It’s curious when one becomes the subject of one’s academic endeavors. I became involved with the Center on Aging at the University of Texas Medical Branch when it was first created in the late 1980’s and did an internship experience in 1990. I was then in my 40’s and felt quite distant from the population I was studying.

Now, in my 70’s I have joined Pogo who said, “He is us.”

Aging does bring changes. Short term memory becomes an issue. Passing thoughts that used to stick in my mind, now slip away easily. It is necessary to focus on passing thoughts to attach them in my mind and I find the calendar and notepad apps on my phone to be essential tools. Strength and balance are other issues. My horse riding activities pointed up how long it took me to develop the strength and balance necessary to participate in dressage competitions.

I recently was asked to contribute an article for the Summer Horse Show Series Supplement in the Dripping Springs Century-News. In the article (click on the link below) I go deeper into the challenges presented by the passage of time.

Riding in Competition (May 2018)


Humor in America, The Morphology of a Humorous Phrase: “We have met the enemy and he is us”

Hay bales banner UTMB logo

The occurrence of multiple, chronic health problems is often a pattern as we grow older. These debilitating conditions may make one want to re-read the Book of Job to try to get some perspective.

My UTMB colleagues and I taught a graduate course between 2006 and 2012 that was titled, Suffering: Cultural and Spiritual Perspectives. It was developed and taught by Kay Sandor, Ph.D., RN, Harold Vanderpool, Ph.D., Th.M., and myself.

One of the topics we visited was why does God allow bad things to happen. As the texts, we used two classic books by Frankle and Kushner (see below). The academic discipline of  Theodicy was also relevant to this topic. Theodicy is an area of philosophy that attempts to answer the question: Why does God permit the manifestation of evil? One of the faculty, Vanderpool, is an expert on Theodicy and his section on this topic was brilliant.

In 2008, he needed to leave the course. To enable his ideas to still influence the course, we made a short movie (22 minutes) in which he condensed his views on Theodicy and it was a part of the course until 2012 when we stopped teaching it.

The movie is below.

Further, between takes the camera captured Dr. Vanderpool musing on karma and cheap grace. This is included as a bonus.

As an aside: Dr. Vanderpool has a new book out: Palliative Care: The 400-Year Quest for a Good Death, Harold Y. Vanderpool, McFarland Press.


  • Book of Job, New Oxford Annotated Bible, 3rd Edition, Oxford University Press, 2000, p. 726 Hebrew Bible.
  • Frankel, V. (1959). Man’s Search for Meaning. Boston: Beacon Press.
  • Kushner, H. S. (1981). When Bad Things Happen to Good People. New York: Avon Books.

The two movies are copyright © 2008 by Harold Vanderpool and used here with his permission

Yesterday I stopped in at the post office in Driftwood. It’s a tiny building with a steel roof and apparently one employee. It has great ambiance and it’s fun to just visit there. Driftwood is a small town between my home and Austin. It has a Methodist church, defunct general store/gas station and a post office. There are wineries, restaurants and small subdivisions nearby as one goes towards Austin but Driftwood itself is as small and rural as it gets. But, as I posited in last week’s post, will it remain rural?

This thought reminded me of a post done two years ago that discussed dying small towns. I present it below with some minor edits.

We made a movie about older people in East Texas and one of the subjects was Lois Dyes. She was 93 at the time of this interview and was the oldest person we interviewed. She tells a wonderful story and it all centers on the little town of Melrose, Texas.

In addition to her story, I was intrigued by the little town too. It is a dying town. All the stores are closed. Only the two churches (with tiny congregations) and a catfish restaurant are still open. The Dyes family owns the restaurant. Mrs. Dyes taught at the school in Melrose and its closed also.

Small towns struggle in the U.S. Many small, rural towns seem to exist on a delicate balance. Just a few stores run by aging owners, no jobs with a career, and maybe a post office. For these little towns just one change in the local equation could cause a major economic shift.

For example, Keen (2008) discusses how some small towns actually do not have electricity and depend on generators for electric power. Rising prices for diesel fuel could drive people out of business. She give an example of a general store in rural California where the refrigerators, freezers, lights and ice machines are powered by diesel generators. The store owner says, “I’m scared to death of rising fuel prices.” (Note: in early 2015, with gas prices quite low, these people must be feeling some relief.)

