Rodger Marion

I just had to write about Steve Brill’s article, Bitter Pill, in this week’s Time magazine (Brill, 2013). This long examination of health care billing practices makes many, many telling points, but there are three that are most relevant to me.

First. Many other countries in the world provide better health care to their citizens at much lower cost. A short list of countries who do it better for less: Argentina, Australia, Canada, Chile, France, India, Spain, Switzerland.

Second. Solutions to our health care issues are focused around paying for health care and not how it is priced. There is apparently no competition in the American free market when it comes to health care. My laptop computer is a marvel of science and technology and costs one tenth of what something vaguely similar would have cost 40 years ago. Modern health care has advanced also since the 1960’s but it has become vastly more expensive rather than less.

Third. Medicare is amazingly efficient and with its marketing power only pays what it actually costs providers to provide. Everyone whines about Medicare’s levels of reimbursement (See section 4 of Brill’s article on page 43) but a quote from Jonathan Blum says, “Hospitals don’t lose money when they serve Medicare patients” (page 47). I explored the potentials of Medicare as a profit center in Capitalism Abhors a Vacuum (http://wp.me/pH3Dx-9t).

Brill in the end recommends that the American health care system get serious about reducing costs and avoid the government provider systems typical in those example countries above.

I’m less optimistic. I say nationalize the whole lot.

Reference

Brill, Steve. Bitter Pill. Time, 2013, March 4, 181, 8, 16-55.

Image: Could not locate original source.

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:15 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 is a short primer on long term insurance. To begin, what is it? Basically it’s an insurance policy which covers the often ridiculous prices associated with end of life care. A good policy will cover costs associated with home health care, adult day care, assisted living facilities, and long-term care facilities.

Sure, there is a chance your patients will never need this sort of care. Or that this can’t happen to you. Well, we all know we’re living longer than we were a few generations back. In fact your chances of developing some form of dementia almost double for each five year period after the age of 65 (N. I. H, 2011).

I recently attended a community lecture given by local State Farm agent Cary Bohn. He cited an interesting statistic from the 2009 Field Guide from the National Underwriter Company that said the chances of needing long-term care by the age of 65+ is 1 in 2; while the chances that your house will be lost in a fire is 1 in 96!  His rationale was that while the average middle aged American wouldn’t dream of forgoing insuring their home, why go without long-term care insurance? After seeing those statistics I was more inclined to feel the same.

What about Medicaid? Well that’s a tricky subject as qualifying for benefits depends on the state you live in and your personal financial situation. Many people falsely think that Medicaid will cover them if and when they need long term care. Strict income/asset limits must be met by the applicant, meaning that you’ll have to be near insolvent to qualify. There are law practices devoted to essentially bankrupting people so they can qualify!

Other considerations to think about when deciding on, or recommending the possibility of long term care insurance are:

• How comfortably you think you would want to be while you were receiving daily care?
• Realizing that that many facilities do not accept Medicare as payment.
• Or, you or a loved one won’t have a private room at a Medicaid facility either.

On the flip side, there are some serious downsides to purchasing a long term care policy.

For example, you could end up overpaying. For this reason it’s wise to seek at least two different quotes from insurers and weigh the options. Premiums could rise. While it’s true that your premiums will likely be lower if you purchase a policy while you’re in the age bracket of 40-50, insurer’s often raise rates the closer you get to the 70-80 age bracket. Another useful thing to consider is the longevity of the company you’re purchasing from. Check out the financial health of your insurer at www.thestreet.com.

Finally, there is always the possibility of your company giving you a fight when it’s time to use your benefits.  Read all paperwork with a careful eye before signing anything and make sure you’re clear on what and how much your policy covers (Kristof, 2009).

Guest blogger is Andrea Stephens, Texas AHEC East – North Central Region

References

1. National Institute on Aging, N. I. A., National Institutes of Health, N. I. H., U.S Department of Health and Human Services, H. H. S., & World Health Organization, W. H. O. National Institute on Aging & National Institues of Health, (2011). Global health and aging (11-7737). Retrieved from National Institutes of Health website: http://www.nia.nih.gov/sites/default/files/global
2. Kristof, K. (2009, 06 17). Long-term care insurance: 4 biggest risks to avoid. CBS: Money watch. Retrieved from http://www.cbsnews.com/8301-505146_162-51312771/long-term-care-insurance-4-biggest-risks-to-avoid/

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:15 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.

