Booster Shots

Oddities, musings and news from the health world

Category: elderly

When the question about healthcare overhaul is simply: 'What about me?'

July 7, 2010 | 10:37 am

Pills "The most common question people have about health reform is 'How will I be affected?' The answer, of course, depends on the individual, as different demographic groups will be affected very differently." So begins a series of briefs from the Robert Wood Johnson Foundation.

The briefs, released Tuesday, analyze the expected impact of the healthcare overhaul on young adults, children, older people and (sort of) people who buy insurance on the individual or small-group market. The latter is a bit too complex to easily distill, it seems. 

The summaries are not what you would call light reading (and can we have a motion to ban the abbreviation PPACA?), but they are informative. And, of course, brief

(PPACA stands for Patient Protection and Affordable Care Act -- what most people call the health overhaul or health reform law -- and it's likely something of a deterrent to consumers looking for straightforward, easy-to-understand information.)

-- Tami Dennis

Photo: Overall, the nation's seniors will see prescription drug coverage improve, the analysis says. But some will also see the premiums increase. Credit: Mark Boster / Los Angeles Times

Book Review: 'The Longevity Prescription' by Robert N. Butler

June 5, 2010 |  5:52 pm

Longevity Is 80 the new 50? It is when you compare Americans' average life expectancy today -- about 78 -- with what it was a century ago, when the average American lived to about  50.

In "The Longevity Prescription," Pulitzer Prize-winning author Robert Butler writes that this three-decade dividend, as he calls it, doesn't have to be lived out in declining health as many assume.

Common ailments such as heart disease, arthritis and lung problems are arriving a full decade later than they did 100 years ago. This suggests that we have it within our power to increase the chances of staying healthy longer, says Butler, founding president of the International Longevity Center and founder of the National Institute of Health's National Institute on Aging. 

Genes play only a small part in longevity, he says -- studies consistently find a link of 5% to 35% between parent and child. He says research clearly shows that a healthy lifestyle can make a big difference in helping people live longer and push back or avoid the onset of chronic illness, lack of mobility and cognitive decline.

Of course, this won't be news to many. There has been a steady flow of research and stories for years suggesting that good health habits can make a difference. What Butler has done in his beautifully written new book is integrate these findings with inspiring stories, clear explanations, compassionate advice and step-by-step strategies to offer an easy-to-follow prescription for a more healthy life.

Yes, most people know they should be getting regular sleep, reducing stress, eating better, exercising more, getting preventive care and nurturing their relationships -- all topics in the book. It's putting these things into practice that can be the hard part. This is where "The Longevity Prescription" is particularly useful.

Want to keep your brain in good working order? He prescribes "cognitive calisthenics": Find an activity that challenges your brain and invest at least 20 minutes a day, five days a week in it, monitoring progress and increasing challenges. His suggestions include turning off the TV, bookmarking a favorite news website, learning a word a day, reading a book or an e-book, learning to play an instrument, memorizing a poem, playing puzzles, pursuing a passion.

He writes that a good marriage at age 50 has been shown to be a better predictor of good health at age 80 than a low cholesterol count. But friendship is priceless as well, he says.

If you need a little primer on enriching or deepening friendships, he suggests first finding three friendships important to you: one healthy and active, one dormant and one broken. Examine all three for lessons good and bad and try to put them in good working order. Then he offers practical suggestions for doing so, among them: Be a listener, think before you speak, practice forgiveness, be positive, try out tolerance, say no when necessary, don't be smothering, be accessible, keep in touch. 

Not rocket science, right? But invaluable advice all the same. Each chapter of Butler's book offers similarly common-sense suggestions and ideas. He starts with a quiz you can take to rate your "longevity index" and ends with a contract to fill out, committing yourself to taking good care of your health.

-- Anne Colby

Photo: "The Longevity Prescription: The 8 Proven Keys to a Long, Healthy Life," Robert N. Butler MD, Avery, $26. 


Book Review: "Passages in Caregiving"

Book Review: "The Roadmap to 100"

Book Review: "The Strong Women's Guide to Total Health"

Book Review: 'Passages in Caregiving' by Gail Sheehy

May 22, 2010 |  9:00 am

Book jacket of Passages in Caregiving-1 Caring for a loved one with a chronic illness -- a parent, partner, sibling or child -- is a role no one aspires to but many of us will take on.

In her superb new book, "Passages in Caregiving," Gail Sheehy writes that someone is serving as an unpaid family caregiver in almost one-third of American households. It's a job that lasts an average of five years.

"Nobody briefs us on all the services we are expected to perform when we take on this role," she writes.

That statement is no longer true, for "Passages in Caregiving" -- written from Sheehy's personal experience supplemented by a generous dose of reporting -- does it well. Her book outlines the road that awaits caregivers and gives practical advice to help them on the journey. It's an ambitious and readable blend of memoir, reportage, consumer advice, pep talk and love story.

Sheehy, author of the bestselling 1976 book "Passages" and many other books and articles, was married to Clay Felker, the legendary editor who founded New York magazine and cultivated such writing talents as Tom Wolfe, Jimmy Breslin and Gloria Steinem. They were a high-profile New York media couple with a life many would envy.

Then one day a phone call came that changed everything. It was a cancer diagnosis for Felker. As they absorbed the news and started making the rounds of doctors, Sheehy realized she had taken on a new role: family caretaker. She thought this would last six months to a year and then their life together would go back to normal. It didn't. 

Continue reading »

More can be done to help seniors prevent falls

May 13, 2010 |  2:42 pm

Falls can be devastating for senior citizens, causing serious health problems and even death. But a policy brief from the UCLA Center for Health Policy Research finds there's much more that can be done for seniors to help prevent falls.

Kzup3cnc Researchers looked at data from the 2007 California Health Interview Survey to see how seniors followed up with medical care after a fall.  In 2007, 14.5% of Californians age 65 and older fell to the ground more than once, according to the brief. About 21% of people age 85 and older had multiple falls. Those at even higher risk of falling included women, people with low incomes and people with disabilities and chronic conditions. More than half a million seniors in California fell more than once in 2007, a jump of about 100,000 from 2003. Seniors who suffer one fall are at greater risk for more falls.

Though 91% of the state's seniors saw a doctor in the last year, falls were not often the reason they went. A little less than half of seniors who had more than one fall said that was the reason they visited the doctor.

That's significant, since they could get information from the doctor on how to prevent future falls. Among seniors who have had multiple falls, 70% said they had done one or more of six suggested preventive activities, and about half did two or more (those include talking with a health professional about how to reduce falls, and using a cane or walker). That still leaves many who didn't follow up with any prevention strategies.

"Following up with a doctor after a fall is critical to senior health," said Steven Wallace, lead author of the brief, in a news release. Wallace, the center's associate director, added, "The safeguards we discuss are some of the best ways of preventing additional falls and the disastrous health consequences associated with falls."

Among the strategies to reduce falls recommended in the brief were training emergency medical professionals and paramedics to encourage seniors to get medical attention after falling, even if they weren't injured. Also suggested were community-based senior programs, targeted to those at risk for falls, that include exercises such as tai-chi as well as home and medication assessments.

-- Jeannine Stein

Photo: Seniors may have to use a cane or a walker following a fall. Credit: Justin Sullivan / Getty Images

Book Review: 'The Roadmap to 100' by Walter M. Bortz II and Randall Stickrod

April 24, 2010 | 12:25 pm

RoadmapcoverWhat if you could live to 100 and not just survive but thrive -- even in your elder years? Dr. Walter M. Bortz II and Randall Stickrod, authors of "The Roadmap to 100," say it's not only possible but probable that many of us will do so.

There will be as many as 6 million centenarians in the world by the middle of this century -- most of them healthy, functional and largely independent, Bortz and Stickrod write. But conversely, there's also a large population that may die at a younger age than the previous generation and be in poorer health while alive, putting a strain on healthcare resources, they say. 

Which of these groups people fall into largely is not determined by hereditary factors but by lifestyle choices, they write. "Longevity is neither an accident nor an isolated phenomenon. It is a product of specific healthy behaviors, a direct consequence of health maintenance."

With "Roadmap," Bortz and Stickrod say, they are "issuing a clarion call to reclaim ownership of our health, to learn to take responsibility for it and not rely blindly on medical technology to repair the damage we do to ourselves."

They present a persuasive case, backed up by numerous studies, and outline specific behaviors people can adopt to live longer and live well. However, they may be preaching to the choir. Their science-oriented book is geared to an educated reader who probably already knows the components of a healthy lifestyle. 

Bortz is no stranger to the topic. He's former co-chairman of the American Medical Assn.'s Task Force on Aging, former president of the American Geriatric Society and author of "Dare to Be 100." Stickrod, a science and technology publisher and writer, was the founding executive publisher of Wired magazine.

The two have examined studies and writings on aging, exercise, obesity, nutrition and disease and come up with several factors they believe contribute to longevity. Their top prescription for a long and productive life might be summed up in two words: Move more.
Continue reading »

It's hard to predict what a person's last year of life will be like

April 1, 2010 | 10:47 am

Oldage It's natural to assume that we see death coming in old age; that we slow down, become disabled and then die. But that's not necessarily the case, according to an enlightening study published Thursday in the New England Journal of Medicine.

Researchers identified five distinct trajectories in the last year of life -- no disability, catastrophic disability, accelerated disability, progressive disability and persistently severe disability. But they found these trajectories varied widely among people and their conditions. Only advanced dementia was really predictable. Those people had high levels of disability throughout the last year of life.

For five other categories (cancer, organ failure, frailty, sudden death and other conditions), from 26.8% to 80% of people were not disabled or had very low levels of disability until only a few months before death. Overall, more than half of the 383 study participants were not disabled 12 months before death. A high number of people who died of cancer, for example, were not disabled during the last year of life.

"These results indicate that for most decedents the course of disability at the end of life does not follow a predictable pattern based on the condition leading to death," the authors, from Yale University School of Medicine, wrote.

The study raises some important points. First, for policymakers, it's hard to know how to allocate resources for healthcare services when disability varies so much in the last year of life. Second, for patients and families, the unpredictable nature of this final year suggests the need to plan for a variety of scenarios. Another study, also in the current issue of the New England Journal of Medicine, found that advance directives, documents that specify the kind of medical care desired, or not desired, at the end of life, work fairly well and are valued by patients and their families. Given the unpredictability of the last year, it seems prudent to have an advance directive prepared in old age, no matter how good you're feeling.

For more on end-of-life care, see this recent L.A. Times Health section.

-- Shari Roan

Photo by Justin Sullivan / Getty Images

A couple of things to remember about that blueberry-juice study

January 22, 2010 |  8:52 am

Berries Antioxidants? Blueberries have them. Potentially beneficial phytochemicals? Ditto. Memory-boosting powers? Um...

Researchers at the University of Cincinnati compared nine elderly adults with "early memory changes" who drank blueberry juice every day with a group of similar adults who didn't. After 12 weeks, those who drank the juice performed better on learning and recall tests.

The researchers wrote: "The findings of this preliminary study suggest that moderate-term blueberry supplementation can confer neurocognitive benefit ..."

And from this comes the headlines "Blueberry juice may boost memory," "Blueberry juice could halt memory loss," "Blueberry juice could stave off dementia."

Earlier research in rodents had suggested blueberries might have a positive effect on memory, but ... nine people? A 12-week study? It's a starting place for further research. 

Eat blueberries if you like them, drink blueberry juice if you like it. But at this stage, a balanced diet is a smarter way to go than cramming yet another food stuff onto what is likely already a full plate.

Here's the abstract from the study, published Jan. 4 in the Journal of Agricultural and Food Chemistry. 

-- Tami Dennis

Photo credit: David Karp / For the Times

Perhaps the answer for elderly surgical patients is less sedation

January 20, 2010 | 11:04 am

Anesthesia The question was: What can be done about postoperative delirium?

Researchers at Johns Hopkins gave it some thought, conducted a double-blind, randomized study (the gold standard) of elderly patients undergoing hip fracture repair and concluded that, hmm, maybe they shouldn't be sedated quite so heavily.

Here's the abstract, published in the January issue of Mayo Clinic Proceedings. It concludes:

"The use of light propofol sedation decreased the prevalence of postoperative delirium by 50% compared with deep sedation. Limiting depth of sedation during spinal anesthesia is a simple, safe, and cost-effective intervention for preventing postoperative delirium in elderly patients that could be widely and readily adopted."

Here's a related editorial urging caution.

And if the word "propofol" rings a bell, it should. It was the much-discussed drug found in Michael Jackson's body after his death: Jackson pleaded with doctor for powerful anesthetic, records show

Very different uses though. Very.

-- Tami Dennis

Photo credit: Los Angeles Times

This new year, resolve to be happy

January 4, 2010 |  1:53 pm

Instead of planning to lose weight, find a better job, be a better person (typical New Year’s resolutions, according to a recent Marist poll) why not use 2010 to focus on what’s really important – your own happiness?

Dropping a few pounds and getting a raise might seem like means to that end. And happiness itself might sound like a nebulous, unachievable goal. But happiness might be worth pursuing in its own right – and, according to recent research, could be a much more measurable and tangible goal than previously thought.

Want a primer on that special feeling? A three-part PBS series, "This Emotional Life," tonight will look at why we feel what we feel, through a scientific lens and through the wisdom of such celebrities as Larry David, "Seinfeld" co-creator: "I don't think it's that much of a mystery. If you don't have a job that you like, and you're not having sex, you're just not gonna be happy."

Show host Daniel Gilbert, who sat down with NPR today for an interview, said the larger point on relationships and happiness rings true. "If you're not involved in a relationship," the Harvard psychologist said, "then indeed we see that people who aren't in romantic relationships are less happy than those who are."

Perhaps happiness is contagious, too. In an article published in the Journal of Personality and Social Psychology, researchers found that the feeling created by absence of relationships -- loneliness -- spreads like a disease:

Results indicated that loneliness occurs in clusters, extends up to three degrees of separation, is disproportionately represented at the periphery of social networks, and spreads through a contagious process.  

Another reason to pursue happiness and avoid loneliness this year – scientists say it’s just as important on the New Year’s resolution list as quitting smoking or losing weight. As Health reporter Melissa Healy blogged last month, loneliness can be as bad for your health as smoking and obesity. 

One double-take worthy theory presented in the PBS show: That, controlling for health problems, older people are generally happier than younger people. Counterintuitive as that notion might seem, it’s been gaining strength in recent years. Health reporter Shari Roan found some logical explanations for the theory in a 2007 story:

[M]ost scientists now think that experience and the mere passage of time gradually motivate people to approach life differently. The blazing-to-freezing range of emotions experienced by the young blends into something more lukewarm by later life, numerous studies show. Older people are less likely to be caught up in their emotions and more likely to focus on the positive, ignoring the negative.

In a special to The Times, Marnell Jameson explores how scientists are starting to quantify and measure happiness -- and what their conclusions are. She starts with a quick quiz: 

True or false:

___ I would be happier if I made more money, found the perfect mate, lost 10 pounds or moved to a new house.
___ Happiness is genetic. You can't change how happy you are any more than you can change how tall you are.
___ Success brings happiness.
Answers: False, false and false. 

Want to find out why? Read Jameson's story, and check out the first part of “This Emotional Life” tonight, airing at 9 p.m. on KCET.   

-- Amina Khan

Last call for Medicare Part D

December 29, 2009 | 11:19 am
Attention, seniors: If you meet the age and income requirements for Medicare, Thursday (just two days away) is the last day to pick a drug plan that works for you. Given that plans change their pricing and restrictions from year to year, it's vital to do a little bit of research to find the best fit.

When the Medicare window opened in November, Your Money/Your Health columnist Francesca Lunzer Kritz gave a helpful guide on picking a drug plan and navigating the enrollment process. "Don't just check the out-of-pocket price for a drug; figure out the plan's total charges for it," she wrote. "Here's why: Medicare adds up the plan's costs and the beneficiary's costs to determine how much has been spent on medicines. If you and the plan together spend $2,830 or more (up from $2,700 last year), you'll find yourself in the so-called doughnut hole, paying the full cost of your medications until your out-of-pocket expenses reach $4,550, up from $4,350 in 2009."

Consumer Reports also provides a quick rundown of the pros and cons of Medicare and Medicare Advantage, and the Medicare Rights Center answers a range of questions, from paying for healthcare costs that Medicare doesn't cover to caring for a senior who uses the healthcare plan.

And, last but not least, there’s the Medicare website, where you'll be able to compare plans and sign up for one all at the same time.

-- Amina Khan


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