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Bullying Is Ageless: Conflict And Violence Widespread In Nursing Homes, Study Finds

Ulrich Joho/flickr

Ulrich Joho/flickr

By Nell Lake
Guest Contributor

For Eileen, who is disabled and reliant on a wheelchair to get around, life in a nursing home isn’t easy. Particularly when it comes to the other residents: “There’s this guy,” she says. “He made advances to me all the time. I did not want his advances. Many times I had to take my grabber and actually strike him to get him to leave me alone.” Another resident, Eileen says, is a “real bully. She has terrorized quite a few people. She tries to boss people around. She says harassing things.”

In coping with this type of hostile behavior, Eileen (who asked not to be identified) has plenty of company. New research released last week shows that aggression among residents in nursing homes is widespread and “extremely high rates of conflict and violence” are common, according to study author Karl Pillemer, professor of gerontology in medicine at Weill Cornell College of Medicine in New York. His stark findings, presented at the annual meeting of the Gerontological Society of America: One in five people living in the nursing facilities studied was involved in at least one “negative and aggressive encounter” with another resident during a four-week period.

“In most environments — say my work environment at a university — someone yelling at me angrily is so unusual that it would keep me up all night worrying about it,” Pillemer says. Yet such conflict in nursing homes appears to be routine.

Abuse and Mistreatment

As part of the study, researchers examined patient records at ten nursing homes in New York state, interviewed staff and residents, and recorded incidents through direct observation. In a sample of more than 2,000 residents, 16 percent were involved in incidents of cursing, screaming, or yelling; about 6 percent in physical violence such as hitting, kicking, or biting; one percent in “sexual incidents, such as exposing one’s genitals, touching other residents, or attempting to gain sexual favors”; and 10.5 percent in events researchers labeled “other” — residents entering rooms uninvited, for example, or rummaging through others’ belongings. Continue reading

Facing The Inevitable: From Lost Keys To Dementia

I recently turned 50 and, on cue, my AARP card came in the mail and my doctor told me to schedule my first colonoscopy.

Also on cue, I’ve noticed what seems to be my own increased mental scattered-ness — misplaced keys, sluggish name recall. As a catastrophizer, I immediately link this apparent (but my doctor assures me normal) ever-so-slight decrease in cognitive sharpness to full blown Alzheimer’s and the start of a bleak, diminished future.

I am slightly comforted by two factors. First, I’m hardly alone. As Michael Kinsley eloquently reports in his recent New Yorker piece, “Have You Lost Your Mind?” we baby boomers are the first generation to have witnessed our parents cognitive decline and know in terrifying detail what’s in store for us; but at least we’re all on this sinking ship together. Second, there’s a lot of genetics behind Alzheimer’s and cognitive decline, and in that department, I’m not in bad shape. My parents kvetch, but they’re both nearly 80 and my mother, in particular, lives an incredibly active life on her own in Brooklyn: she recently learned chess, ushers off-Broadway with friends most weekends and walks and does yoga everyday.

joeduty/flickr

joeduty/flickr

Also, researchers are busily trying to tackle this problem on numerous fronts. On Sunday, for example, Harvard scientists reported what felt like a breakthrough: a new protein that in mice seems to have a rejuvenating effect on brains and muscles.

And a fairly technical study just out in Biological Psychiatry also hints at the possibility of future fixes: using something called “imaging genetics” researchers at the Lieber Institute for Brain Development and the National Institute of Mental Health are trying to identify “key molecular switches that control age-related memory impairment” and are specifically looking at a protein known to play a role in human memory, called “KIBRA and the gene responsible for its production.” Continue reading

Younger Muscles And Minds: Protein Turns Clock Back In Mice

Nonagenarian Olga Kotelko, left, on her way to victory in her age group in the 100-meter dash at Sacramento State in July 2011. Pat Peterson, right, won a younger age group. (Ken Stone/masterstrack.com, with permission)

Nonagenarian Olga Kotelko, left, on her way to victory in her age group in the 100-meter dash at Sacramento State in July 2011. Pat Peterson, right, won a younger age group. (Ken Stone/masterstrack.com, with permission)

Just about a year ago, Harvard stem cell scientists reported promising news for elderly heart failure patients: In mice, they found, a protein called Growth Differentiation Factor 11 could undo heart damage wrought by aging.

But was it just a heart thing? Or might GDF11 apply more broadly to other ways that we get older but not better?

New research finds that the protein has similarly rejuvenating effects on brains and muscles — though again, only in mice, so it will be years before we’ll know whether humans might see similar benefits. But GDF11 does circulate in the human bloodstream as it does in the mouse, so it’s not totally outlandish to imagine that we might someday pop pills to increase our circulating GDF11 to stay stronger, smarter and generally healthier as we age. And already, researchers are discussing the need to seek potential benefits for patients with Alzheimer’s and other degenerative diseases.

Upcoming papers in the journal Science found that when given GDF11, some older mice — the equivalent of roughly 70-year-old humans — became able to run as long and smell as well as young mice.

