Elder Law Prof Blog

Make These a Part of Your Exercise Routine?

We all know how important it is to keep moving! But what gives us the maximum benefit, at least from the standpoint of being the most you can be (I sound like the old Army ad "Be all you can be") when you are older. The Washington Post ran this informative article, The longevity files: A strong grip? Push-ups? What actually can help you live to a ripe old age.

Here are some tips from the article--pushups, walking speed, sitting on the floor and standing up (known as sit-rise) and grip strength matter.  But those are not magic elixirs--instead they are representative of your ability,  "that you are still strong and nimble enough" to do them. "What these tests have in common is they’re good shorthand of things that matter for longevity: overall health, fitness and muscle strength. A fit person walks faster than someone out of shape, and getting up off the floor is tricky for people with weak bones and muscles."

As the article notes, there is no magic pill for longevity, but exercise does help... a lot. Even short amounts of exercise make a difference.  Oh and it's not just exercise; sleep matters as well as does diet.  Alcohol in moderation and keeping stress under control are also important.  Having friends and a purpose are also discussed in the article. 

This reminds me of so much of what we were taught in health and gym classes back in high school.  So now that you've read this post, read the article and then take walk.

 

Thanks to Professor Naomi Cahn for sending me the link to the article.

Hunger Amongst America's Elders

Kaiser Health News addressed the topic of hunger amongst elders in Starving Seniors: How America Fails To Feed Its Aging.

This is incredibly sobering

[M]illions of seniors across the country quietly go hungry as the safety net designed to catch them frays. Nearly 8% of Americans 60 and older were “food insecure” in 2017, according to a recent study released by the anti-hunger group Feeding America. That’s 5.5 million seniors who don’t have consistent access to enough food for a healthy life, a number that has more than doubled since 2001 and is only expected to grow as America grays.

While the plight of hungry children elicits support and can be tackled in schools, the plight of hungry older Americans is shrouded by isolation and a generation’s pride. The problem is most acute in parts of the South and Southwest. Louisiana has the highest rate among states, with 12% of seniors facing food insecurity. Memphis fares worst among major metropolitan areas, with 17% of seniors like [one mentioned in the article] unsure of their next meal.

You're thinking to yourself, surely there are options. What about those federally funded meals programs? Something else? Uh....not likely.

[G]overnment relief falls short. One of the main federal programs helping seniors is starved for money. The Older Americans Act — passed more than half a century ago as part of President Lyndon Johnson’s Great Society reforms — was amended in 1972 to provide for home-delivered and group meals, along with other services, for anyone 60 and older. But its funding has lagged far behind senior population growth, as well as economic inflation.

The biggest chunk of the act’s budget, nutrition services, dropped by 8% over the past 18 years when adjusted for inflation, an AARP report found in February. Home-delivered and group meals have decreased by nearly 21 million since 2005. Only a fraction of those facing food insecurity get any meal services under the act; a U.S. Government Accountability Office report examining 2013 data found 83% got none.

Oh and by the way-the act expires at the end of this month-it's now up to COngress to reauthorize and determine its budget.  Food stamps may be an option, but "only 45% of eligible adults 60 and older have signed up for ... SNAP, the food stamp program for America’s poorest. Those who don’t are typically either unaware they could qualify, believe their benefits would be tiny or can no longer get to a grocery store to use them."

Government programs have long wait lists but there are those who get help, "2.4 million people a year benefit from the Older Americans Act’s group or home-delivered meals, allowing them to stay independent and healthy."  Poor diet, hunger, and starvation have significant consequences, in some instances resulting in major health issues or even death.

Where you one of those kids growing up whose parent said something along the lines of "eat your vegetables (or clean your plate), there are children starving in (insert country)?  Nowadays it may be "eat your vegetables, grandma is starving...."

Keep an eye on Congress' actions on reauthorization-it's important!