Stages in Human Development

As I progress through midlife, I’ve begun to slack off on my exercise routine. With all the demands on my schedule, finding time each week to run, do sit-ups, and push around weights seems a lot less important than it did 10 years ago.However, the results of a new study have given me reason to reconsider. A study published last week shows that people who are fit at midlife have a much lower risk of developing Alzheimer’s disease and other forms of dementia later on in life.

The study was conducted by The Cooper Institute of Dallas, in collaboration with UT Southwestern Medical Center and the Cooper Clinic. The 24-year study followed more than 19,000 healthy men and women. The subjects completed a preventive medical exam at the Cooper Clinic when they were on average, 49 years of age.

Using Medicare records, their health was again evaluated 24 years later. After adjusting for age, smoking, diabetes, cholesterol and other health factors, researchers found that compared with those in the lowest 20 percent for fitness in midlife, those in the highest 20 percent had a 36 percent reduced risk of dementia (DeFina, 2013).

“This is a profound study that shows exercise can have long-term effects on more than our physical health,” says Laura DeFina, MD, of The Cooper Institute. “We’ve known that exercise is beneficial to brain health in the short-term. What’s unique about this study is that it demonstrates the long-term, positive effect of fitness on the brain.”

“The exercise we do in middle-age is relevant for not only how long we live, but also how well we live. This data provides insight into the value of lifelong exercise and its protection against dementia in older age,” says Jarett Berry, MD, of UT Southwestern Medical Center and a co-author on the study. “The fear of dementia in later life is real, and the possibility that exercise earlier in life can lower that risk is an important public health message.”

I think I’ll put on my tennis shoes and go hit the gym.

By guest blogger Tom Knight, Center Director, Texas AHEC East – North Central Region

Reference

DeFina, LF et al. The association between midlife cardiorespiratory fitness levels and later-life dementia: a cohort study. Annals of Internal Medicine, 5 February, 2013.

Image – Could not locate the original source

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:15 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.

Today’s Austin American Statesman has an article on Dustin Hoffman’s new film (Jan 25, 2013, page D1). It’s about a group of retired musicians and how they are facing, dealing, suffering, celebrating the final decades of their lives. The article goes on to mention a possible trend in filmmaking.

The trend is that our most famous actors and directors (Hoffman, Maggie Smith, Spielberg, etc.) are moving into their 70s and are making films about themselves as old people. These films show old people not using the stereotypes of years past (Think Aunt Bee of Mayberry in The Andy Griffith Show from the 1960s) but using a new vision that shows active, intelligent people dealing with interesting and challenging situations. Two films in this new mode are Hoffman’s Quartet and Amour by Michael Haneke.

There have been films in the past that celebrated being old. Think Trip to Bountiful or Driving Miss Daisy. But these films still showed old people as “old and out of the mainstream.” I think it’s possible to create a new vision of how people plan and mindfully live their whole lives. And this vision will be reflected in our popular culture, like films.

These new films will not take youthful themes and insert old people. No geriatric version of Iron Man or Bill and Ted’s Excellent Adventure. Or wizened old philosophers like Yoda in Star Wars: Episode V or the old Kung Fu master in The Karate Kid.

I’m not sure what roles old people will play in these future films. That is so because those of us moving into the seventh decade don’t know who we are either.

Will media shape us? Or will we shape the media?

We remade the 1960s. The future better watch out!

A personal note. I’m getting close to 70 myself (well 68 in May) and have been using this winter to study some new directions in filmmaking and seek a story to fashion into my next film. The current film in distribution, <Impasse>, deals with stagnation and awakening in middle age. The next one will push into elder realms. I’m not asking for ideas, but I am aware that this next film will investigate some exciting aspect of the last of the summer wine.