The Harvard press release quotes Doug Melton, chair of the university’s Department of Stem Cell and Regenerative Biology, as saying he couldn’t “recall a more exciting finding to come from stem cell science and clever experiments. This should give us all hope for a healthier future. We all wonder why we were stronger and mentally more agile when young, and these two unusually exciting papers actually point to a possible answer:  the higher levels of the protein GDF11 we have when young. There seems to be little question that, at least in animals, GDF11 has an amazing capacity to restore aging muscle and brain function.”

I spoke with Harvard stem cell biologist Amy Wagers, a leader in the GDF11 research, about what it means. Our conversation, edited:

I imagine our headline shouldn’t say ‘Fountain of Youth discovered.’ How do you prefer the effects of GDF11 to be described?

I like ‘healthy aging.’ It’s really important to say that we don’t have any idea whether GDF11 might affect lifespan at all, but it does seem to improve or enhance healthy function in multiple different tissues.

What’s our best understanding at this point of what GDF11 does biologically?

I would say our understanding is still in its infancy. What we know is that GDF11 is a protein that is produced and present in the bloodstream at high levels when you’re young and it goes away as you get older. When you add it back to older animals, there are beneficial effects on a number of different tissues.

At the organismal level, we know that it enhanced muscle repair capacity and skeletal muscle structure so that physical function is improved. We know that in the brain it increases the production of neural stem cells and functioning of the olfactory system. And we know in the heart it reverses cardiac hypertrophy. Continue reading

Aid-In-Dying Loophole: Advocates Want You To Know You Can Stop Eating And Drinking

Lee J. Haywood/flickr

Lee J. Haywood/flickr

By Nell Lake
Guest contributor

One sunny day in the spring of 2012, Kathleen Klein sat in a car by the California coastline with her 84-year-old mother, Jackie Wilton. The two women had been quietly gazing at the view, watching seagulls along the shore. “I’m ready to go,” Klein recalls her mother saying. “Not go home…Go.”

Klein didn’t need the clarification. Her mother had been speaking of wanting to die for years, ever since Wilton was diagnosed with an unspecified dementia a few years before. Wilton’s memory had become significantly impaired. But even before her diagnosis, Wilton was clear: She wanted to die before she became severely incapacitated.

Not long after the conversation by the water, Wilton asked Klein explicitly for help in ending her life. In interviews and a recent blog post, Klein remembers wanting to help her mother, but of being unwilling act illegally.

Even if Wilton had lived in one of the five states with an aid-in-dying law, she would not have qualified for such aid from a physician. That would have required a doctor’s determining that she would likely die within six months. Given the usual course of chronic, progressive dementia, Wilton would likely have lived much longer.

So Wilton needed another option for ending her life. Soon Klein heard a radio interview about “the possibility of helping someone die by letting them stop eating and drinking,” she wrote. “The way I understood it, it was the only legal form of assisted suicide.”

Klein mentioned the scenario to her mother. Wilton said she would think about it. A few days later, Wilton again mentioned wanting to die. “I asked her if she remembered the idea I had run by her. She didn’t, so I told her again. I suggested we give it a try (a ‘dry run,’ we called it) for a day and see if she wanted to continue.”

Wilton began the “dry run” on April 28, 2012.

No Food, No Drink

Most often referred to as VSED — voluntary stopping of eating and drinking — the practice of giving up food and drink in order to hasten one’s death is being increasingly publicized by aid-in-dying advocates as a legal alternative to physician-assisted suicide.

VSED is legal everywhere, even in states without aid-in-dying laws, and in cases in which a person, like Wilton, would not qualify for assistance with dying even in those states.  Compassion and Choices, a leading “death with dignity” organization, is beginning to more actively promote VSED as an option because “it’s something that patients can openly pursue, in open dialogue with their physicians, with the support of hospice,” says Barbara Coombs Lee, the group’s director. “We do want to make it more public. We want to make it more visible because it upholds the truth that ultimately patients should be and are in charge. That’s kind of a consciousness-raising task. Continue reading

The Grandma Effect: A Little Caregiving Sharpens Brain, A Lot Dulls It

(Douglas/flickr)

(Douglas/flickr)

There’s an old saying in medicine: “The dose makes the poison.”

Personally, I find the adage holds true in many contexts, from nutrition to exercise to parenting: often too much of a good thing turns toxic.

Here’s the latest twist: A new report finds that grandmothers who care for their grandkids once a week experience a boost in mental sharpness. But if that one day of cozy caregiving expands to five or more days a week, it can put grandma on edge, and her brain can grow duller, with more memory and other cognitive problems.

Here’s what the researchers conclude, from the abstract:

The data suggest that the highest cognitive performance is demonstrated by postmenopausal women who spend 1 day/week minding grandchildren; however, minding grandchildren for 5 days or more per week predicts lower working memory performance and processing speed. These results indicate that highly frequent grandparenting predicts lower cognitive performance.