Another example. The U.S.P.S. proposed to close thousands of post offices, most in small, rural communities where Internet services are limited and people depend on the post office (Podkul & Stephenson, 2012).

People fear that the loss of their local post office would cause the whole town to go (Vogel, 2011).

The town of Gabbs, Nevada is shrinking like Melrose. Vogel’s article says, “The town looks like a place where time stopped in the 1950s. Three-fourths of Gabbs’ residents are older than 60. It’s a place where many people are living on Social Security and food stamps. They depend on the Postal Service to deliver not only their mail, but also life-saving medications. Almost everyone moves away after high school because there are no jobs. If the U.S. Postal Service closes the post office in this 300-person community, they will face 80-mile rides to Fallon or 60-mile trips to Hawthorne to transact business.”

One resident of Gabbs said of losing the post office, “It will kill the town.”

Well, the U.S.P.S. has backed off on closing these small post offices (Liberto, 2012). Communities will have a choice of closing them, having shorter hours or having them privatized and run as “village post offices.” Still, the point remains that small, rural towns are hanging by a thread and their aging residents are running short on options.

It’s not just about services for the elderly either. Rural life offers a quality of life that is closer to nature, where people are friendly, and the air is clean. Qualities not to be lost.


  1. Keen, J. High gas prices threaten to shut down rural towns. USA Today, July 2, 2008 (
  2. Liberto, J. Ax won’t fall on rural post offices. NNMoney, May 9, 2012 (
  3. Podkul, C & Stephenson, E. Towns go dark with post office closings. Reuters, Feb 24, 2012 (
  4. Vogel, E. Residents say closing post office would kill small Nevada town. Las Vegas Review-Journal, Oct. 24, 2011 (

Based on the post from week 59 – Lives Lived in East Texas, Part 3 – Old People, Old Towns.

Join us for a live discussion about this post on Friday at noon. Link to the meeting room in the virtual world of Second Life: Also, see Discussion and SL tabs above for details.

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.

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:

Image Source: Microsoft Office

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:

Microsoft Office image (2013)

Microsoft Office image (2013)

Once upon a time, researchers focused on survival as the gold standard outcome for life.  While mortality continues to be a critical measure, concepts related to quality of life are integral to many health care professions.

As a physical therapist, I work with patients to develop functional goals that are linked to participation in life.  During a literature search (most likely for something unrelated), I became curious about the emergence of different life measurement terms in research.  I searched for the oldest article titles in Pub Med ( that included each term and found:

  • Mortality (1841)
  • Quality of life (1959)
  • Successful aging (1967)
  • Active life expectancy (1983)

From a measurement perspective, death is a concrete event; successful aging is abstract.  Abstract concepts are inherently challenging to define and quantify.  Terminology and operational definitions for successful aging are diverse.  Measures of success may focus on physical ability/disability, cognitive function, emotional or social health, disease, or combinations of different health domains (Lowry, 2012).

What is wrong with different definitions?  Basic epidemiologic measures such as prevalence prove problematic.  The range for “mean proportion of successful agers” across 28 studies was “0.4% to 95%” (Lowry, 2012).

So is successful aging a public health issue?  Do older adults view successful aging differently than health care providers?  Reichstadt et al. (2010) conducted qualitative interviews on perceptions of “successful aging” with 22 community-dwelling older adults.  Themes included balance between “self-acceptance/self-contentment” and “engagement with life/self-growth in later life.”

Discussion Questions

  • Share your own definition of successful aging.
  • What other terms are used for quality of aging in your community or health care setting? How is the outcome measure defined?


  1. Lowry KA, Vallejo AN, Studenski SA. Successful aging as a continuum of functional independence: lessons from physical disability models of aging. Aging Dis 2012;3:5-15.
  2. Reichstadt J, Sengupta G, Depp CA, Palinkas LA, Jeste DV. Older adults’ perspectives on successful aging: qualitative interviews. Am J Geriatr Psychiatry 2010;18:567-575.

Our Guest Blogger this week is Rebecca Galloway, PT, GCS, CEEAA, Assistant Professor,  SHP Department of Physical Therapy.

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: