civil-Rights-Museum-Downtown-Memphis-Tennessee-USA-by-Adam-JonesWe all age (some better than others). But what happens to those who age in prison? We usually think of prisoners as young but there is an increasing number of 65 and older prisoners in the system. Aging men and women are the most rapidly growing group in US prisons. The number of sentenced state and federal prisoners age 65 or older grew at 94 times the rate of the overall prison population between 2007 and 2010. The number of sentenced prisoners age 55 or older grew at six times the rate of the overall prison population between 1995 and 2010 (1)

The question is what to do with older prisoners? How can we humanely address their needs? The Texas prison system has about 300 beds statewide for sick and mentally ill inmates, as well as two prison hospital facilities, in Texas City and Huntsville, but these facilities were not specifically designed to care for the needs of the elderly.  Older prisoners who are frail, have mobility, hearing, and vision impairments, and are suffering chronic, disabling, and terminal illnesses or diminishing cognitive capacities may have difficulties functioning in these facilities (1).

States are considering radical alternatives to prison hospital facilities for elderly convicts.  Some consider early release to a family home, while some states use private nursing homes (2). Regardless of the method for the delivery of care, carefully thought must be given to ensure that we are appropriately treating those who are incarcerated and ageing.

This week’s Guest Blogger is Amanda W. Scarbrough, PhD, MHSA. Healthcare Administration Program Coordinator and Assistant Professor, Department of Health Services and Promotion, Sam Houston State University.



Image Source: Photograph by Adam Jones, released for public. Accessed at:

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Past Posts: We have addressed the issues surrounding the aging population in US prisons twice before:

  1. Feb 3, 2012 – Al Capone is Old and Sick and in Jail -
  2. May 31, 2013 – Growing Old in Prison –

musical score excerpt I keep coming back to creativity in old age (1). I see creativity and the products of our creative minds and spirits as a major component of why we are going through this particular life. While there are more components to our lives and not everyone seeks creative expression but those who do have a lot tied up it.

Over the last eighteen months, I have been writing, producing, directing and editing a 96-minute, feature film that will be released in early Spring 2015. I consider that to be my creative endeavor and I’m grateful that I can still do such projects as the age of 70 draws near.

I am reminded of a very real concern that we all have as age and its associated consequences march on. That concern is the loss of the ability to do one’s creative expression. I’ve written before about people who held onto their creativity in spite of impairments and who found ever increasing creative options. For example, Matisse who switched to collage (paper constructions) at the end of his life when confined to a wheelchair. He felt these, gouaches découpés, were the culmination of his creative processes (2).

Music has been on my mind recently. My film is at the stage in post production where the musical score is being written and the composer and I are engaged in the process of mating music with images and dialog. Today, my thoughts followed this music theme to movies about musicians at the ends of their careers and how they deal with the changes.

Two movies come to mind: Quartet and The Last Quartet.

Quartet, both a play and a film (3, 4), deals with four retired musicians, singers actually. They live in a retirement home and every year the residents present a concert to celebrate Verdi’s birthday. These four want to participate but find their singing voices are not up to the task. They do a great deal of soul searching and in the end they do perform at the concert. However, as an adaption to age, they do so by lip-syncing to a previous recording of themselves when they were at their prime.

The Last Quartet is different. “After a classical string quartet’s 25 years of success, Peter, the cellist and oldest member, decides that he must retire when he learns he has Parkinson’s Disease”(5). The film focuses on how Peter deals with his retirement from the group and the various ways in which the other members respond. It reminds us of how our lives become intertwined with those whom we work as well as family.

Time spent with these films is productive. One of the strengths of film is how it opens issues, shows how various people respond and allows us to examine our own thoughts and feelings. More pedantic methods (lecture, formal seminars, etc.) rarely allow such freedom to form our own strategies and understandings.


  1. See earlier blogs: Art and Death and Creativity and Choices.
  2. Henri Matisse: Paper Cut Outs (gouaches découpés). Accessed at
  3. Quartet (1999, play) by Ronald Harwood is available for performance from Samuel French (
  4. Quartet (2012, film). Written by Ronald Harwood and directed by Dustin Hoffman.
  5. A Late Quartet (2012). Directed by Yaron Zilberman.