Films Mentioned

1. Amour – http://www.imdb.com/title/tt1602620
2. Andy Griffith Show, The – http://www.imdb.com/title/tt0053479
3. Bill and Ted’s Excellent Adventure – http://www.imdb.com/title/tt0096928
4. Driving Miss Daisy – http://www.imdb.com/title/tt0097239
5. <Impasse> – http://www.imdb.com/title/tt1996148
6. Iron Man – http://www.imdb.com/title/tt0371746
7. Karate Kid, The – http://www.imdb.com/title/tt0087538
8. Last of the Summer Wine – http://www.imdb.com/title/tt0069602
9. Star Wars: Episode V – http://www.imdb.com/title/tt0080684
10. Quartet – http://www.imdb.com/title/tt1441951
11. Trip to Bountiful – http://www.imdb.com/title/tt0090203

Image

Mel Brook’s The 2000 Year Old Man – http://www.imdb.com/title/tt0388667
Image itself found at http://youtu.be/NO04zWdh8_Y

During the Christmas break we were lucky enough to spend time with extended family. During one of our gatherings we were watching a football game. At a break a commercial came on for a dating website service, “…committed to helping senior men and women find love every day.” The ad showed mature men and women with perfect hair, very few wrinkles, who barely looked 50 talking about dating for those over 50. My mother-in-law, who is in her 60’s and has been single for over 10 years, was watching the ad with me. I turned to her and sheepishly said, “What do you think about something like that?” She looked at me with an inquisitive expression and said, “I don’t know.” I asked her, “Why?” and she said, “I’m not sure that I want to date again at this point in my life.”

Not wanting to push the issue, I dropped the conversation but it triggered some thoughts about seniors and dating.  Forty-five years ago, in 1967, the average life expectancy for males was 67 and for females was 74 (see reference 1).  Fast forward to 2012, life expectancy for males is 83 and for females was 85 and older women outnumber older men at 23.0 million older women to 17.5 million older men. (see references 2 and 3). Further, in 2010, older men were much more likely to be married than older women, 72% of men, 42% of women. Widows accounted for 40% of all older women in 2010. There were over four times as many widows (8.7 million) as widowers (2.1 million).

Given statistics on the imbalance of older men and women, what (if anything) can senior dating services offer older adults? With increased use of the Internet and social websites, senior dating sites can help decrease social isolation by linking older adults with likeminded adults in their communities. They can offer seniors someone to talk to, to do activities with and in general offer some companionship. This is not to say that all senior dating sites are worthwhile but after careful investigation to ensure the reputation of the site, senior dating websites should not be ruled out as ways to meet new people.

Guest Blogger: Amanda W. Scarbrough, Ph.D., East Texas Area Health Education Center

References

1. “Life Expectancy in the USA 1999-98”. http://demog.berkeley.edu/~andrew/1918/figure2.html. Retrieved on January 11, 2013.
2. “Life Expectancy” http://www.ssa.gov/planners/lifeexpectancy.htm, Retrieved on January 11, 2013.
3. “A Profile of Older Americans: 2011”, www.aoa.gov/aoaroot/aging_statistics/Profile/…/2011profile.pdf, Retrieved on January 11, 2013.
4. Rodger adds a link to a set of ratings for popular senior dating services: http://senior-dating-websites.no1reviews.com

Join us for a real-time discussion about questions raised by this essay at a new time on any Wednesday from 12:15 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.

The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.

Here’s an excerpt:

600 people reached the top of Mt. Everest in 2012. This blog got about 2,100 views in 2012. If every person who reached the top of Mt. Everest viewed this blog, it would have taken 4 years to get that many views.

Click here to see the complete report.

In 1970, Dianne and I saw the Broadway cast performance of the musical “Hair” in San Antonio. One of the songs  had this line “… this is the dawning of the Age of Aquarius…” and on last Friday (12-21-12) it finally dawned. After 40 plus years of waiting the Age of Aquarius has begun and the dreams of a generation are moving into the final act of their time on stage.

I wondered however if we of the Baby Boomer generation are too late for this great age of enlightenment.

A digression: The exact moment of this dawn is open to opinion as the beginning point for this new age has different interpretations. According to Wikipedia, “In Western astrological traditions, precession is measured from the March equinox, one of the two annual points at which the Sun is exactly halfway between its lowest and highest points in the sky. Presently, the Sun’s March equinox position is in the constellation Pisces and is moving back into Aquarius. This signals the end of one astrological age (the Age of Pisces) and the beginning of another (the Age of Aquarius)” (http://en.wikipedia.org/wiki/2012_phenomenon). But since others make its beginning as 1844 or 2600, I figure now is good enough for government work (http://en.wikipedia.org/wiki/Age_of_Aquarius).

So, how do we, the now older generation, use a new age of enlightenment as we move into the time period of final reflections and letting go. Well, the only thing I know is to reflect and discuss. There is actually no answer except what we decide for ourselves. Thus, to aid our processes, people of all ages need to mindfully consider the paths they have trod and where the future road leads.

