Thanks to Monica, one of the attorneys here at Katten & Benson, for sharing this great article about the oldest African American, Mississippi Winn. Miss Winn died recently at the young age of 113. Another amazing fact about her is that she was one of two known people left whose parents were likely born into slavery. Her niece said that even though she was 113, she thought she was young. Her family thinks one reason she lived as long as she did was because she just handled things as they came, of course, no husband or children might have been a factor as well.
I have my own Miss Winn story. Many years ago, when I still worked in the hospital, one of my patients was a nun, Sister Winifred. At the time that I knew her, she was 101. She was mostly deaf, and didn't see well, and she used to tell us that she figured God decided she had seen and heard enough.
She had been a teacher for many, many years, despite the fact that she did not really want to be a teacher. But she became a teacher anyway, because that is what the Church needed her to do, so she did it. Despite this, she had middle-aged, former students visit her in the hospital. I suspect teaching truly had been her calling, because she had clearly been beloved by many of her students.
The day I told her she was going to be discharged and would be able to return to her convent, she took my hand and said this to me: "I will pray for you every day for the rest of my life. I know that won't be long, but I will pray for you every day". She ended up living another three years. I never doubted that I was in her prayers.
Knowing her for even a short time was a gift I will always cherish. I hope all of you have the opportunity to be touched by a remarkable older adult.
Wednesday, January 19, 2011
Wednesday, December 22, 2010
Merry Christmas?
I knew it had been a long time since I had posted anything, but I didn't realize how long. Clearly it's been a busy autumn, and now it's only four days until Christmas. The presents are bought and most are wrapped and under the tree, but I still have baking to do, and a house to clean up before my youngest brother and his family arrive from North Carolina. They'll be here for more than a week, and while I will love having them here, there will be no restful time during this holiday season. I've given myself a pass on Christmas cards this year, but somehow it's hard to let that go.I did want to share this intriguing blog post I just read from the New York Times about parent-child relationships. A gerontologist at Cornell University did some research and found that parents will talk about having a favorite child, and how that sometimes influences who the chosen caregiver is. Kind of interesting reading, not sure what I think about it.
Anyway, I do hope everyone has a Merry Christmas, a Happy Hanukkah, a festive Kwanzaa, and a safe and Happy New Year!
Thursday, September 16, 2010
The Tracks of My Tears
I've been thinking a lot about end of life issues lately. Partly because we talked about it in class this week, partly because the 27th anniversary of my Dad's death was earlier this month, and partly because I'm going to 2 funerals in the next few days
The funerals are the worst part of middle age, as far as I'm concerned. Although I bet it gets worse when it's my friends who are dying, and not their parents.
During this week's lecture, and then with a facebook chat with a friend, I've had the opportunity to think and talk about the fact that we don't do grief and mourning well in this country.
We're lucky if we get 3 days off when someone in the immediate family dies, and if it's a cousin or an aunt or uncle, we're fortunate if we can take the few hours it might take to go to a local funeral. Once the funeral is over, well, that's all she wrote. We are expected to go back to work and get on with our lives like nothing happened. I read an article that popped up on Yahoo this week, and Michelle Williams (she was married to Heath Ledger) was talking about hard it was after he died. She made the comment that in Victorian times we got to wear black, then gray, then mauve, then pink, as we moved through the mourning period. Today there is no acceptable outward manifestation of our grief, and I think that's a shame.
The other thing that's gone the way of Victorian times is the vocabulary of grief. We don't know what to say to each other when we grieve. Platitudes like "He's in Heaven now with his Dad" (said to my mother when my 22 year old brother died) can cause more pain than comfort to some. My Dad was only 50 when he died, so Mom's response was that both of them were too young to be dead. As one friend pointed out, after his father's death, getting syrupy sympathy cards only made him dread more cards, and his father was still dead as a doornail.
I know that I struggle with knowing what to say, what to do, how to comfort those who are in pain. And looking back at the times I've been in mourning, it's hard to say what helped the most. Except I know my friends showing up at the funeral meant a lot, my friends making me go to baseball games I didn't care about meant a lot (during my Dad's illness--thanks, Roger), and my friends who pulled me forward and out of the daze of grief meant a lot. It wasn't so much what anyone said, but absolutely what they did.
