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Wednesday, April 26, 2023

Can You Be Too Old for Surgery?



Operating on older adults can have negative outcomes. Is there an age where we should no longer be on an operating table?


Bob McHenry’s heart was failing. At 82, the surgeries he needed were high risk, but otherwise he would die. The surgeon went over possible complications, but it felt to the family like there was only one alternative. They agreed to the operations.

A national study published by researchers at the Yale School of Medicine found that one in seven older adults (65 and up) dies within a year of having a major surgery. A third of those with likely dementia will perish, while older adults with frailty and/or having emergency surgery are even more likely to die. Age plays a role, too. At age 90 and above, patients are six times more likely to die than those aged 65 to 69. 

Quality vs. Quantity

Of critical importance to older adults is what their life may look like after surgery. Will they have disabilities? Can they live independently? Will their quality of life be worse?

Bob McHenry had a stroke during his first operation. After the anesthesia wore off, he had severe cognitive impairment and couldn’t swallow or speak. Although he lived another five years, they were marked by increasing dementia and physical decline. His daughter, Karen McHenry, regretted the decision to operate from the day it took place. 

More researchers are starting to look at quality of life after surgery, as well as quantity. One of the Yale researchers, Dr. Thomas Gill, found that among older adults, one in three had failed to return to baseline functionality six months following major surgery. 

“What older patients want to know is, ‘What’s my life going to look like?’” Dr. Zara Cooper, a professor of surgery at Harvard Medical School and the director of the Center for Geriatric Surgery at Brigham and Women’s Hospital in Boston, said. “But we haven’t been able to answer with data of this quality before.”

The new data may usher in a whole new approach to determining if surgery is ethical. 

“This opens up all kinds of questions: Were these surgeries done for a good reason? How is appropriate surgery defined? Were the decisions to perform surgery made after eliciting the patient’s priorities and determining whether surgery would achieve them?” said Dr. Clifford Ko, a professor of surgery at UCLA School of Medicine and director of the Division of Research and Optimal Patient Care at the American College of Surgeons.

As the 65-and-over population increases, they will face two further obstacles. Medicare spends a little over half of its total budget for inpatient and outpatient surgical care, according to an analysis done in 2020. And fewer people are deciding to become physicians, including surgeons in a wide range of specialties. By 2033, there will be 30,000 fewer surgeons than needed to meet the anticipated demand. 

One thing doctors can do is talk to patients about expectations before deciding on whether or not to undergo the knife. As it turns out, older adults have different criteria for deciding if surgery is the right answer for them. They most value the ability to live independently and spend quality time with loved ones, according to Ko. Doctors need to engage in shared decision-making with patients, telling them the best outcome and the worst, and letting them know what life will be like if things don’t go well on the operating table. 

Five Questions

Surgeons can guide decisions by asking five questions, according to Cooper:
  • How does your health affect your day-to-day life? 
  • When you think about your health, what’s most important to you? What are you expecting to gain from this operation? 
  • What health conditions or treatments worry you most? 
  • What abilities are so critical to you that you can’t imagine living without them?

Some surgeons are also using standards of care that are particular to their older patients. One of these is “twilight” anesthesia, which uses mild doses of drugs to block pain, reduce anxiety and induce a temporary loss of memory. Another is to provide non-narcotic painkillers after procedures.

As for the McHenry family, Bob’s wife, Marjorie, fell and broke five ribs several years after her husband’s fateful operation. A lung collapsed, and she had internal bleeding. Doctors proposed a complex surgery. Daughter Karen intervened. 

“This time around, I knew what questions to ask, but it was still hard to get a helpful response from the surgeons,” Karen said. “I have a vivid memory of the doctor saying, ‘Well, I’m an awesome surgeon.’ And I thought to myself, ‘I’m sure you are, but my mom is 88 years old and frail. And I don’t see how this is going to end well.’”

Her mother discussed her situation with the palliative care team and decided against undergoing surgery. Three years later she is mentally sharp, moves around well with her walker, and enjoys the activities offered in a care facility. 

“We took the risk that Mom might have a shorter life but a higher quality of life without surgery,” Karen said. “And we kind of won that gamble after having lost it with my dad.”



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Monday, April 24, 2023

How to Pay for Age-in-Place Support



Millions of seniors need help with the cost of aging in their home. Here’s where to find it.   


The vast majority of older Americans want to grow old in their own home. A recent survey by AARP found that 85% of people 65 and up desired to stay in their residence as long as they could. But many of us will need help doing so as the years go on. This may require home modifications, help with transportation, home health services, and other assistance as we age.

Any time we need to seek more care, we need to look at how much that might cost. After all, a set budget can only stretch so far without breaking. Luckily, there are a variety of private and government programs that help seniors with the burden of increasing needs they will face to remain living at home, whether it be one they own or rent. (For help with the cost of caregiving, see this month’s Lifestyle blog.) 

Financial Professionals Help Seniors to Age in Place 


Financial planners may find that they are helping older clients with much more than managing their money. “A lot of the [retirement-related] conversations we have with clients are around the non-financial aspects,” said Jason Siperstein, CFP and president of Eliot Rose Wealth Management in West Warwick, Rhode Island. 

Seniors have questions about how to access services they may need now or in the future, and they appreciate financial planners who can help them navigate these systems. They want to know how to use Zoom when they can no longer travel, how to call an Uber or Lyft to get to the doctor, and who to contact if they need minor home repairs, or just a little extra help.

Professionals must be aware, for instance, that although Uber has a phone number — 1-833-USE-UBER (1-833-873-8273) — it only works with texting, so it’s of no use to a client without a phone that has texting capability and a senior who knows how to use it. Better for these clients is to recommend GoGoGrandparent,  where older adults can make a call to order ride services and more from any phone.

Financial professionals need to know when to refer a client to a health advocate or local home modification specialist. Older adults look to their financial advisor as a trusted source of broad knowledge as their needs expand. “You can’t talk about money without talking about life,” notes Siperstein. 

Medicare Services

Telehealth enables you to get health services via communications technology, such as over your phone or computer. It is a lifesaver for patients who have trouble getting to a doctor or healthcare office. Your original Medicare plan will cover telehealth services through 2024 at any location in the US, including your home, at the same rate as you would pay going into an office for these services, including office visits, psychotherapy, and consultations.

Medicare Advantage (MA) plans have more leeway to provide telehealth services after 2024; be sure to research details from your specific plan. Medicare and Medicare Advantage both cover an annual fall risk assessment with accompanying  home safety assessment. Medicare Advantage may pay for the cost of needed grab bars for your shower, shower seats, traction strips, or walk-in tubs for the bathroom, or wheelchair ramps and/or hall widening to accommodate a wheelchair. Be aware that in 2023 a mere 10% of MA plans cover bathroom safety devices, and less than 1% in 2022 would pony up for home modifications.

Medicaid Services

Medicaid is healthcare coverage administered by the state for individuals who meet financial qualifications, including both income and assets. If you qualify for Medicaid, you’ll need to research what your state plan will cover. This may include basic durable medical equipment that is deemed “medically necessary,” as well as assistive technologies and tools, such as a medical alert device. For more information, consult the American Council on Aging.

Home Modifications

There are a variety of area-specific programs that specialize in helping with home modifications for older adults. Check this site to get a list of programs in most states. Rebuilding Together https://rebuildingtogether.org/faq#One is another program that covers a wide swath of the US from coast to coast. Local affiliates can assist with home repair and remodeling for qualifying applicants.

Area Agency on Aging

Check with your local Area Agency on Aging office by visiting here or calling 1-800-677-1116. Get connected to find help with finances, health care, and social needs at this impressive network for senior services. Meals on Wheels can be a lifesaver for older adults, or you may find that a local senior center meets your needs for making friends and getting together. 

Veterans’ Programs

If you or your spouse is a veteran of the armed services, don’t hesitate to contact your local VA to chat about options available in your area. Veterans’ programs tend to have more autonomy in how funds are used than the majority of other government programs, so don’t lump the two together. VA services can include home health care, adult day care and even hospice. If a veteran was hurt or became ill in the line of duty, check out the Program of Comprehensive Assistance for Family Caregivers.

Tax Credits

The Child and Dependent Tax Credit can be claimed by caregivers for some care-related costs. This tax credit reduces your tax bill by up to $1,100 annually at the federal level. Read this AARP article for details and tips on how to claim this credit. Your state may also have a similar program. 

If you want to live where you are as long as possible, it’s a good idea to check on available services long before you need them. An ounce of prevention is worth a pound of cure when you’re planning where to spend the rest of your life, and how you’ll manage it financially. 




This article is not intended to be a substitute for professional financial advice from a qualified financial advisor.
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Friday, April 21, 2023

How to Pay a Caregiver (Even if That’s You)



Caregiving can help seniors age in place. A variety of programs may be able to help with the cost, even if that care is given by a family member.


Unpaid care is provided by 41.8 million Americans to adults over age 50 according to a recent survey. That amounts to almost 17% of the population. This puts a tremendous strain on these caregivers, who must bear a financial, physical, and emotional burden for their toil. But overwhelmingly, older adults want to age in place. We checked for programs that could help provide payment for this crucial service. 

Medicare

You  must be homebound and under a doctor’s care to get home health services under Medicare. An example would be after hip surgery. Medicare Advantage plans are required to provide the same level of home health care coverage as Original Medicare, however that may come with different rules, restrictions, and costs. Certain Medicare Advantage plans offer additional limited help at home under defined circumstances. Be sure to comb through your plan carefully to determine what benefits you may qualify for. 

Beware Medicaid “Estate Recovery” Programs  


Federal law mandates all states to have “estate recovery” programs that seek to reimburse Medicaid for expenses, such as those paid out to caregivers. But states have leeway regarding whom they bill and what assets they'll go after. Some use a private contractor to recoup money from the estate of Medicaid participants. For more on the estate recovery program, go here. For a story on what happened to one family affected by estate recovery, read this. Before you elect to use Medicaid’s waiver program, it’s a good idea to check how aggressive your state is about clawbacks and what assets that may affect. The lookback period is five years in most states, so do your planning well in advance of when it will be needed.  

Medicaid

Medicaid is a joint federal and state health insurance program that mostly serves individuals with low incomes or disabilities. Medicaid’s Home and Community Based Services waivers can pay for homemaking, personal care, adult day health services and more. It may pay a family member to provide care. Check here for a complete list of covered services. However, be aware that many states actively claw back these payments after the death of the Medicaid recipient. 

Area Agency on Aging

Connect with your local Area Agency on Aging by going here. Caregivers may be able to obtain respite care (a break from their duties), education and training, information and assistance, counseling and support groups, and supplemental services through the National Family Caregiver Support Program. It’s available for people 60 and above, or less than 60 with a diagnosis of Alzheimer’s disease or related disorders. 

Veterans

The VA has considerably more leeway than many government programs. If the person receiving care is a veteran, it is crucial that you check out what benefits he or she may qualify for. Caregivers of veterans may be able to get paid through the Veteran Directed Care program or Veteran Aid & Attendance Pension Benefit.

State-by-State Resource Guide

The Family Caregiver Alliance has a wonderful state-by-state guide to help you find resources where you live. For instance, your state Department of Human Services may have a program which would pay caregivers. Make sure to access this tool for resources you may otherwise miss. 

Other Options for Family Caregivers

Some long-term care policies allow payments to go to a family caregiver. Check your policy benefits to see if this is an option. The insurance company or agent should be able to help you find the information you need. 

It’s possible that a relative could take a leave from their job to care for you and continue to get paid. They’ll need to check with their human resources department to see if this is an option. 

Finally, family members may be willing to pay a member or outside caregiver for in-home services. This may be a viable option, especially when compared with the cost of moving a loved one to a care facility.




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Tuesday, April 18, 2023

What Happened to Driverless Cars?



We were told self-driving cars would be here by now. Where are they?


We won’t see fully self-driving cars until 2030, and then only in the most expensive models, reports consultancy Accenture. How could that be? More than $100 billion has been put toward the technology, which has promised to advance consumer safety and convenience. Tesla founder Elon Musk has announced every year since 2017 that the means to create a true self-driving car will be available “next year.” 

But even the esteemed entrepreneur and billionaire has continually gotten it wrong. Why? It’s a lot harder to mimic common sense in software than anyone thought. 

Seniors Want Driverless Cars

The promise of autonomous vehicles is alluring. More Americans have been killed in car crashes than in all the country’s wars combined. We could potentially save lives while making car ownership unnecessary; why not summon a car from a nearby fleet to go to the store or make a cross-country trip?

Older people would no longer have to worry about failing eyesight or slower reaction times. If you could say, “Take me to Dr. Smith at Elmwood Heart Specialists” or “Drive me to the nearest grocery store,” you are going to get there. Seniors could look forward to a full lifetime of autonomous travel without depending on friends or family members. 

Edge Events

Most of the work of creating driverless vehicles has been done. They can handle changing traffic lights, turns, and other commonly encountered situations. What they have much more trouble with are the “edge events,” or unusual things that happen rarely overall, but are critical to safe driving. 

Edge events include a ball rolling into the street, followed by a child chasing it. It might be a tumbleweed blowing across a highway, a bicyclist who stops at an intersection, a sign that has fallen partway across the road, a dog running into traffic… and on and on. These are the situations that a human being can instantly process, but artificial intelligence (AI) struggles to interpret.

In one widely publicized incident, a woman was killed by a driverless car while walking her bike across the street. Autonomous vehicles have had trouble recognizing motorcycles and have rammed into the back of parked emergency vehicles, among other mishaps.

“I think if every car was a self-driving car, and the roads were all mapped perfectly, and there were no pedestrians around, then self-driving cars would be very reliable and trustworthy,” says Melanie Mitchell, computer scientist and professor of complexity at the Santa Fe Institute. “It’s just that there’s this whole ecosystem of humans and other cars driven by humans that AI just doesn’t have the intelligence yet to deal with.”

The Last Ten Percent

Humans can generalize from one situation to another, but if AI masters how to handle a situation, it cannot apply that knowledge to slightly changed circumstances. 

“It’s a challenge to try to give AI systems common sense, because we don’t even know how it works in ourselves,” says Mitchell.

There’s a saying in the tech world that once you have 90% of the work done, you only have 90% left to do. That last 10% of figuring out how to get something to work is always the most difficult. 

“It’s really, really hard,” said then-CEO of Google’s self-driving car company Waymo, John Krafcik, of the technology in 2018. “You don’t know what you don’t know until you’re really in there and trying to do things.”

Driverless Cars and Trucks Are on the Road

For now, companies are having success with driverless vehicles making deliveries, where passengers don’t have to be protected. Self-driving trucks are on the roads, often operating at night on highways, when there is less traffic and no pedestrians or bicycles to contend with.

GM’s Cruise is running a fully driverless robotaxi service in San Francisco, Austin, and Phoenix, but only after dark. The company was in the hole $1.4 billion last year alone, and it has yet to be seen how much more it’s willing to throw at the technology without turning a profit. 

Given how much work has been done in the field and the obvious benefits the technology could offer, it seems likely that we will see driverless cars on the road in the future. But older adults will have to hang in there several years longer before a more perfected technology ensures their rollout.


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Wednesday, April 12, 2023

Plant a Tree for a Longer Life



Trees are vital to our health, according to recent studies. Especially in urban environments, planting more trees may yield considerable health benefits. 


Spring is coming to a nation that has seen record snowfall, cold, and storms this winter. What better way to welcome the season of renewal than by planting a tree for the future? As it turns out, trees are linked to multiple benefits, especially if you are a city resident. The more trees, the better it is for everyone around them.

A study led by US Forest Service researchers in Portland, OR found that the more trees in a neighborhood, the longer people there lived. For thirty years, the Portland nonprofit Friends of Trees planted a variety of oaks, dogwoods, and other trees – more than 50,000 of them – around the city. The trees grew to shade sidewalks, muffle traffic noise, absorb pollution, and provide a pleasing visual display.

How to Plant a Tree Anywhere  


If you want to increase your impact, or if you just aren’t the type to feel comfortable with a shovel in your hands and dirt on your boots, a nonprofit may be just what you need. Visit the Arbor Day Foundation to help them reach their goal of planting 500 million trees by 2027. This group plants trees all over the world, with more than 50 years of experience. It’s a great place to shop for trees and get expert advice or send them a donation and they’ll do all the work.

What was unexpected were the health gains the arboreal species made in the neighborhoods where they were planted. After controlling for race, income, age, and education, it turns out that in these areas, fewer people died. For every 100 trees put in, researchers discovered there was about one fewer death due to non-accidental causes. 

Trees As Healthcare

“Urban trees are an essential part of our public health infrastructure, and they should be treated as such,” said Geoffrey Donovan, the Forest Service researcher who led the study that was published in the December 2022 issue of the journal Environment International.

The effect blossomed as the trees grew, spreading their limbs and casting shade, providing habitat for birds and animals. Or as Donovan noted: “Bigger trees, bigger impact on mortality, which is what you would expect.”

Previous studies have found that plants in the environment can lower blood pressure, reduce rates of depression, and increase physical activity. Conversely, when the emerald ash borer decimated trees from Minnesota to New York, researchers found higher rates of cardiovascular and lower-respiratory-tract illness in counties where the ashes were hardest hit. 

Throwing Shade to Save Lives

Stifling summer temperatures take lives every year. A recent study published in The Lancet medical journal estimates that 2,644 lives (more than a third of those lost) could have been spared across 93 European cities if tree cover had been increased to 30%. 

Urban heat islands (UHI) are caused when pavement and buildings absorb the sun’s heat, raising temperatures by up to 3 degrees in high-density areas. Greening cities can reverse this trend, cutting down on energy use as the need for air conditioning lessens. 

The 2022 World Economic Forum looked at the economics of preventing nature loss, such as avoiding urban sprawl, which threatens 44% of global GDP. The report found a return on a $583 billion investment would be $1.5 trillion with a potential for creating 59 million jobs. 

The World Economic Forum’s UpLink initiative aims to plant a trillion trees by 2030 in forest and urban environments. On a more practical level, you can help expand green initiatives where you live. Join a group that adds trees to local sidewalks and parks or plant a sapling in your backyard. To find free trees, usually available around Arbor Day on April 28 this year, go here.

There is joy in watching a tree grow, nourishing it while its branches lengthen and spread. Perhaps it will bear fruit or provide a show of blooms to welcome springtime. It’s a gift to you and generations to come.






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Monday, April 10, 2023

Famous & 65

Look who's turning 65 this month

Find out which celebrities are turning 65 this month!



Image Source: Wikipedia

April 3 - Alec Baldwin, actor 

Superstar Alec Baldwin has won a slew of acting awards for appearances ranging in movies such as Beetlejuice and To Rome with Love and television shows including the iconic 30 Rock. Most recently, he’s been on the front pages for his involvement in a shooting accident that left a cinematographer dead on the set of his movie Rust. But you already know all that. 

