When does aging begin? There’s an interesting question. We have always assumed for this column that aging has to do with old people. Actually, in a sense aging begins immediately after birth. Every day cells in our body die. I assume they die of “old age.” They are of course replaced with new cells and the process goes on. Habits fixed at 20, can have a causative effect on health at 80. We are always changing and each change is a step towards that moment when the whole organism, that is me and you, dies. Death is the final step in aging and birth the logical first step.wine bottle

I looked around for others with this viewpoint that aging is a process that begins at birth and found an interesting web site dealing with the notion of  “transgenerational design.” This is the notion of designing products and services that pay simultaneous attention to the needs and desires of different age groups. It has a number of useful categories and the overview of the aging process was especially valuable and the design of a transgenerational house was quite clever (1).

Then, there are those who would define aging as a process of decay. Thus, humans would not begin to age until after they stopped growing and had reached maturity. Also, there is the viewpoint that aging, being a degenerative process, can be stopped or slowed down (2). The anti-aging movement has a very good point and there are many things we can do to improve our odds at having long, healthy and productive lives.

I think though aging as a term can be used in a number of contexts.

So as aging vs. anti-aging we have value judgments based on wellness and function. For example: good diet and exercise can maintain function and thus reduce the effects of aging.

In another sense, we have aging as a simple chronological fact. After every day we are older. Every day we age.

I’m going for something more philosophical. Let’s think of aging as the process a fine wine goes through. We get better as we age.


  1. Transgenerational Design Matters. http://transgenerational.org/aging
  2. Anti-Aging Today. http://www.anti-aging-today.org

Some Housekeeping for the Blog and Discussion

The blog will take a holiday break for the last two Fridays of December, with publication renewing on Friday, January 2, 2015. Happy New Year! Also, the discussion will go on holiday as well.

I’m thinking of moving the Weekly Discussion on Aging over to Friday at noon. The discussion is held on the UTMB Island in Second Life and attendance has been sporadic. We are going to be hosting a gathering to listen to the NPR program, Science Friday, at 1 pm (Texas time) on the SL UTMB island, so maybe the discussion would be more popular as a prelude. If the discussion moves to Fridays, then I’ll probably move the blog posting back to Wednesday.

Stay tuned for the final plan.





I have a friend who lives on a farm in Minnesota. Her father, who is around 90 and still actively farming, has a condition that makes his hands shake quite a lot. He is very patient and careful but eating is a frustrating experience due to his severe tremor.spoonNow he has a new computer controlled spoon that vastly reduces the shaking and makes eating much more enjoyable (1, 2).

This product is the Liftware spoon and it is described on the Liftware web site as “Liftware is a stabilizing handle and a selection of attachments that include a soup spoon, everyday spoon, and fork. Liftware is specially designed to improve the lives of those with Essential Tremor, Parkinson’s Disease, or other motion disorders” (3, 4). This is a very cool product and appears to be the first such product on the market (5).

A few years ago, my friend’s father and I played golf on a day that was over 90 degrees and even with his tremors he was hitting some pretty good shots that day. A computer controlled putter however might cut a few strokes off his game. Heck, it would probably improve mine.


  1. A Spoon That Shakes To Counteract Hand Tremors. All Things Considered, NPR program, May 13, 2014. Audio recording found at: http://www.npr.org/blogs/health/2014/05/13/310399325/a-spoon-that-shakes-to-counteract-hand-tremors
  2. Anupam Pathak, John A. Redmond, Michael Allen, Kelvin L. Chou. A noninvasive handheld assistive device to accommodate essential tremor: A pilot study. Movement Disorders, 2013; DOI: 10.1002/mds.25796
  3. LiftLabs (owned by Google) web site found at: http://www.google.com/liftware
  4. Lifeware demonstration and promotional videos. Found at: https://vimeo.com/74643550 and https://vimeo.com/user15993486
  5. International Essential Tremor Foundation. Describes a number of devices to help those with tremors to do ADL activities easier. Found on the Assistive Devices page: http://www.essentialtremor.org/treatments/assistive-devices

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.

You may have heard of food desert and wondered just what does that mean?  The term food desert was coined by the U.S. Department of Agriculture and refers to urban neighborhoods and rural towns without ready access to fresh, healthy and affordable food.  Instead of supermarkets and grocery stores, these communities may have no food access or are served only by fast food restaurants and convenience stores that offer few healthy, affordable food options.  In terms of distance, if you live in an urban community and have to travel at least one mile to get to a grocery store you are in a food desert.  For rural towns, where the population is more sparely distributed, it means needing to travel at least 10 miles for groceries.  If you have a car and can drive, that doesn’t sound like a great distance.  However, if you require a bus, taxi or special transportation to get to the grocery store, 10 miles can be a huge barrier.  In terms of health, the lack of access contributes to a poor diet and can lead to higher levels of obesity and other diet-related diseases, such as diabetes and heart disease. food truck

The elderly are at increased risk of malnutrition due to many reasons including poor dentition, decrease in taste buds and appetite, difficulty cooking and preparing health food.  Health conditions common among the elderly, such as dementia, arthritis, and diabetes combined with financial constraints and fixed income, all contribute to increased risk of malnutrition.  But what about the impact of poor access to good, healthy food on health?  Just how widespread is the issue of food deserts and what is being done about it?