The funerals are the worst part of middle age, as far as I'm concerned. Although I bet it gets worse when it's my friends who are dying, and not their parents.
During this week's lecture, and then with a facebook chat with a friend, I've had the opportunity to think and talk about the fact that we don't do grief and mourning well in this country.
We're lucky if we get 3 days off when someone in the immediate family dies, and if it's a cousin or an aunt or uncle, we're fortunate if we can take the few hours it might take to go to a local funeral. Once the funeral is over, well, that's all she wrote. We are expected to go back to work and get on with our lives like nothing happened. I read an article that popped up on Yahoo this week, and Michelle Williams (she was married to Heath Ledger) was talking about hard it was after he died. She made the comment that in Victorian times we got to wear black, then gray, then mauve, then pink, as we moved through the mourning period. Today there is no acceptable outward manifestation of our grief, and I think that's a shame.
The other thing that's gone the way of Victorian times is the vocabulary of grief. We don't know what to say to each other when we grieve. Platitudes like "He's in Heaven now with his Dad" (said to my mother when my 22 year old brother died) can cause more pain than comfort to some. My Dad was only 50 when he died, so Mom's response was that both of them were too young to be dead. As one friend pointed out, after his father's death, getting syrupy sympathy cards only made him dread more cards, and his father was still dead as a doornail.
I know that I struggle with knowing what to say, what to do, how to comfort those who are in pain. And looking back at the times I've been in mourning, it's hard to say what helped the most. Except I know my friends showing up at the funeral meant a lot, my friends making me go to baseball games I didn't care about meant a lot (during my Dad's illness--thanks, Roger), and my friends who pulled me forward and out of the daze of grief meant a lot. It wasn't so much what anyone said, but absolutely what they did.
Tuesday, August 10, 2010
More on Predicting Alzheimer's
Here is a followup story to my last post: Spinal Fluid Test is Found to Predict Alzheimer's.
The good thing is that the research is moving quickly on Alzheimer's disease. The number one predictor for developing Alzheimer's is age, with over 20% of women over age 85 developing the disease (2010 Alzheimer's Disease Facts and Figures). And face it, age is not a risk factor we can control. We can eat right, exercise, and do all the crossword puzzles imaginable, but if we're lucky, we'll all age.
I still have qualms, though, about doing spinal taps on people. The article indicates that it isn't as risky a procedure as it once was, but then it goes on to say that most internists and family doctors aren't experienced with the procedure. It was suggested in the article that spinal tap centers could be established, but you know, I have mixed feelings about that. It's just one more silo in an already too fragmented health care delivery system.
The other, probably bigger issue for me is one of ethics. Again, who decides? One doctor in the article suggested it should be a decision made between a doctor and the patient. But can my health plan force or strongly encourage me to have the test? If I want the test, will my insurance company pay for it? If I test positive, will I lose my coverage? Will my provider then pay for early treatment?
If I decide to have the test today, what other kind of ramifications will it have for me? I just purchased long term care insurance, but I'll bet I would have been denied if I had tested positive. Will future employers not hire me?
I think the research is good, but at this point I think that's where it needs to stay--in the realm of controlled research. That's not to say I won't change my mind in the future, I probably will. But I don't want us rushing in to something without really thinking through the long term ramifications for every day people, and making sure that new technology and procedures don't make an already terrible diagnosis even more terrible.
The good thing is that the research is moving quickly on Alzheimer's disease. The number one predictor for developing Alzheimer's is age, with over 20% of women over age 85 developing the disease (2010 Alzheimer's Disease Facts and Figures). And face it, age is not a risk factor we can control. We can eat right, exercise, and do all the crossword puzzles imaginable, but if we're lucky, we'll all age.
I still have qualms, though, about doing spinal taps on people. The article indicates that it isn't as risky a procedure as it once was, but then it goes on to say that most internists and family doctors aren't experienced with the procedure. It was suggested in the article that spinal tap centers could be established, but you know, I have mixed feelings about that. It's just one more silo in an already too fragmented health care delivery system.
The other, probably bigger issue for me is one of ethics. Again, who decides? One doctor in the article suggested it should be a decision made between a doctor and the patient. But can my health plan force or strongly encourage me to have the test? If I want the test, will my insurance company pay for it? If I test positive, will I lose my coverage? Will my provider then pay for early treatment?
If I decide to have the test today, what other kind of ramifications will it have for me? I just purchased long term care insurance, but I'll bet I would have been denied if I had tested positive. Will future employers not hire me?
I think the research is good, but at this point I think that's where it needs to stay--in the realm of controlled research. That's not to say I won't change my mind in the future, I probably will. But I don't want us rushing in to something without really thinking through the long term ramifications for every day people, and making sure that new technology and procedures don't make an already terrible diagnosis even more terrible.
Wednesday, July 14, 2010
Preclinical Alzheimer's ?
An article in the New York Times today reports that medical experts are recommending new guidelines to diagnose Alzheimer's dementia earlier. We're pretty sure the disease starts 10-20 years before people become symptomatic, in fact I was at a seminar yesterday and heard that very statement. But I view this news with trepidation.
The experts propose using MRI scans (expensive), PET scans (even more expensive), and biomarker testing (not even that common, and certainly expensive) to determine if a person "preclinical Alzheimer's". Some of the reasons given for diagnosing earlier is so that the disease can be treated. Except that there aren't any drugs on the market yet that will do that. Aricept and Namenda can only do so much, and as far as I can tell, they might not be effective in this particular instance.
Another reason given is that it will give people the chance to make plans and get their affairs in order. Except most don't do that now. It's rare that we have someone come in and say they've just been diagnosed and they want to do or review their estate planning and talk about when they might need a guardian. Of course I want people to do that, but I don't think many people in their 50's will do that if that faced with a diagnosis of "preclinical Alzheimer's".
I invite you to share your thoughts about this news. Me, I'm going to be chewing on it a while.
The experts propose using MRI scans (expensive), PET scans (even more expensive), and biomarker testing (not even that common, and certainly expensive) to determine if a person "preclinical Alzheimer's". Some of the reasons given for diagnosing earlier is so that the disease can be treated. Except that there aren't any drugs on the market yet that will do that. Aricept and Namenda can only do so much, and as far as I can tell, they might not be effective in this particular instance.
Another reason given is that it will give people the chance to make plans and get their affairs in order. Except most don't do that now. It's rare that we have someone come in and say they've just been diagnosed and they want to do or review their estate planning and talk about when they might need a guardian. Of course I want people to do that, but I don't think many people in their 50's will do that if that faced with a diagnosis of "preclinical Alzheimer's".
I invite you to share your thoughts about this news. Me, I'm going to be chewing on it a while.
Tuesday, July 6, 2010
The Beers List
Just to clarify, I'm not going to talk about Shiner Bock, Rahr Ugly Pug or Corona today.
In my last couple of posts I've talked about some of the negative effects medications can have on older adults. I was pretty unhappy that the nurse at the orthopedic surgeon's office told Mom to take Benadryl, and when we told Mom's geriatrician later in the week, she too was pretty unhappy. In fact, she said she would talk to the surgeon personally.
But like that nurse, I'm sure many of you have never heard of the negative side effects of Benadryl, a common, over the counter medication. One resource available, at least to know which medications have potential negative side effects, is the Beers List (originally published in the Archives of Internal Medicine).
Now, my intent here is not to encourage everyone to go out and question every single prescription prescribed for older adults. Doctors often have to weigh the risks and benefits of a medication. Most people are going to take a strong chemotherapy drug for cancer, despite potentially toxic side effects. The issue is that even common drugs like Benadryl can have really nasty side effects in older adults, that younger people don't have, and too many medical professionals don't know that. So, use the Beers list as a resource, and be sure to talk to your doctor about why a particular medication is prescribed, so you can be an informed consumer.
In my last couple of posts I've talked about some of the negative effects medications can have on older adults. I was pretty unhappy that the nurse at the orthopedic surgeon's office told Mom to take Benadryl, and when we told Mom's geriatrician later in the week, she too was pretty unhappy. In fact, she said she would talk to the surgeon personally.