Image Source: Portion of the score from Theme from Impasse (2010) by Jason M. Marion .

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Aging provides opportunity for the accumulation of signs and symptoms that could indicate a plethora of diagnoses.  A common challenge in health care is deciding what “should” be done, which is more complicated than determining what “could” be done.  This decision-making process involves analysis of potential benefit and risk of harm.  Harm-benefit analysis is informed by clinical facts and “judgments about what constitutes an acceptable risk or an acceptable quality of life. (1)” Still complicated?  Consider a multiple choice test in which the “best” answer may be different for each patient.MC test and pencil

A recent initiative to promote informed medical decision-making is “Choosing Wisely® (2).”  Organizations created evidence-based lists of “Things Providers and Patients Should Question” to “make wise decisions about the most appropriate care” for individual scenarios (2).  I found it interesting to screen the 140-page summary list for aging wisdom.  Here are some examples (2):

  • “Don’t prescribe a medication without conducting a drug regimen review” (American Geriatrics Society).
  • “Don’t delay palliative care for a patient with serious illness who has physical, psychological, social or spiritual distress because they are pursuing disease-directed treatment” (American Academy of Hospice and Palliative Medicine).
  • “Don’t recommend screening for breast or colorectal cancer, nor prostate cancer (with the PSA test) without considering life expectancy and the risks of testing, overdiagnosis and overtreatment” (American Geriatrics Society).
  • “Avoid physical restraints to manage behavioral symptoms of hospitalized older adults with delirium” (American Geriatrics Society).
  • “Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia” (American Geriatrics Society, American Psychiatric Association).
  • “Don’t recommend percutaneous feeding tubes in patients with advanced dementia; instead, offer oral assisted feeding” (American Academy of Hospice and Palliative Medicine, American Geriatrics Society, AMDA – The Society for Post-Acute and Long-Term Care Medicine).

Physical therapists have now joined this initiative and one of the “5 Things Physical Therapists and Patients Should Question” directly addresses a key principle for effective geriatric rehabilitation:

“Don’t prescribe under-dosed strength training programs for older adults. Instead, match the frequency, intensity and duration of exercise to the individual’s abilities and goals” (American Physical Therapy Association) (3).

Have other health professions developed lists for “Choosing Wisely®?”

What tests/procedures/treatments do you think aging adults and their health providers should question?

This week’s Guest Blogger is Rebecca Galloway, PT, PhD, GCS, CEEAA, Assistant Professor, Department of Physical Therapy, UTMB School of Health Professions.


  1. Sokol D. “First do no harm” revisited. BMJ 2013;347:f6426 doi:10.1136/bmj.f6426.
  2. ABIM Foundation. Choosing Wisely: An initiative of the ABIM Foundation. . 2014. Accessed 11-6-2014.
  3. American Physical Therapy Association. APTA Releases Its Choosing Wisely List of What to Question. . 9-15-2014. Accessed 10-9-2014.

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Image Source: Microsoft Office

I hate product ads that appear to be misleading and that are aimed at older people who might be a more vulnerable audience. Well, actually I hate any ads that seem targeted at groups that you think would know better but probably don’t. Like those ads selling you sacks of coins, where, who knows, there might be a rare and valuable coin inside. Or when you have 10 minutes to order your super, energy-saving, space heater before they are all sold out.

In Thursday’s Austin American Statesman (10-30-14), there was an ad for a health product that claimed “Drug companies fear release of ‘Jacked Up’ pill.” This is a product, that the ad asserts, will stimulate increased testosterone levels in men over 50 and that cites exceptional benefits of increased energy, focus, drive and libido. It also includes the usual disclaimer at the bottom in fine print, “These statements have not been evaluated by the US Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease. Results based on averages.”

So, within the above qualification, I will assume this product is meant for men in normal, good health who are experiencing a reduction in energy, focus, drive or libido, who may have lower testosterone, and who might, on the average, feel better if they take this product.