 

Jelly Drops For Folks with Dementia

Sounds yummy, doesn't it.  My dear friend, colleague and frequent blog reader ran across a story about Jelly Drops  which are described on the company's website as "Hydrating treats for people with dementia." The article sent by my friend explains that "they’re hydrating treats shaped like raindrops that come in a treat box with a see-through lid. The drops are meant to be appealing to people with dementia, as well as easy to grasp and swallow, and they contain water and electrolytes to help keep elderly patients hydrated."  Both the story and the website explain the inventor's motivation for creating the product.  The photo on the website shows colorful and yummy looking pieces. Hopefully the product will be available before long. Anyone who has had a relative with hydration issues will understand the value of a product such as this.

 

BTW, Happy 4th of July!

 

 

Medical Marijuana for Treatment of Dementia Agitation

Months ago, when my family was considering alternatives for care of my mother as her health deteriorated and her home became increasingly unsafe, I was talking with different providers about the challenges of care when the individual is a heavy smoker (as my mother, at age 92, still was at the time).  There are few options, and most licensed facilities bar smoking completely or limit it to locations that are not workable for someone with impaired movement.  I joked with one provider that smoking cigarettes was prohibited but that Arizona had recently authorized medical marijuana.  Arizona Statutes Section 36-2801 permits medical marijuana for those with debilitating medical conditions, including "agitation of  alzheimer's disease." 

The provider laughed and said, "oh, we don't permit smoking of marijuana either." I wasn't up-to-date on the technology!  Apparently the preferred dispensation at that location was via "gummies."  If you google "marijuana gummies" you get a remarkable range of products.

In this brave new world of medical marijuana, I can see reasons for the interest, especially in the search for safe and effective ways to help individuals whose form of dementia is marked by severe agitation.  Can marijuana "take the edge off" in a safe way?  Can doses be monitored and evaluated appropriately?  Do "gummies" provide reliable or consistent doses of the active ingredient, most likely THC?  Can there be an associated positive effect -- improved appetite (the proverbial "munchies")?  Are there reporting mechanisms on the effects of use, especially in facilities that provide dementia care, that will help capture success rates and any risks?  What about individuals with dementia who suffer from both agitation and delusional thinking -- could medical marijuana potentially reduce one symptom but increase another?  Is the CDC tracking medical marijuana gummies or other products in the context of dementia care?  

The National Conference for State Legislatures (NCSL) maintains a website on state medical marijuana laws.  NCSL reported that as of 11/8/18, 33 states, plus D.C., Guam and Puerto Rico, have approved "comprehensive" public medical marijuana programs, with additional states allowing limited use of "low THC, high CBD" products in limited situations that are not deemed comprehensive medical marijuana programs.

In January 2017, the National Academies of Sciences, Engineering, and Medicine released a report based on review of "over 10,000 scientific abstracts" for marijuana health research, offering 100 conclusions related to health and ways to improve research. The conclusions are organized according to whether there is "conclusive or substantial" evidence, moderate evidence, or limited evidence about effectiveness or ineffectiveness of medical marijuana in a variety of contexts.  One conclusion suggests there is limited evidence that cannabis or cannabinoids are effective for "improving anxiety symptoms," while a separate conclusion states there is limited evidence that such substances are ineffective for "improving symptoms associated with dementia."  

I'm relatively new to review of literature associated with medical marijuana for dementia care/treatment, and welcome hearing from others who are aware of authoritative sources of information. (And just to be clear, this isn't a product we're considering for my mother!) I can see this topic becoming more important with time in our aging world, especially as additional sources of dementia-treatment evidence may become available. 

It's 5 o'clock somewhere... Baby Boomers and Alcohol Consumption

Recently the Washington Post published an article comparing generational alcohol intake. Teenagers and college-age people drink less while this group pours another round opens with this observation "[e]xperts on alcohol abuse have found one demographic group that’s drinking at an alarming rate. Not teenagers. Not college-age people. It’s baby boomers." The first few paragraphs of the article focus on younger individuals and then turns to Boomers, noting that it's "been known for half a century is that baby boomers tend to like alcohol more than the “silent generation” that preceded them."