One way to stimulate this reflection is through movies. Not educational ones (nothing against those) but dramatic films offer more for the heart than movies made for teaching. An old favorite is “On Golden Pond” where the characters reflect on their lives and the inevitable  future when one of the partners dies and leaves the other to finish the trail alone. A new film also exploring the end of the road is “Amour.” Finally, I do recommend one of my films, “Healer,” for the way it considers illness and our time span on this earth.

Since the film “The Hobbit” is just out, we’ll close with a quote from Mr. Bilbo Baggins:

The Road goes ever on and on
Down from the door where it began.
Now far ahead the Road has gone,
And I must follow, if I can,
Pursuing it with eager feet,
Until it joins some larger way
Where many paths and errands meet.
And whither then? I cannot say.

J.R.R. Tolkien, “The Fellowship of the Ring”

Resources

• On Golden Pond (1981) – http://www.imdb.com/title/tt0082846
• Amour (2012) – http://www.imdb.com/title/tt1602620
• Healer (2008) – http://www.imdb.com/title/tt1367211

Image – http://en.wikipedia.org/wiki/File:Milkyway_Swan_Panorama.jpg

Join us for a real-time discussion about questions raised by this essay at a new time on any Wednesday from 12:15 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.

Since today was the mythological “end of the world” day, I was casting about for something positive in the news. On page after page the pickings were slim in these days of rising costs and endless Obamacare debate. I did find one possible chink in the wall on the editorial page of the Austin American Statesman (Wohlgemuth, 2012)

The author was lamenting that the 10% cut in Medicare reimbursement to providers mandated by California’s Medi-Cal program will drive more providers to stop accepting new patients. Already only 57% of California physicians accept new Medi-Cal patients and physicians are saying “if rates are cut any further, they won’t even cover the cost of treatment, and physicians will be treating Medicaid patients at a loss.”

The final point of the editorial was that Texas is facing the need to cut Medicare too, that only one third of Texas physicians now accept new Medicare patients and won’t any further cuts be awful?

Will it be awful? Might it be just what a resourceful health care entrepreneur needs?

Every Medicare patient a physician refuses to treat is money on the table and in the best of capitalism’s strengths, someone will want to pick that money up. What health care practice, or any business for that matter, cannot cut 10% of it’s overhead if the option is to go out of business? Or what entrepreneur could not come up with a new business model to take advantage of this niche market?

There are many ways to deliver appropriate and quality care at lower cost. Hire physicians assistants or nurse practitioners. Make better use of clinical diagnostic skills and do fewer tests. Minimize waste and disposable supplies. Automate accounting and billing. Make efficient use of electronic medical records to avoid duplication and unnecessary lab tests and studies. Pay staff less in terms of salary. Accept less in personal salary. Offer more aggressive, long term preventive care.

Someone said, “There is always a way someone else can do the same for less and at lower quality.” Actually, looking at other markets in our modern industrial world that quote is inaccurate. One can always do better for less.

Remember a final caveat for capitalism: There is no opportunity that will not be taken take up by someone.

Reference

Wohlgemuth, A. California Medicare ruling a cautionary tale for Texas. Austin American Statesman, 12-21-12, A11.

Join us for a real-time discussion about questions raised by this essay on any Wednesday morning at 8:15 to 8:45 a.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Guest Blogger:  Tony DiNuzzo, Ph.D., Director, ETGEC-C

Psychologists, such as Dr. Ben Martin, have written extensively on the significant differences between being lonely and being alone.   Obviously, many people considered “alone” live very rich, happy lives.  But what really is “being alone” in this context?  For most it means living alone – no spouse, partner, friend or family member living under the same roof.  What about having a cat or dog or fish – does that take care of it? What if they have many friends outside the home, at work, are active in the community, volunteer, play in a musical band.  They are not alone.  Yet all these souls may suffer from loneliness.  So it is the quality of those relationships that provides a difference between aloneness and loneliness.  Having close relationships translate into feeling less lonely – even if you live alone.

In terms of age, Dr. Martin writes that “contrary to many beliefs, the elderly are not the most lonely among us.”  They seem more comfortable in being alone or with themselves.   They may have a stronger sense of self compared to a younger soul, especially a teenager, who may be worried about being left out, restless and bored if there is not constant contact and stimulus.