What this product might be is never stated but I’m going to guess it’s some herbal preparation. If you search for “herbs and testosterone” you will discover many, many options but none quite so abstract as the “jacked Up” product. I decided to go to my usual choice for herbal information: the American Botanical Council. See below for results. There are a lot of studies with a lot of results. Simply the diversity of citations is enough to warn one that there is no simple, “wonder” treatment here.

I also checked out another usual source, the National Center for Complementary and Alternative Medicine, but found nothing specific on “testosterone and herbs.”

Maybe “Jacked Up” is not based on an herb. Maybe it’s caffeine and sugar. I have no idea, but I would steer any client or friend away from such a source and send them instead to the literature and then to a licensed health care provider of their choice.


Results of a search for “testosterone” on the American Botanical Council web site:

Image Source:

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Since next week is elections for various Federal and state offices, I was wondering what the voter turn-out rates were for older citizens and if they had changed over time.  I first hit upon a summary of exit poll results from interviews of randomly selected voters as they exited voting places across the country on Tuesday, November 6, 2012 (1). This sample broke down into four groups: age 1-29 – 19%, age 30-44 – 27%, age 45-64 – 38% and 65 and over – 16%.

That number for the 65+ seemed to disconnect, so I found another source. This time a Pew Research summary of the Census Bureau’s voting report (2). It said, “The turnout rates of adults ages 65 and older rose to 71.9% in 2012 from 70.3% in 2008.” This seemed more in line with my expectations. See attached figure.PF_13_05_08_VoterTurnout_03

Another report from the Census Bureau shows that the 65+ group had the highest voter turn-out rate among all age categories.  This has not always been the case. “The phenomenon of elderly Americans voting at higher rates than all other age groups is a fairly recent development in American elections. Between 1964 and 1992, voting rates for the 65 years and older group were either lower than or not statistically different from at least some other age breakdown” (3).

I then wondered about the exit poll survey that showed that the 65+ group were only 16% of those polled. Are the elderly simply grumpy people who won’t respond to survey takers’ requests upon exiting the polls?  Maybe, but what about early voting and mail-in voting?

An older report (1994) from the Federal election administration provides some insight but because early voting and mail-in voting is managed by the states, the available data was rather limited (4). Texas actually provided fairly good data on a county-by-county basis and showed early voting rates between 47% to 24% in the largest counties. Mail-in ballots were lower, varying from 1.7% to 5.5% (p. 40). A report from the organization, Nonprofit VOTE, shows that early voting has expanded over the last twenty years (5). “National polls showed 33-40% of voters voted early in-person or by mail, up from 31% in 2008 and 23% in 2004″ and “Older voters prefer to vote early, while younger voters prefer to vote in-person on Election Day. The same poll revealed that nearly half of voters 65 and over had either cast their votes in advance or were planning to, compared to a quarter of young voters aged 18-29.”

I used early voting this last Wednesday and it seems from the local news that early voting rates are way up this go around (6). Frankly as a techie person, I’m waiting for on-line voting myself.


  1. How Groups Voted in 2012. Roper Center for Public Opinion Research. Accessed at
  2. Paul Taylor, P. & and Mark Hugo Lopez, M. H. Six take-aways from the Census Bureau’s voting report. Pew Research Center. Accessed at
  3. File, T. Young-Adult Voting: An Analysis of Presidential Elections, 1964–2012. U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau, April 2014.
  4. Rosenfield, M. Early Voting. National Clearinghouse on Election Administration, Federal Election Commission, April 1994.
  5. America Goes to the Polls 2012. Nonprofit VOTE, Accessed at
  6. Roth, Z. After push to mobilize new voters, turnout surges in Texas. MSNBC, 10/22/14.

It’s curious how the mind jumps from point to point. As an example, let’s look at my mind this morning.

Lockheed_P-38_Lightning_USAF_The newspaper today was describing a man’s car collection and one of the cars was a 1942 Oldsmobile B-44 Sedanette. The B-44 was in honor of WWII bomber airplanes. That reminded me of the P-38 Lightning, another WWII airplane. The P-38 reminded me of Antoine de Saint-Exupéry, who was flying an F-5B photoreconnaissance version of that plane in July 1944 when he was shot down and killed (1).