Consider this:

"Researchers see a steady rise in alcohol use and binge drinking — as well as what’s known as Alcohol Use Disorder (AUD), an umbrella term for mild, moderate and severe abuse of alcohol —  in the 65-plus demographic. Between 2005 and 2014, the percentage of older Americans who reported engaging in past-month binge drinking (defined as women consuming four or more drinks in about two hours, and men consuming five or more) increased from 12.5 percent to 14.9 percent ... [and] [t]he increase in drinking among older Americans is most pronounced among people with greater levels of education and income, and among women.... At continuing care communities, alcohol is typically available as a social lubricant for the majority of residents who haven't graduated to assisted living...."

according to one expert quoted in the article.

One thing that is implicated in this is the perception or impression that moderate alcohol consumption is healthy. "[M]any boomers have embraced the notion that moderate drinking is good for them, compared to abstaining. The evidence there is mixed. A number of studies have shown a reduction in heart attacks among moderate drinkers. But a new study published in the Lancet last week showed no overall improvement in life expectancy among people who had one drink a day compared to those who abstained, and a decrease in life expectancy with any additional drinking. The study's authors concluded that the reduction in heart attacks was offset by other health risks."

Peeps and Pensions: Serious Litigation Ensues

Those ubiquitous peeps appear like clockwork on the shelves of grocers, drug stores and confectioners along with the chocolate Easter bunnies and those other candies destined for someone's Easter basket. An article last week in the Washington Post.  Trouble in candy land:How Peeps, pensions and a lawsuit threaten to upend the American retirement system discusses the issues regarding the company's pension coverage for workers.  The company participates in a multi-employer pension plan and offers current workers (who are members of a union) a traditional pension plan. The company wants to leave that system and offer new works a 401(k) without paying a $60 million fee imposed pursuant to federal law.  This $60 million fee does have a specific purpose: "to ensure future retirees’ benefits are covered, and if [the company] succeeds in escaping it, union officials fear the unprecedented ruling would prompt thousands of other firms to do the same. This chain reaction could divert workers and money at a time when new employees are seen as crucial to ensure ample funding for the wave of retiring baby boomers — putting payouts for millions of pensioners at risk."

The dispute resulted in a strike and, as is typical in a town where one company can mean so much, people taking both sides of the dispute.  Matters deteriorated and now there is a lawsuit from the company against the union, asking for compensation and claiming the strike was unlawful.  The suit will have far-reaching ramifications since multi-employer pension plans exist beyond this one:

In total, 10 million current and retired workers participate in multi-employer pensions, according to the Pension Benefit Guaranty Corporation. These pensions allow employees to move from one job to another within the same pension and carry their retirement benefits with them.... Many of these multi-employer pensions are on track to run out of money. If the pension runs out of money, retired workers might only get a small percent of the money they thought they had earned through decades of work.

There's a bit of a domino effect in these kind of pension plans, since, as the article notes, "[i]f one of the companies paying into the multi-employer plan falters, the other firms are left on the hook to pay even more to stabilize the fund."

Not sure how this will all come out in the end, but for now,  go enjoy your peeps!

Voluntary Stopping Eating & Drinking (VSED) When Capacity Lacking?

You may have read recently about a woman who had an advance directive that addressed artificial nutrition and hydration. The SNF where she lived was hand feeding her, over her husband's objections. The trial court sided with the SNF and the state ombudsman who had argued that "state rules to prevent abuse required the center to offer residents three meals each day and provide help eating, if needed."  Can one provide in her advance directive that she refuses in advance oral fluids and foods at some point in the future? The Kaiser Health News article, Dementia Patient At Center of Spoon-Feeding Controversy Dies, explores the specific case as well as the issue.  The patient, as the title explained, died last week. 

Here's the issue illustrated in this matter.

At issue is whether patients with Alzheimer’s and other progressive diseases can stipulate in advance that they want oral food and liquid stopped at a certain point, hastening death through dehydration. It’s a controversial form of what’s known as VSED — voluntarily stopping eating and drinking — a small but growing practice among some terminally ill patients who want to end their lives. In those cases, people who still have mental capacity can refuse food and water, usually resulting in death within two weeks.  .... “The right to VSED is reasonably well-established, but it’s when a person isn’t competent that’s the issue,” said Paul T. Menzel, a retired bioethicist at Pacific Lutheran University in Tacoma, Wash., who has written extensively on the topic.

So in thinking about a person saying no to food and fluids, "VSED doesn’t require a law or a doctor’s approval. But the question of whether it’s possible for people who can no longer actively consent to the procedure remains ethically and legally unclear. That’s especially true for patients who open their mouths to accept food and fluids...." 

Have you looked at your state's laws to see if there is a position on this?  According to the article, almost 24 states have laws on "assisted feeding" some of which "specifically prohibit withdrawing oral food and fluids. Other states address only artificial feeding or are unclear or silent on the issue [and] ... Idaho — appears to sanction withdrawal of assisted feeding by a health care proxy" according to an expert quoted in the article. However, "Idaho state law also prohibits any form of assisted suicide and requires “comfort care” for patients if artificial nutrition and hydration is withdrawn. It’s not clear whether a request to halt assisted feeding would be honored" said an expert on Idaho's statute on Medical Consent and Natural Death Act.

 

 

GAO Report on Federal Low-Income Programs

The GAO has issued a report that examines various federal programs for low-income individuals. Federal Low-Income Programs: Eligibility and Benefits Differ for Selected Programs Due to Complex and Varied Rules  offers the following findings

Six key federally funded programs for low-income people vary significantly with regard to who is eligible, how income is counted and the maximum income applicants may have to be eligible, and the benefits provided. In fiscal year 2015, the most current data available, the federal government spent nearly $540 billion on benefits for these six programs—the Earned Income Tax Credit (EITC), Medicaid, the Housing Choice Voucher program, Supplemental Nutrition Assistance Program (SNAP), Supplemental Security Income (SSI), and Temporary Assistance for Needy Families (TANF). The target population for each of these programs differs, for example, people who are elderly or disabled or who have dependent children. Further, some programs have conditions for continued eligibility, such as participation in work activities under TANF. The six programs also vary in what income is and is not counted when determining an applicant's eligibility. For example, certain programs, such as SNAP, disregard a portion of earned income, while others do not. The maximum amount of income an applicant may have and still be eligible for benefits, which is determined for some programs at the federal level and for others at the state or local level, also differs significantly. As of December 2016, this amount ranged from $5,359 per month for one state's Medicaid program to $0 per month in one state for TANF cash assistance, for a single parent with two children. Benefit levels also differed across the six selected programs, with average monthly benefits for these programs ranging in fiscal year 2015 from $258 for SNAP to $626 for Housing Choice Vouchers, and four of the six programs adjust benefits annually.Legal, administrative, and financial constraints pose challenges to efforts to streamline varying eligibility rules for federal low-income programs, according to GAO's current and previous work. A key challenge is that the programs are authorized by different federal statutes enacted at different times in response to differing circumstances. Other laws, such as appropriations laws, can also have an impact on federal programs and their rules. As a result, streamlining eligibility rules would require changing many laws and coordination among a broad set of lawmakers and congressional committees. A further challenge is that a different federal agency or office administers each program GAO reviewed. For some of these programs, such as TANF, state governments also establish some program rules, making it more difficult to streamline rules at the federal level within or across these programs. Finally, financial constraints may also affect efforts to streamline program rules. For example, if rule changes raise the income eligibility limit in a program, more people may become eligible and that program's costs may increase. Despite these challenges, Congress, federal agencies, and states have taken some steps to streamline program administration and rules, such as by making greater use of data-sharing where permitted by federal law and aligning programs' applications and eligibility determination processes. For example, SSI recipients in most states are automatically eligible for Medicaid, and GAO previously reported that some states have integrated the SNAP eligibility process with other low-income programs, such as through combined applications and common eligibility workers.

The 56 page report is downloadable here as a pdf.  The one page highlights is available here.

Drive to End Hunger

The AARP Foundation Drive to End Hunger with their ambassador, Jeff Gordon, "is committed to solving the hunger crisis among older Americans." The commercial is available on You Tube. If you haven't thought about the issue of hunger amongst older Americans, you will be shocked when you look at the data. For example, over ten million folks age 50 and older are in danger of being hungry. As well, the costs of health care resulting from food insecurity is in the billions (yes billions). The website offers the opportunity to volunteer, donate and resources.

Here's some background about the initiative

Since 2011, AARP Foundation’s Drive to End Hunger campaign has been raising awareness about the problem of food insecurity among older adults, meeting the immediate daily food needs of hungry seniors, and working to establish permanent solutions to end senior hunger once and for all. Through a collaboration with NASCAR team owner Rick Hendrick of Hendrick Motorsports, four-time Sprint Cup Champion Jeff Gordon, Hendrick teammate Kasey Kahne, and both public and private sector organizations, Drive to End Hunger has donated more than 37 million meals to help feed hungry seniors across the country.

Health & Safety Checks by Meals on Wheels?

So Meals on Wheels has an idea. We all know the dangers of isolation and how important it can be to check in with an elder on a regular basis.  Kaiser Health News explains the idea, Meals On Wheels Wants To Be The ‘Eyes and Ears’ For Hospitals, Doctors. "Meals on Wheels, which has served seniors for more than 60 years through a network of independent nonprofits, is trying to formalize the health and safety checks its volunteers already conduct during their daily home visits to seniors. Through an ongoing campaign dubbed “More Than a Meal,” the organization hopes to demonstrate that it can play a critical role in the health care system."

Many nonprofits face challenges, including funding challenges, and Meals on Wheels is no exception. There are competitors now,  less funding and increasing demand for services.  So how would this work?  "Meals on Wheels America and several of the local programs around the country have launched partnerships with insurers, hospitals and health systems. By reporting to providers any physical or mental changes they observe, volunteers can help improve seniors’ health and reduce unnecessary emergency room visits and nursing home placements, said Ellie Hollander, CEO of Meals on Wheels America."  It's a very cost-effective system according to the article and has the potential for bigger savings in health care costs.

There has already been some research done on the effectiveness and advantages of Meals on Wheels. Consider this:

Studies conducted by Brown University researchers have shown that meal deliveries can help elderly people stay out of nursing homes, reduce falls and save states money.

Kali Thomas, an assistant professor at Brown University School of Public Health, estimated that if all states increased the number of older people receiving the meals by 1 percent, they would save more than $100 million. Research also has shown that the daily meal deliveries helped seniors’ mental health and eased their fears of being institutionalized.

There are  projects taking place, with one between Meals on Wheels, Brown U and West Health Institute.  Another is with Meals on Wheels,  Johns Hopkins Bayview Medical Center and Meals on Wheels of Central Maryland, which will attempt "to keep seniors at home and reduce their need for costly health services after hospitalization. The idea is to have trained volunteers report red flags and ensure, for example, that patients with congestive heart failure are weighing themselves regularly and eating properly."  The Maryland project is being run by Dr. Dan Hale (friend and former colleague at Stetson U).

Sounds like a great idea! 

Hunger Among Elders

PBS did a story that is compelling.  Number of seniors threatened by hunger has doubled since 2001, and it’s going to get worse offers that "[n]early one in six senior citizens face the threat of hunger in the United States. Charity and food stamps reach some of these vulnerable Americans, but limited resources and isolation mean many are struggling without receiving help."  The audio of the story as well as a transcript is available here. The story reviews the importance of social service programs, which may be hampered by long wait lists, food banks and more that provide some assistance.  As I mentioned, this is a compelling story. It's also sad.  Thanks to my colleague, Professor James Fox, for sending me the link to the story.

NPR: Drop-in Chefs for Seniors

Occasionally I feel a little "push-pull" from the different directions that writing about "laws and policies of aging" takes me.  One minute I'm writing about hunger for seniors in our nation's capitol, a dynamic driven by poverty, and then there is today's story from NPR on Drop-In Chefs Help Seniors Stay in Their Own Homes.   

"Part of the business plan is keeping the service affordable. In addition to the cost of the food, the client pays $30 an hour for the chef's time. That's usually a couple of hours a week of cooking and cleaning up the kitchen. There's also a $15 charge for grocery shopping. So clients pay on average $45 to $75 a week.

 

And while there are lots of personal chefs out there and services that deliver meals for seniors there are few services specifically for older adults that prepare food in their homes."

All part of the big, complex picture of "aging." 

Related articles

Drop-In Chefs Help Seniors Stay In Their Own Homes

Nation's Capitol Ranks Fourth for Elders at Risk of Hunger

As summarized in a recent article in the Washington Post, a new study places Washington D.C. fourth in the nation for seniors at hunger risk:   

"The report says that more than 20 percent of the District’s elderly have concerns about eating enough food or the right kind of food, compared with more than 24 percent of seniors in Mississippi.

 

The estimates of senior hunger range from about 8 percent in Minnesota to more than 26 percent in Arkansas, which was ranked highest among states where seniors face the threat of hunger. Virginia and Maryland both had rates of about 14 percent.

 

The analysis – conducted by two university researchers on behalf of the nonprofit National Foundation to End Senior Hunger and the National Association of States United for Aging and Disabilities – says nearly 15.5 percent of elders, or 9.6 million people, in the United States face the threat of hunger...."

My thanks to George Washington Law Professor Naomi Cahn for sharing this article. We agree -- depressing news. 

Substance Abuse-No Age Limits

Although some think substance abuse is a problem for the young, a recent story in the New York Times dispels that thought. More Older Adults Are Struggling With Substance Abuse ran October 3, 2014  looks at the number of elders who are substance abusers-whether drugs or alcohol. The numbers are surprising:

An estimated 2.8 million older adults in the United States meet the criteria for alcohol abuse, and this number is expected to reach 5.7 million by 2020, according to a study in the journal “Addiction.” In 2008, 231,200 people over 50 sought treatment for substance abuse, up from 102,700 in 1992, according to the Substance Abuse and Mental Health Services Administration, a federal agency.

Although alcohol abuse seems to rank first,  the "rate of illicit drug use among adults 50 to 64 increased from 2.7 percent in 2002 to 6.0 percent in 2013" according to the story. The article mentions several studies, not only looking at the extent of the abuse, but the reasons behind these addictions. Although for some, retirement may be a catalyst, many times it is not the sole reason, "'with the conditions leading to retirement, and the economic and social nature of the retirement itself, having a far greater impact on substance use than simple retirement itself..."'  Some of the "firsts" experienced in later life, such as deaths of spouses and friends, may be a contributing factor that requires "coping skills" these folks haven't had to yet possess.

The article also touches on the potential lack of doctor training on dealing with elder patients with substance abuse issues, and notes some symptoms associated with dementia may have similar symptoms to those of addictions.

Update on the Dispute about Elders "Overstaying" Their Welcome at McDonald's in Queens

Last week I wrote about a dispute involving a gathering spot for elderly Koreans at a McDonald's restaurant in Flushing, New York.  The owners were trying to eject the seniors, arguing that they weren't ordering food and had turned the seating into a defacto senior center that wasn't pleasing to other patrons.  In response, supporters of the seniors were calling for a boycott. 

On Sunday, communities leaders announced a settlement of the dispute, with the owner agreeing the seniors can stay as long they want, except from 11 a.m. to 3 p.m. 

Stacy Torres, a PhD student at NYU, wrote an op-ed for the New York Times on the controversy, arguing we should encourage public-private partnerships that benefit older adults and businesses.  She concludes: "Battles over public spaces are as old as the city itself, but we have an opportunity to reimagine overlooked resources like McDonald's as new generations of older people find themselves needing places to hang out."

Related articles

'McResolution!': Elected Officials Help Broker Peace at Flushing McDonald's

Elderly Patrons End Dispute With a McDonald's in Queens

NORC + Mickey D's = Problem?

Recently I blogged about NORCs (for Naturally Recurring Retirement Communities) and Villages, two community-based models for aging in place that are popping up around the country, often in larger cities.  Apparently the label "NORC" could also be applied to a not-so "natural" retirement setting -- your local McDonald's restaurant. 

According to the New York Times, that's what's been happening in Flushing, New York, where a group of elderly Korean men and women have been gathering to socialize, starting as early as 5 a.m. and staying on well into the evening hours.   The restaurant owners were not happy, especially as the size of the group increased and members weren't placing orders. Management eventually called the police, seeking removal of those who seemingly ignored posted time limits, requests to vacate or stronger language.  Now politicians and television cameras are involved:

"Whether the Koreans, many in their 70s and 80s, were right or wrong to spend their days at the restaurant, arriving as early as 5 a.m. and paying as little as $1.09 for a cup of coffee during their daylong stays, seemed not to matter much to the small but vocal group protesting against McDonald’s before an assortment of television cameras and photographers. What seemed to nettle the Korean community most was the perception that in asking police officers to remove the group, the business had been rude."

The New York Times coverage of the on-going dispute seems to suggest that heritage and cultural traditions play a part in the "imbroglio," interviewing "Officer Hee-Jin Park-Dance from the Community Affairs Bureau of the Police Department [who] works out of Flushing. She said: “In Korea or any other Asian cultures, the elder is treated like gold. When you see an elder you get up, you give a seat right away. It’s a sign of respect.”

PTSD may hit some vets late in life

Via the Chicago Tribune:

As Vietnam veterans age, many discover they have more time to contemplate their lives. The time for reflection — as well as retirement, reunions with war buddies and the deaths of loved ones — can stir memories from a long-ago war.  An estimated 2.7 million men and women served in Vietnam; Their average age is 64, according to Vietnam Veterans of America. "Most are approaching retirement," said Tom Berger, director of the health council at Vietnam Veterans of America. "Once they retire, their spouse has passed and the kids have left home, without that structure, they begin to think about things."  Anniversary dates and holidays such as Veterans Day may begin to bother people. But even when a veteran seeks treatment late in life, experts say, in many cases the post-traumatic stress disorder had been there all along.

That was likely the case for Steve Aoyagi, 63, of Des Plaines, who said that when he returned from war, he struggled with anger and anxiety. To deal with those feelings, he said, "I buried myself in my work. I worked 50 to 60 hours a week. A lot of overtime. Whatever time I didn't spend at work, I would occupy myself with my kids."  When a neuromuscular disorder forced him to retire in 2002, he began thinking more about the war. "I started having nightmares about the time I spent in Vietnam. The bombs we dropped, the people who were left behind, my best friend getting killed, not being there for him."  When his son deployed to Afghanistan, Aoyagi began to dream of the body bags that were once loaded onto his C-130 aircraft in Vietnam. In his dreams, he looked down at one of the bags and realized it carried the body of his son.

Now, he goes to group therapy three times a week at Captain James A. Lovell Federal Health Care Center in North Chicago. "The way that I'm dealing with my PTSD now — this is so true for the others — is by occupying my time," he said. "Keeping busy keeps me going."

Memories form a complex web of images and emotions. It's hard to know how one event might trigger recollections from decades before, experts say.  At Lovell, more Vietnam veterans are reporting symptoms of late-onset PTSD. "I think that's due to the fact that Vietnam veterans are at an age when they're experiencing more loss and all the life changes that can be triggers," said Anthony Peterson, who runs the center's treatment programs for post-traumatic stress.  The passing of a spouse can stoke feelings of survivor guilt. A serious illness can force a veteran to confront death in the same way he once did in Vietnam.

Read more in the Chicago Tribune.

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Memory Cafes: Hanging Out in a Judgment Free Zone -- with Good Coffee

On yesterday's ride over the Blue Mountains between my Law School's campus in Carlisle and the campus in State College, I caught a great public radio program, interviewing folks at a "Memory Cafe." 

As anyone involved in care for a person with dementia knows, especially those who are "stuck" at home, it can be a challenge.  Both the caregiver and the cared-for person could use a good break now and then. 

That's where the concept of Memory Cafes come in -- a place where folks won't judge about how Alzheimer's or similar cognitive impairments might affect the ability to have a traditional conversation.  Where canes and walkers are welcome.  A place that is warm and friendly. Where people understand -- and can share a laugh, along with good coffee. 