You might not be aware that Baldwin was once a busboy at Studio 54, the infamous NYC disco, or that he lost a run for high school student body president his senior year. And you may have forgotten that he was married to actress Kim Basinger for nine years, producing a daughter and an expensive divorce. (He remarried in 2012 to yoga instructor Hilaria Thomas, with whom he has seven children.)

You may also be unaware that the actor is vegan and a big supporter of People for the Ethical Treatment of Animals (PETA). He has advocated for a range of animals, from manatees to Thanksgiving turkeys. Baldwin has also been a generous donor to cancer centers and other charities. To read more about Baldwin, check out his 2017 memoir Nevertheless.







Image Source: Wikipedia

April 21 - Andie MacDowell, actress 

You may remember Andie MacDowell from key roles in St. Elmo’s Fire, Sex Lies and Videotape (which earned her a Golden Globe nomination for Best Actress), Groundhog Day, or Four Weddings and a Funeral. More recently, she was nominated for a Best Supporting Actress Golden Globe for her 2021 television role in the miniseries Maid on Netflix. 

MacDowell was a model before she turned to the silver screen. Two years out of high school she was spotted by a scout in Los Angeles and signed on to Elite Model Management. She quickly became a hot commodity, appearing in Vogue and in campaigns for Yves Saint Laurent, Armani, Anne Klein, Calvin Klein, and Bill Blass. Her Calvin Klein shots went up on billboards in Times Square, leading to her first film contract for Greystoke: The Legend of Tarzan. Hailing from South Carolina, however, MacDowell’s southern accent was deemed too thick for a jungle dweller, and her lines were dubbed by Glenn Close.

MacDowell has often appeared in ads for L’Oreal cosmetics and hair care since 1986. The perennial beauty switched to small screen roles around 2000, including Jane by Design and the Hallmark productions Cedar Cove and The Beach House.








Image Source: Wikipedia

April 29 - Eve Plumb, actress

“That’s the way they all became the Brady Bunch!” Don’t blame us if the refrain for the TV sitcom runs through your head this week … Eve Plumb played middle sister Jan Brady from 1969 to 1974. What themes were shows that featured her centered around? Well, one was why didn’t Jan have a boyfriend? Then there was her embarrassment about having to wear glasses, and concerns about her future appearance. Or her jealousy concerning her older sister. Marcia, Marcia, Marcia! Ah, childhood.

Plumb was a child actress with credits from The Virginian and Lassie on her CV before landing the role of Jan. She also had several roles on the small screen after The Brady Bunch had run its course, perhaps most notably in 1976’s Dawn: Portrait of a Teenage Runaway. There was also a cascade of appearances on series such as Fantasy Island and Wonder Woman due to her fame from her Brady days.

Today, Plumb follows her decades-long passion for painting. See some of her recent works here. https://bilottagallery.com/product-category/eve-plumb/ She’s been married since 1995 and lives primarily in New York City. 








Image Source: Wikipedia

April 29 - Michelle Pfeiffer, actress and producer

How many men out there swooned to Michelle Pfeiffer as Catwoman in Batman Returns? Plenty, we are betting. The gorgeous actress (she was on People magazine’s cover of their yearly “50 Most Beautiful People in the World” issue in 1990) had to work to get beyond “pretty woman” parts at the beginning of her career but soon made a name for herself in roles such as Elvira Hancock in 1983’s Scarface. She went on to effusive praise for films such as Dangerous Liaisons, The Fabulous Baker Boys, Hairspray and Where is Kyra? 

One of the most successful and highly paid actresses of all time, Pfeiffer formed her own production company in 1990 and began earning $1 million per film. She was soon nominated for a Golden Globe for Best Actress in her role as a foreign spy in The Russia House, one of eight times she has received the coveted nomination. 

Although willing to take the spotlight onscreen, Pfeiffer has a notorious distaste for interviews, a quality which some link to her ability to play down-to-earth characters. She downplays her appearance and is fiercely private. Pfeiffer’s philanthropic efforts include the American Cancer Society and the Humane Society for animal welfare. The actress is a vegan. 
 








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