Add a dose of depression – caused by feelings of loneliness or not – and there is a genuine risk of something bad happening.  The younger person generally hasn’t developed the skills to understand what to do to combat loneliness compared to seasoned old folks who have accepted their aloneness and fight being lonely through being more active in their community, sewing, playing golf, etc.

There is a part of me that sees this as the glass half full.  However, being a person who is getting older, it is challenging to accept aloneness or loneliness  – that it should be embraced and can be “fixed” with a few wise decisions and being proactive in life.  I have to disagree that the elderly are less likely to be lonely or know how to deal with it simply because they have more life experiences and possibly wisdom than a younger person.

Lonely is lonely and it is not a good thing.  As a society we are supposed to be more connected to the world, our family, friends, and communities.  And I know many who fight tooth and nail to NOT be alone.  I run in circles where “successful aging” is the norm.  Those circles of folks are well educated, open minded, talented, artistic – yes, mostly Democrats – and content in their lives.  And at 70, one of my best friends just started dating a wonderful friend of ours who is in her late ’60s.  He lived “alone” for many years and probably still wants to live “alone” now.  But he also wants a girlfriend!  He is not lonely at all.

Still there is a feeling that this circle of fortunate folks is not the norm.  Older adults who lose loved ones, see their health decline, don’t have financial resources or “talent” to stay active are at greater risk for loneness and the accompanying risks of depression, elder abuse, substance abuse and even suicide.  For some reason society doesn’t really look closely at those who are lonely – like the homeless person we look away from because we just  can’t deal with such sadness or are disgusted by it.

So listen to John Prine’s song, “Hello in There.”

So if you’re walking down the street sometime
And spot some hollow ancient eyes,
Please don’t just pass ’em by and stare
As if you didn’t care, say, “Hello in there, hello.”

References

1. Martin, B. (2006). Being Alone Without Being Lonely. Psych Central. Retrieved on December 14, 2012, from http://psychcentral.com/lib/2006/being-alone-without-being-lonely
2. Prine, J. (1971). Hello In There. John Prine (album). Atlantic Records. www.youtube.com/watch?v=RfwGkplB_sY

Image Credit

Grace Kiefer. Linked from http://farm1.static.flickr.com/158/369350933_de56f0cc75.jpg?v=0

Join us for a real-time discussion about questions raised by this essay on any Wednesday morning at 8:15 to 8:45 a.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Acupuncture

Guest Blogger: Bronia Michejenko, RN, MSN, GNP, BC

I have a small cabin on Toledo Bend  in East Texas.  Australian Pete, a gnarly 88 year old, lives two cabins down from me with three old dogs.  Australian Pete has lived in the US for over 60 years but still has his Australian accent.  He works as a helper for home construction projects.  I stopped by over Thanksgiving and he told me that there are times when he is “all stoved up.” He has seen his health care provider and has not found much relief for his chronic aches and pains.  He is looking at alternative therapies.

Millions of older Americans suffer from pain that is chronic, severe, and not easily managed. Pain from arthritis, back problems, other musculoskeletal conditions.  Many are turning to complimentary or alternative medicine (CAM) therapies. A recent survey showed that  40 percent of Americans age 18 or older reported using some form of complementary health practice and people age 50 or older were among the most likely to report use. Rigorous, well-designed clinical trials for many CAM therapies are often lacking; and the safety and effectiveness are uncertain. The National Center for Complimentary and alternative Medicine (NCCAM) is sponsoring research designed to fill this knowledge gap by building a scientific evidence base about CAM therapies – whether they are safe and whether they work for the conditions for which people use them.

Safety should be considered by patients before using complementary health products and practices. Our elderly patients should be encouraged to discuss the use of CAM with their health care provider to determine safety and effectiveness and to  choose carefully when selecting a CAM provider

The National Center for Complementary and Alternative Medicine published a guide using scientific evidence to help clarify what may be effective and what has been shown to have no effect on chronic pain.  I have included two common conditions from the chart in the table below.

In general, there is not enough scientific evidence to prove that any complementary health practices are effective for rheumatoid arthritis, and there are safety concerns about some practices.

