We are moving into the cooler days of autumn and I’m losing my excuses for not exercising more. As I age I’m finding that while my weight is still the same at 150 that my muscles are getting smaller. I need to do better and for me that’s an exercise in willpower over sloth.

Rodger's avatar tries the Tree pose at the Avatar Fitness Club

Rodger’s avatar tries the Tree pose at the Avatar Fitness Club

As we get even older sloth acquires a helper: loss of function. Aging brings physical changes and with those changes comes the need for new approaches to exercise. Now while you see the occasional 90 year old marathon runner, most 90 year olds are doing well to get to the mailbox and even then endurance and balance often require holding on to the mailbox for a moment before hiking back to the house.

For those who still are mobile, gyms or senior centers often offer classes in yoga, tai chi, chair-based exercise, aerobic dance, etc. All of these are good and provide a dose of human contact and companionship, as well as, the exercise part. Here in Wimberley there is an inexpensive yoga class at the community center that fills the hall every week.

When daily travel to the gym or senior center becomes difficult there are some home-based options. Hiring a coach to come to  your house is nice but not necessarily affordable for everyone. I’m aware of three additional options.

First, get an exercise video or find a TV program that offers guidance and, most importantly, moral support for something you like to do for exercise. One video I know about is Tai Chi for Seniors. This was developed by Mark Johnson (http://taichiforseniorsvideo.com) and it’s a well designed program.

The second option is to find a web site that offers basically the same as a video or TV show but web sites have an additional advantage. Web sites usually provide for the users/students to comment to the coach and discuss techniques and progress with each other via text chat. This adds back in the personal, human contact element and can be very supportive. An example of this is Yoga with Adriene. This is a series of yoga videos that are well conceived and that offer the opportunity for socializing as well. It is hosted by Adriene Mishler, who is based in Austin (http://yogawithadriene.com).

My third option is fairly strong on the support side and not much on the exercise. This alternative is to participate in a virtual exercise program in a 3D virtual world. An example of this is the Avatar Fitness Club run by the Cooperative Extension Service. They offer a number of exercise programs that you do as a virtual avatar. Some limited research as shown that virtual exercise can have both mental and physical results. Find the club in the Second Life® virtual world at http://maps.secondlife.com/secondlife/Morrill3/188/95/30

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: http://tinyurl.com/cjfx9ag.

Over the last three years the Weekly Update on Aging has been published 163 times. Over that time period there have been 10,487 views of these thoughtful columns written by those involved with the ETGEC.Rural lighting

How often a single essay (or blog) has been viewed varies from 1 to 849. Below are listed the top three blogs. Each of these has been viewed over 100 times.

Hello in There – Thoughts on Loneliness and Aloneness by Tony DiNuzzo – 106 views

The Kindness of Strangers by Rodger Marion – 313 views

What is Elderspeak? by Bronia Michejenko – the most viewed of all the 163 posts with 849 views.

Following closely are two of my favorites, Yet Another Surprise About Aging (88 views) and Of Cougars and Founding Fathers (71 views).

Y’all may wish to revisit some of these top posts. Further you can use the Search function (on the left there) to jump to any of the posts. I encourage you to explore some of the really incredible richness of the posts from the past.

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Today’s image: One of my favorite photos from a past post that discussed rural electrification.

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. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

As one’s health challenges become more chronic, if not critical, and as one’s ability to be active and distracted declines, there is an abundance of time to consider, ponder, reflect…

My friend, John Daws (green shirt),in the recent remake of True Grit.

My friend, John Daws (green shirt),
in the recent remake of True Grit.

I have heard it said that getting old is tough. This is the time when all those health and mobility issues, that are so easily avoided when young, come to the forefront of one’s awareness. At these times resilience of spirit is required and the old John Wayne adage becomes true, “When the going gets tough, the tough get going.” (It seems to need a “Pilgrim” in there someplace).

During this stage of life there appears to be two options: get busy and involved with something or reflect on the cosmic circumstances of one’s soul and the influences of the infinite on longevity. There is really not much in-between except perhaps television or crossword puzzles.

I have always tended to stay active and busy with my life and work and then deal with things as they come along. That has been a way to avoid stress and sleepless nights worrying about the future. However, I wonder if some more “up front” or assertive path is needed has one moves toward the final decades of life.

I have found that awareness, and that even more subtle state of mindfulness, are elusive qualities. Also, one tends to become serious when exploring these ethereal realms and that can simply be a cover up for sadness and depression. It is essential to toss in some lightheartedness and laugher when considering the infinite. If you have ever seen the Dali Lama in action you know his spirit is playful and light.

Old age is a balance and it’s not for the fainthearted.

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As an aside: Other people are important components of both being busy and involved, and reflecting on the cosmic. And because of this I’m not going to dwell on the value of human interaction, support and love today. We’ll come back to that but too many variables get confusing.

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. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

This week I sent a 50th wedding anniversary card to my cousin and my wife reminded me that we are coming up to that milestone ourselves in 2017. That got me thinking about how we respond when a long-term relationship like these ends due to the death of a spouse.

Some not-too-recent research shows that men are at greater risk of dying after the loss of a spouse than women (1-4). Also, on a happier note this higher risk diminishes over time.

In my current motion picture project, the main character is an older man who experienced the death of his wife. This loss has affected him, not in any tragic way, but in significant ones. For one he has avoided new romantic attachments. Throughout the film, his dead wife visits him and encourages his re-engagement with life. Below is an excerpt from the unfinished film that illustrates one man’s way of coping with loss.

After watching this clip, consider how you will respond should you become the surviving spouse.

References

  1. Helsing, KJ & Szklo, M. Mortality after bereavement. Am J Epidemiol. 1981 Jul;114(1):41-52.

    http://www.ncbi.nlm.nih.gov/pubmed/7246529

  2. Jacobs, S & Ostfeld, A. An epidemiological review of the mortality of bereavement. Psychosom Med. 1977 Sep-Oct;39(5):344-57.

    http://www.ncbi.nlm.nih.gov/pubmed/333498

  3. Martikainen, P & Valkonen, T. Mortality after the death of a spouse: rates and causes of death in a large Finnish cohort. Am J Public Health. 1996 August; 86(8 Pt 1): 1087–1093.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380614/

  4. Martikainen, P & Valkonen, T. Mortality after death of spouse in relation to duration of bereavement in Finland. J Epidemiol Community Health. 1996 Jun;50(3):264-8.

    http://www.ncbi.nlm.nih.gov/pubmed/8935456

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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. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

cloudsAs I progress in life I have occasion to visit new and different health care providers. Every one of them gives me a six to eight page form requesting information. It’s the same information every time. It may be formatted differently but it’s still the same information: name, DOB, address, insurance, past history, ROS, permissions, etc.

The electronic medical record was planned to eliminate this endless repetition by putting every one’s information in a “machine readable form” that could then be read by the computer systems at any health care facility.  My colleague, Bruce Niebuhr, and I spent many years following the evolution the electronic patient record or electronic medical record.  Recent years have seen significant advances in the field.

Many hospitals and group medical practices now use some form of electronic record keeping (1). Sharing of information between hospitals and affiliated group practices has increased also. Thus, one can be referred to a provider and that person can access your information on-line. This however does not happen very often. From Thompson, “For example, the [WRJF] study found that 42 percent of hospitals now meet federal standards for collecting electronic health data, but only 5 percent also meet federal standards for exchanging that data with other providers to allow widespread physician access to a patient’s records” (2).

Even with good inter-provider cooperation, I still find myself in the position where one office swears they sent over the data but when I get there that information is nowhere to be found. Again, I offer my own copy for inspection so we can proceed.  This is the interplay of human fallibility with computer systems and it highlights the basic ethical question regarding information. Who owns it and who is responsible for insuring it is available where and when it’s needed.

I think the case is clear that there are many “owners” in this endeavor. The patient owns themselves and whatever he/she can personally report about themselves is theirs. The providers own what they create: test results, assessments, notes on treatments, internal accounting and so forth. Everyone has privacy rights. Patients have the right to control who sees test results owned by the provider. Providers have the right to keep internal accounting and employee data private.  It’s a complicated process.

What about putting all this information “in the cloud?”  The cloud is that transparent realm of distant servers where everything is kept and you can access it anywhere, anytime. It works for your favorite musical selections and family pictures, but how about medical data (3, 4)? Security issues aside (they can always be solved), I like the idea because with a cloud-based information structure there can be many interfaces. There can be one for providers and one for patients. Everyone could review, edit, add and delete information as necessary and stay within their ownership and privacy rights. I’d never have to fill out those redundant “new patient forms” again.

References

  1. Robert Wood Johnson Foundation . Hospitals, Physicians Make Major Strides in Electronic Health Record Adoption, July 8, 2013.
    http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2013/07/hospitals–physicians-make-major-strides-in-electronic-health-re.html
  2. Thompson, D. U.S. Hospitals Triple Use of Electronic Health Records, US News and World Report, July 8, 2013.
    http://health.usnews.com/health-news/news/articles/2013/07/08/us-hospitals-triple-use-of-electronic-health-records-report
  3. Terry, K. Medical Practices Move Health IT To Cloud, InformationWeek, 9-6-2013.
     http://www.informationweek.com/healthcare/electronic-health-records/medical-practices-move-health-it-to-cloud/d/d-id/1111447?
  4. Spottswood, T. Electronic Medical Records in the Cloud: How Safe is It? Northwest Regional Primary Care Association.
    http://www.nwrpca.org/health-center-news/200-electronic-medical-records-in-the-cloud-how-safe-is-it.html

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. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Blanco County CourthouseSummers can be hot! I remember really hot Summers when I was a teen in Oakland, California. Summers there are often cool but I remember some Summers that were very, very hot.  I’d awaken in the morning and the sun would be bright and the air screamed, “Heat is coming!” My Mother, on those days, would draw all the blinds to keep inside what coolness the night had imparted and in the afternoons we would huddle around our little fan waiting for sundown to bring relief.

I loved to be outside in the heat. I’d ride the bus across Oakland to go to my judo school where I taught children in the afternoons and learned from my masters in the evenings. The judo school was not air conditioned but no one was concerned. We just pushed on. We were like Jack London’s character, David Grief, who “was a true son of the sun, and he flourished in all its ways” (1).

Many people in Texas live through the Summer without air conditioning. How do they manage? In the days before AC, Texas homes were designed to be a little cooler in the Summer by catching breezes and letting the heat escape. Many not-so-old-fashioned houses and apartments are not designed to take advantage of nature and really require AC (2).

The sun can be an unfriendly neighbor. During the California 2006 heat wave, there were 140 confirmed deaths and an additional 515 suspected deaths due to extreme heat (3). Summer’s heat can be dangerous for the very young, the very old and the careless.

Three things I learned recently and that seem relevant: 1) dial 211 for information on community resources, 2) many communities provide “cooling centers” as a place to get a respite from the heat, and 3) the CDC has good educational materials for “safety in the heat.”

Cooling Centers in Texas

https://www.211texas.org/zf/taxonomy/detail/id/650894

References

  1. London, Jack. A Son of the Sun (Adventures of Captain David Grief). Curtis Publishing Company, 1911
  2. Life Before Air Conditioning
    http://mentalfloss.com/article/16842/life-air-conditioning
  3. CDC 24/7 – Saving Money Through Prevention – California’s Success. Centers for Disease Control and Prevention.
    http://www.cdc.gov/nceh/tracking/success/savingmoney_california.htm?s_cid=ostltshyh_cs_029

Resources

Image

The old Blanco County Courthouse has never had air conditioning and makes use of high ceilings and cross breezes to stay cooler.

http://www.historicblanco.org

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Ky Jan home healthIn 1975, I joined a team of educators at the University of Kentucky who were engaged in a very unique form of health science education (See Connelly, Assell & Peck below for further details). We gathered students from across the spectrum of health professions and, along with a faculty member as sponsor, had them live in a rural, Kentucky town during the month of January. Hence the name of the experience: Kentucky January.

The purpose of the three week experience was to allow the students to become more familiar with the health disciplines that were on the team and to study the health care system as it manifested in a rural community. Our premise was that students rarely got to explore all aspects of a community and plot out how they integrated into an efficient or inefficient system.

Our students explored the local hospital from surgery to midnight rounds with the janitor. We visited the coroner, funeral homes, physician and dentist offices, city hall, county health department, local businesses and factories. Since many of our teams were in Appalachian towns, they went down into coal mines and sought out the local moonshiner.

The highlight of every team was travelling with the visiting nurses of the home health agency to remote homesteads in the rugged hills. This is where the students got to meet real people on the fringes of the system and gain an understanding of where the system worked and where people fell through the cracks.

Two weeks ago, I mentioned that my wife, Dianne, was in the hospital with pneumonia. She is home now and recovering but weakened after two weeks in the hospital and the residual effects of pneumonia. Before discharge her physicians suggested a rehabilitation facility for a while as she needed time and assistance for recovery. Dianne had had it with institutions and wanted to get home. So, enter the modern home health agency in a Texas rural area not unlike Appalachia.

This week we have had two visits from a nurse and two visits from the physical therapist. Both have been extremely helpful and of significant benefit.

Home health is a care option that deserves consideration.

Reference

Connelly, T, Assell, P and Peck, P. Interdisciplinary education for health science students in the rural home health agency: Kentucky January. Public Health Reports, 1975, Jul-Aug, 90(4), 325–330.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1437732

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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. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

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