Saint-Exupéry was a pioneer flyer and author of many well-known books, The Little Prince, Wind, Sand and Stars, etc. Recalling his last flight reminded me that he was quite old to have been in a fighter airplane over France in 1944.

He wrote on the last day of his life, “… I fight as earnestly as I can. I must be the oldest fighter pilot in the world. The normal age limit for the type of fighter plane I fly is thirty. And the other day I had mechanical trouble while flying over Annecy at the precise moment I became forty-four years old! … If I’m shot down, I won’t regret anything.” (2, p. 208)

Saint X, as he liked to be called, learned to fly in 1921 when airplanes were little more than sticks, fabric and wire (3). His P-38 Lightning was an all-aluminum, twin engine, turbo-supercharged, fighter that could hit 400 miles per hour. Aviation had advanced several generations between 1921 and 1944 and Saint-Exupéry had shown great flexibility in advancing as technology marched onwards.

This is where Saint X, who never really lived long enough to be an old person, fits into our new old person model. The old are no longer the depository of the past but are staying on top of new developments and current trends. I recall how my parents and their friends (all greatest generation) were so old. My friends (and me too) are in the same chronological ballpark now and we are so young. It boggles the mind.

As this is supposed to be an interactive discussion, I’d like to hear some stories of how the old are staying new. Got anything interesting to share?


  1. Lockheed P-38 Lightning. From Wikipedia, the free encyclopedia. See section 7.6 discussing Antoine de Saint-Exupéry.
  2. Saint- Exupéry, A. de. Wartime Writings: 1939-1944.  Harcourt Brace Jovanovich, San Diego, CA., 1986.
  3. Liukkonen, P. Antoine de Saint-Exupéry (1900-1944) – in full Antoine-Marie-Roger de Saint-Exupéry. Authors’ Calendar – Books and Writers, 2008.

Image Source:

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The latest information on the average life expectancy for people in the US has inched up to 78.7 years. Women of course live longer than men on the average too. If you make it to 65, men will go on for another 18 years with women again getting a few more years extra (1, 2).

What does one do with all this time?



Endless visits to physician’s offices?


In a new book, Being Mortal, Atul Gawande takes a look at quality of life for an aging population (3, 4). He also points out that the healthcare system is good at keeping us alive but pretty poor at helping people to fulfill their dreams and potentials.

A quote from Being Mortal: “People with serious illnesses have priorities besides simply prolonging their lives. Surveys find that their top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others and achieving a sense that their life is complete. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The question therefore is not how we can afford this system’s expense. It is how we can build a health care system that will actually help people achieve what’s most important to them at the end of their lives.”
Catrinas 2
I don’t think he goes far enough. It’s all well and good to stay connected to family and friends and feel one’s life is complete as death comes nigh, but there is the creative side of some people that must be fostered. Not everyone has creative output in the arts, music, dance, literature, etc., but 1) we all benefit from the creative output of others, and 2) those that do create need to be helped to hold on to the creativity until death.

In Stranger in a Strange Land by Robert Heinlein (5) a reference is made about a person who died in the middle of composing a poem and who was so engrossed in his work that not noticing  dying, went on to complete the poem anyhow. The character in the book points to this remarkable art with great pride.

Who knows maybe life will repeat fiction and someone will create art at the moment of death and provide for us an essential connection between the two planes of existence.


  1. CDC report finds US life expectancy reaches new high. Fox News, Oct. 8, 2014.
  2. National Center for Health Statistics. Health, United States, 2013: With Special Feature
    on Prescription Drugs. Hyattsville, MD. 2014.
  3. Cummings, Q. A Book About Dying Tells You How to Live. Time, Inc., Oct. 9, 2014
  4. Gawande, A. Being Mortal. Doubleday Canada, 2014.
  5. Stranger in a Strange Land. From Wikipedia, the free encyclopedia.

Image: A sculpture illustrating Catrina, one of the figures used in Day of the Dead (Spanish: Día de Muertos) celebrations. La Catarina © Tomas Castelazo, / Wikimedia Commons / CC-BY-SA-3.0, via Wikimedia Commons.

Join us for a real-time discussion about questions raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. We use the self-same virtual world as was mentioned above. See Discussion and SL tabs above for details. Link to the virtual meeting room:


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