From Wisconsin Public Radio, here's a bit of history and a description of a cafe in Appleton, Wisconsin:

“'Memory Cafes' got their start in the Netherlands and are common now both there and in England. They are 'judgment-free zones' for people with mild dementia or memory loss.

 

About a dozen people gathered last week at a cafe session at a coffee shop in Appleton. John McFadden is a co-coordinator of the memory cafe and plays the ukulele to welcome participants. Betty Ann Nelson came with her husband, Duane. The Nelsons have been married 58 years and have attended several cafe sessions since they began earlier this year."

Some sessions might involve activities, such as a program called "Time Slips" where participants pass around amusing photos and are invited to tell the story.  One photo showed nuns on bumper cars at an amusement park, leading a customer to describe them as "Holy Rollers."

For more on the concept, follow the links on Wisconsin Public Radio to listen to this radio account.  

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Watertown aims to become first dementia-friendly community

The Waiting Game: Food Insecurity for Older Adults

In the October 14 issue of The Nation, writer Trudy Lieberman's article on "The Real Hunger Games" describes the struggle of a 64 year-old widow for food:

"Perdue tried to get help from Meals on Wheels Atlanta. In mid-April of 2012, she was twenty-seventh on a waiting list of 120. In November, she was still on the list, which had grown to 198. Her daughter finally found another program.

Such is the world of food rationing for the elderly—the hidden hunger few ever see. Tenille Johnson, one of two case managers at Meals on Wheels Atlanta, said there were others on the list who were even more in need than Perdue. In 2012, the program served 106,000 meals—up from 84,000 three years before—and it will serve about 114,000 this year. “We’ve been able to up our game and reduce the waiting list to between 145 and 160 seniors, but the need has outpaced us,” says executive director Jeffrey Smythe. “The numbers are going up more quickly than we projected. We have waiting lists all over the metro Atlanta area, even in suburban counties.”

The Nation writer first reported on underfunding for programs assisting home-bound elderly in 1998. "Little has changed in the last fifteen years," she reports.  Except, as her article demonstrates in detail, the need is greater, on a nation-wide basis. 

"The National Association of Area Agencies on Aging says nearly 60 percent of all Older Americans Act programs had waiting lists in 2010, but the ones for home-delivered meals are particularly urgent, since food is so basic to good health."

Remember the Older Americans Act (OAA), first enacted in 1965? Meals on Wheels was once a core component of OAA's programming, and administered to the states through Area Agencies on Aging. Charities, churches and other nonprofits have not been able to cover the gap in funding.  As discussed earlier on this Blog, Congress still has not reauthorized the OAA,and as Lieberman's article demonstrates, there are very real consequences to Congressional gridlock and Congress's failure to address even uncontroversial programs while rehashing party-politics on the Affordable Care Act. 

Hat tip to Kevin Schock, Penn State Law, for spotting this timely article.

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Arizona Tops 50-State Ranking Of Disability Services

Via United Cerebal Palsy:

Arizona’s Medicaid program provides the best services for people with intellectual and developmental disabilities, according to a national ranking released Wednesday.

The annual list produced by United Cerebral Palsy compares services and quality of life for people with disabilities all 50 states and the District of Columbia.

Arizona, Michigan, California, New Hampshire and Vermont came in at the top of the list this year.  Meanwhile, for the sixth year in a row, Mississippi was dead last, with Illinois, Arkansas and Texas rounding out the low performers. (Find out where your state stands »)

The analysis looks at a number of factors including the way people with disabilities live and participate in their communities in each state, how satisfied people are with their lives and how easily they are able to access services and supports.  The latest ranking is based primarily on data from 2010, the most recent available. Even though some states outperformed others in the ranking, those behind the report caution that all states have room for improvement. They point out that 268,000 Americans with disabilities are currently on waiting lists for Medicaid waivers which would allow them to receive home and community based services.  On a positive note, however, the analysis found that in 36 states at least 80 percent of residents with developmental disabilities are now being served in the community.