But like that nurse, I'm sure many of you have never heard of the negative side effects of Benadryl, a common, over the counter medication. One resource available, at least to know which medications have potential negative side effects, is the Beers List (originally published in the Archives of Internal Medicine).
Now, my intent here is not to encourage everyone to go out and question every single prescription prescribed for older adults. Doctors often have to weigh the risks and benefits of a medication. Most people are going to take a strong chemotherapy drug for cancer, despite potentially toxic side effects. The issue is that even common drugs like Benadryl can have really nasty side effects in older adults, that younger people don't have, and too many medical professionals don't know that. So, use the Beers list as a resource, and be sure to talk to your doctor about why a particular medication is prescribed, so you can be an informed consumer.
Monday, July 5, 2010
It's a Rainy Day Today
It's raining this morning. Not really earth shattering news, except that it's almost July in Texas, a time when rain is a scarce commodity.
Something I often talk to the adult children of my clients about is how they can encourage their parents to spend money for care. I talk about how their parents saved all this money "for a rainy day" (see, there is a connection), and yet the parents don't recognize that it's not only raining, but it's a storm out there. But my clients aren't the only ones who don't see the rain.
As professionals, doctors, nurses, social workers and other health care providers have often failed to recognize the storm warnings. Today there is an excellent article in the New York Times about the need to prepare for more care for older adults. This is something I've talked about before. There just aren't enough health care professionals being trained in the very specific care needs of older adults.
Just as an example, I've been to two doctor's appointments with my mother recently, one to her orthopedic surgeon, and one to her geriatrician. Mom has been having trouble sleeping since her surgery, and the nurse at the surgeon's office told Mom to take Benadryl to help her sleep. After the appointment I told Mom she was not going to take Benadryl because of the potentially negative side effects this medication has in older adults (seizures and hallucinations, to name two). Now, I chose not to argue with the nurse, and I'm sure some will criticize me for missing the teachable moment, but this is a nurse that I had gotten off on the wrong foot with, and I suspected she would not take kindly to my interference.
But this is a perfect example of how someone in a medical practice catering to mostly older adults is not properly trained. Luckily, Mom has me to tell what is OK and not OK, but I'm not a medical person, I just happen to know a little more than some. I wonder sometimes how many like Mom have followed this nurse's advice, and had a bad drug reaction, which might have resulted in a hospitalization.
I guess the moral here is that we all need to find ways to encourage young people to fall in love with the idea of working with older adults, and do what we can to support those who already do. Geriatricians are among the lowest paid doctors out there, yet they are the ones who spend the most time with their patients, and that should be rewarded.
Something I often talk to the adult children of my clients about is how they can encourage their parents to spend money for care. I talk about how their parents saved all this money "for a rainy day" (see, there is a connection), and yet the parents don't recognize that it's not only raining, but it's a storm out there. But my clients aren't the only ones who don't see the rain.
As professionals, doctors, nurses, social workers and other health care providers have often failed to recognize the storm warnings. Today there is an excellent article in the New York Times about the need to prepare for more care for older adults. This is something I've talked about before. There just aren't enough health care professionals being trained in the very specific care needs of older adults.
Just as an example, I've been to two doctor's appointments with my mother recently, one to her orthopedic surgeon, and one to her geriatrician. Mom has been having trouble sleeping since her surgery, and the nurse at the surgeon's office told Mom to take Benadryl to help her sleep. After the appointment I told Mom she was not going to take Benadryl because of the potentially negative side effects this medication has in older adults (seizures and hallucinations, to name two). Now, I chose not to argue with the nurse, and I'm sure some will criticize me for missing the teachable moment, but this is a nurse that I had gotten off on the wrong foot with, and I suspected she would not take kindly to my interference.
But this is a perfect example of how someone in a medical practice catering to mostly older adults is not properly trained. Luckily, Mom has me to tell what is OK and not OK, but I'm not a medical person, I just happen to know a little more than some. I wonder sometimes how many like Mom have followed this nurse's advice, and had a bad drug reaction, which might have resulted in a hospitalization.
I guess the moral here is that we all need to find ways to encourage young people to fall in love with the idea of working with older adults, and do what we can to support those who already do. Geriatricians are among the lowest paid doctors out there, yet they are the ones who spend the most time with their patients, and that should be rewarded.
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