According to the USDA Economic Research Service and its High Priority Performance Goals approximately 23.5 million people live in food deserts. More than half of those people (13.5 million) are low-income.  It is extremely difficult to come up with a fair and accurate estimate of the number of elderly, 65+ years of age, who live in food deserts.  Estimates among elderly living in food deserts have ranged anywhere from 10% in urban communities to 25% in rural areas.   According to Eric de Place (2009), residents with lack of access to grocery stores end up over-spending, or buying food with limited nutritional value, or both. Fresh fruits and vegetables—so important for a healthy diet—are in short supply, if they exist at all.   Finding local or organically grown food is even more remote.  So food deserts can result in poor health, tight budgets for those who can least afford it, or long cumbersome bus trips to other neighborhoods. He acknowledges that the problem is most severe for the elderly, single parents, and the disabled.  It’s not just an urban land use issue: it’s a problem with profound social justice implications.

Many agree that solutions to food deserts are few and mostly inadequate.  Legislation has been proposed, such as developing a revolving fund to offer loans to small grocers that can operate in food deserts.  But somehow throwing money at the problem never seems to work well, especially in politics.  Others suggest community involvement, such as volunteering at your local food bank, offer a ride to your elderly neighbor who is having difficulty accessing grocery stores.  Large food conglomerates, such as Wal-Mart, have a double-edged sword.  While many blame large food chains for putting smaller, local grocery stores out of business due to feasibility of competing with offering lower prices.  Yet many bus lines have large stores, including Wal-Mart, on their stop routes.  Another ‘solution’ may be to for private taxi companies to offer a lower, standard rate for elderly traveling to the grocery store.  De Place warns that assuming vulnerable low-income populations can just buy laptops, get high-speed Wi-Fi, order healthy groceries on-line and have them delivered, is obviously not a solution. Even if the tools of the Internet Age were widely available and affordable—and they’re not yet — they wouldn’t be of much use to the elderly, immigrants with limited English, or folks who don’t have a credit card or bank account.   Some grocery stores offer delivery service.  But then affordability for the service becomes a barrier.  Local community farmers markets are becoming more popular.  But if you’ve ever been to one, the majority of visitors are young and full of resources, such as money, energy and bright eyes.

Is it possible that more health providers, especially social workers and community health workers, can become more involved in identifying at risk elderly, who may be having issues accessing good, healthy food?

So, as I consume my huge Thanksgiving dinner and try not to feel guilty, I can hope that maybe increased awareness, empathy and community involvement can work in tandem to possibly increase access to food among older populations in our communities.  Anyone have any other ideas?


  1. Eric de Place (@Eric_deP), March 5, 2009. Deliver Us from Food Deserts. Economy & Jobs, Food & Sustainable Living, Land Use & Transportation
  2. Associated Press, 2012. Residents do Without in America’s Food Deserts. http://www.nbcnews.com/id/5353901/ns/health-fitness/t/residents-do-without-americas-food-deserts/
  3. Morton, L.W. and Blanchard, T.C. Staved for Access: Life in Rural America’s Food Deserts.  Rural Realities, Vol. 1 (4), 2007.

Our Guest Blogger this week is Tony DiNuzzo, Ph.D., Director, East Texas Geriatric Education Center/Consortium, UTMB.

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.

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.


  1. http://www.hrw.org/news/2012/01/26/us-number-aging-prisoners-soaring
  2. http://www.governing.com/news/headlines/gov-states-look-to-nursing-homes-to-lower-prison-health-care-costs.html

Image Source: Photograph by Adam Jones, released for public. Accessed at: http://www.readthespirit.com/religious-holidays-festivals/tag/milestones

Join us for a real-time discussion about ideas 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.

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 – http://wp.me/pH3Dx-3m
  2. May 31, 2013 – Growing Old in Prison – http://wp.me/pH3Dx-cf

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 http://www.henri-matisse.net/cut_outs.html
  3. Quartet (1999, play) by Ronald Harwood is available for performance from Samuel French (http://www.samuelfrench.com/p/9245/quartet)
  4. Quartet (2012, film). Written by Ronald Harwood and directed by Dustin Hoffman. http://www.imdb.com/title/tt1441951
  5. A Late Quartet (2012). Directed by Yaron Zilberman. http://www.imdb.com/title/tt1226240

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

Join us for a real-time discussion about ideas 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.

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. http://www.choosingwisely.org/ . 2014. Accessed 11-6-2014.
  3. American Physical Therapy Association. APTA Releases Its Choosing Wisely List of What to Question. http://www.apta.org/Media/Releases/Consumer/2014/9/15/ . 9-15-2014. Accessed 10-9-2014.

Join us for a real-time discussion about ideas 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.

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: http://cms.herbalgram.org/searchresult.html?searchfor=testosterone&option=all&KY_WS_LOW=2636%7C2631%7C2626%7C2627%7C2629%7C2633%7C2638%7C2641%7C2888%7C6543%7C1%7C7107

Image Source: http://sdwriters.files.wordpress.com/2012/03/cocaine.jpg

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.


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