For further information visit the NCCAM Web site at   http://nccam.nih.gov/health/providers/digest/chronicpain.htm

For the complete chart from above see http://nccam.nih.gov/health/providers/digest/pain/science/chart

References:

1. Lee M., Shin B, Ernst. E. Acupuncture for rheumatoid arthritis: a systematic review. Rheumatology. 2008, Dec, 47, 12, 1747-53.
2. White P, Bishop F, Prescott P, Scott C, Little P, Lewith G. Practice practitioner or placebo? A  multifactorial mixed methods randomized controlled trial of acupuncture.  Pain. 2012, Feb, 153, 2, 455-62.
3. Morone N, Greco C, Rollman B, Moore C, Lane B, Morrow L, Glynn N, Delaney J, Albert S, Weiner D. The design and methods of the aging successfully with pain study.  Contemp Clin Trials. 2012, Mar, 33, 2, 417-25.

Join us for a real-time discussion about  questions raised by this essay on any Wednesday morning at 8:15 to 8:45 a.m.  See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Last night I saw a TV ad for an immunization, sold by Merck, that folks over 60 can take to reduce the odds of developing Shingles (http://vimeo.com/39234180 and Span, 2012). I had not heard Shingles mentioned since my aunt developed it back in the 1970’s. The ad said that 1 in 3 persons might develop Shingles and that the odds increase as we age.  Welcome to the “Golden Years.”

Since I had not come across Shingles as a topic of conversation, let alone actual consideration, in almost forever, I wondered about the accuracy of those odds and did a little checking.

However, before proceeding here is a quick primer on Shingles, the disease.

“After you have chickenpox, the virus that caused it, called varicella, [or the vaccination taken to prevent it] remains in your body. It’s always inside you, lying dormant in your nerve cells. At some point later in life, your immune system may weaken, allowing the virus to resurface as Shingles… There is no cure for Shingles. The Shingles rash usually lasts up to 30 days… Shingles can sometimes lead to serious complications. About 1 in 5 people [who demonstrate the disease] end up with postherpetic neuralgia, or PHN. This is long-term nerve pain that may develop after the Shingles rash heals, and it can last for months, or even years.” (http://shinglesinfo.com). Finally, topical steroids and oral antihistamines can help reduce the itching and there are antiviral medications that may help if administered within 72 hours of onset of symptoms.

Since like 99.5% of us who are currently over 40 have had chicken pox or were vaccinated for it, shingles is hovering in wait for our immune systems to change due some random event. A couple of  studies give insight to the incidence rate. Yawn (2007) found an adjusted rate of 3.6 per 1000 person-years in a sample of adults with higher rates among people older than 50 years. The CDC says that, “The incidence among people 60 years of age and older is about 10 cases per 1,000 U.S. population annually. Brett (2007) interprets these sorts of findings to mean that a 70 year old person has about a 10% chance of developing Shingles over the next decade.

The recently approved vaccine for the prevention of reactivation of varicella-zoster virus (VZV) appears to reduce “the incidence of shingles by 51 percent and the incidence of PHN by 66 percent…”  (NFID) A recent clinical trial (Schmader, 2012), showed reduction of almost 70%. All is not totally rosy as Arroyo (2012) raises the specter of introducing yet another virus to ones system that may activate in some clever new fashion down the way. However, if this new expression takes 30 or 40 years to activate, one need not be too concerned unless life expectancy increase rapidly as well.

References

1. Arroyo, JC. Unsettled Issues of Zostavax Vaccine. Clin Infect Dis., 2012, 55, 6, 889-890. First published online June 13, 2012. http://cid.oxfordjournals.org/content/55/6/889.1.short#
2. Brett, AS. What Is the Incidence of Shingles? Published in Journal Watch General Medicine, November 15, 2007. http://general-medicine.jwatch.org/cgi/content/full/2007/1115/1
3. Centers for Disease Control and Prevention (CDC). Shingles (Herpes Zoster) Clinical Overview. http://www.cdc.gov/shingles/hcp/clinical-overview.html
4. National Foundation for Infectious Diseases (NFID). Shingles Information for Health professionals. http://www.nfid.org/idinfo/shingles/Information-for-Health-Professionals
5. Oxman MN et al for the Shingles Prevention Study Group. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med, 2005, 352, 2271-2284.
6. Schmader, KE et al. Efficacy, safety, and tolerability of Herpes Zoster Vaccine in persons aged 50–59 years. Clin Infect Dis., 2012, 54, 7, 922-928.
7. Span, P. The Shingles Vaccine Returns. The New York Times, 5-15-2012. http://newoldage.blogs.nytimes.com/2012/05/15/the-shingles-vaccine-returns
8.  US Food and Drug Administration. Zostavax™ questions and answers. Available at http://www.fda.gov/BiologicsBloodVaccines/Vaccines/QuestionsaboutVaccines/UCM070418.

Image Source

Detail from a photo at shinglesinfo.com. http://www.shinglesinfo.com/shinglesinfo/shingles-in-depth/shingles-pictures.jsp?WT.mc_id=ZX09M&WT.srch=1

Last September I mentioned my elderly cat Gus (Remnants of the Day, 9-15-12, http://wp.me/pH3Dx-7y). At that time he was loosing weight and maybe had arthritis. I want to return to and finish his story today.

My cat Gus

Thirteen years ago, when Dianne and I adopted Gus from the Homeless Pet League we had to sign a paper promising never to let him be an outdoor cat. If we adopted him, he had to be an indoor kitty. We held to that promise, but Gus never agreed with our decision. He was always trying to get out. He wanted to be an outside cat.

Gus was the best cat. Friendly and welcoming to our guests. He always wanted to be where we were. Hanging about as a shadow. Happy to live with us. Happy for thirteen years, until recently…

Gus continued to loose weight and motor control. The arthritis medicine had no apparent benefit. He became incontinent and wandered around lost. We were convinced he’d either had a stroke or had developed dementia. To save the carpets and keep him from endless wandering, he was living in the guest bathroom. Finally, this week we took him to the vet for a consultation.

The vet said that his body was just about used up and that there was nothing he could do anymore. It was time to help Gus to go. Dianne and I held Gus as the vet found a little vein in his skinny arm and administered a chemical to stop the heart. In about 20 seconds he ever so softly and quietly slipped away.

I found a spot near our creek, on a little rise, in a small grove of trees. Gus is buried there in a deep, rocky place safe from digging predators. He can watch the sun rise each morning over the hills and catch the mist rising from the creek on foggy days. He’s an outside cat now.

The absolutely most scary thing in all the world is becoming unable to care for yourself and ending up in a nursing home to fritter away your last days in the dayroom watching TV. And as a fitting irony this “final option” costs a fortune and will drain your life savings quicker than you can say, “poor old thing.”  The only bright spot to this scenario is maybe you will be a happy Alzheimer’s case and not care a fig. Just hope your children can rise to the task of managing your last days.

Kelly Green (2012) has some excellent advice on how to plan for your time of growing dependence “on the kindness of strangers.” But it’s that sort of advanced planning that falls in with buying a cemetery plot or clearing out the junk in the attic. Few people actually do it until one must, and then even though it’s a nerve racking crisis, no one learns from the experience.

My parents had an awful time with twelve years of both being limited to wheelchairs and a full-time staff of three caregivers. They remained in their home and, while my Dad had a brief nursing home stay, they both died at home. So it was probably as good as it was going to be but it was still awful.

Now, my wife and I are a little better prepared for our decline but it’s still not something that is part of the flow of our lives.

The end of life is an anomaly and a product of our culture. We have lost the extended family that took care of everyone all the time. When one was born there was an old person in the house dying. We lived in a process that supported us throughout life. We have lost that and are replacing the once extended family with various sorts of institutions that meet specific needs.

Now the old model of everyone living and working in one place and providing support at all stages of development was not a model of choice but one of necessity. There were no outside institutions nor funding sources to pay for them. Everyone did what they had to do.

Still there is a lot to say about a communal life as opposed to an institutional one.

Join us for a real-time discussion about  questions raised by this essay on any Wednesday morning at 8:15 to 8:45 a.m.  See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

For Further Reading:

1. Greene, K. The Cost of Living Longer. Wall Street Journal, Family Finances, 10-26-2012, http://online.wsj.com/article/SB10001424052970203937004578079184108523030.html.
2. Niederhaus, SG & Graham, JL. Together Again: A Creative Guide to Successful Multigenerational Living. M. Evans (Rowman & Littefield Publishing), Lanham, Maryland, 2007, http://www.togetheragainbook.com/

Sources:

1. Image from the Vibrant Nation website – http://www.vibrantnation.com/wp-content/uploads/family5.jpg
2. The title comes from A Streetcar Named Desire by Tennessee Williams http://www.imdb.com/title/tt0044081/quotes?qt=qt0215723