And here’s more info on the study (via news release) published online in the journal Menopause:

Taking care of grandkids one day a week helps keep grandmothers mentally sharp, finds a study from the Women’s Healthy Aging Project study in Australia…That’s good news for women after menopause, when women need to lower their risks of developing Alzheimer’s disease and other cognitive disorders.

On the other hand, taking care of grandchildren five days a week or more had some negative effects on tests of mental sharpness. “We know that older women who are socially engaged have better cognitive function and a lower risk of developing dementia later, but too much of a good thing just might be bad,” said NAMS Executive Director Margery Gass, MD. Continue reading

Study Finds Fivefold Increase In Alzheimer’s Deaths: Why It Matters

JAQ'S PhotoStorage/flickr

JAQ’S PhotoStorage/flickr

By Nell Lake
Guest contributor

Consider a hypothetical 70-year-old woman; she could be your mother, your sister, your wife. Call her Margaret. She’s becoming ever-more forgetful; one day she gets lost on her way home from the grocery store. A neurologist diagnoses Alzheimer’s.

Over the next five years, Margaret’s thinking continues to decline. She speaks less, confuses words, falls often. She needs a wheelchair, becomes incontinent. No longer able to manage her care, you move her to a nursing home. A year later, the disease has spread to the part of Margaret’s brain that controls swallowing; she has difficulty eating. Because of this she “aspirates” her food — bits of it enter her lungs, and Margaret develops pneumonia. Within weeks, her lungs stop working, and Margaret dies.

Margaret’s story is a difficult one, but common. It also illustrates a conundrum: Did Margaret die of pneumonia, or Alzheimer’s?

On some level, the answer doesn’t matter much: death is death. But as a matter of public health, the answer is deeply important: funding for medical research, new treatments and ultimately, someday, a cure, tends to flow toward the most widespread and deadly diseases. That’s why a new study out this week is getting so much attention; should its findings become widely accepted, they could substantially increase the pace and effectiveness of Alzheimer’s research in the U.S.

Massive Underreporting

The study, published Wednesday in the journal Neurology, confirmed what clinicians and researchers have long assumed: Alzheimer’s deaths have been greatly underreported.

The research found that 500,000 people die each year from Alzheimer’s — more than five times the number most recently reported by the CDC. That makes Alzheimer’s the third leading cause of death in the United States, after heart disease and cancer. Currently the CDC ranks Alzheimer’s sixth as a cause of mortality, with 84,000 deaths reported on death certificates.

The new report’s fuller accounting of Alzheimer’s deaths reinforces a basic but frequently overlooked fact: The illness is entirely fatal. A progressive brain disease that gradually impairs memory, reasoning and personality, Alzheimer’s eventually damages all brain functions, so that even walking, eating and breathing become impossible. Alzheimer’s kills because the brain is no longer able to keep the body alive. Continue reading

Why To Exercise Today: For Women, Svelte Aging Without Disability — And It’s Not Sitting

DSCN7346

This winter is a struggle. We’re awash in excuses not to get outside and move freely, and exercise seems secondary to just getting through the day. Yesterday, when it started raining ice, for instance, didn’t you just want to wrap up in layers with a hot cup of sweet tea? But, of course, that’s precisely what you shouldn’t do.

Two recent reports re-emphasize everything you already know, but with added detail: fitness (and that involves weight, nutrition, exercise and overcoming a sedentary lifestyle) matters.

Why? Well, here are some of the specifics (that are not actually about exercise per se, but related to it): for women, staying at a healthy weight and avoiding obesity can truly allow you to age (past 85, even) without disability.

Here’s Paula Span in The New York Times on “Weight Gain and Older Women“:

When the researchers looked at the impact that obesity or being overweight — calculated by body mass index — took on the women’s health, “we found that women with a healthy body weight had a greater chance of living to 85 without developing a chronic disease or a mobility disability,” Dr. Rillamas-Sun said. “The heavier you are, the worse your chances of healthy survival.”

And in another blow to the reclining life, researchers at Northwestern report that “every additional hour a day you spend sitting is linked to doubling the risk of being disabled.”

This is less a “why to exercise” finding than a “why not to sit” finding. Still, my point is that the more you’re jogging (or doing water aerobics, or yoga, or shoveling when necessary) the less you’re sitting.

Here’s how the Northwestern news release sums things up: “If there are two 65-year-old women, one sedentary for 12 hours a day and another sedentary for 13 hours a day, the second one is 50 percent more likely to be disabled.” Continue reading

Some 70-Something Women Having ‘Best Sex Ever’? Really? (Yes.)

(Jennie Ivins/Flickr Creative Commons)

A vintage Fisher Price “grandmother lady.” (Jennie Ivins/Flickr Creative Commons)

By Dr. Aline Zoldbrod
Guest contributor

Imagine you’re a stereotypical “old lady,” with a lined face and gray hair, walking down the street. Some young guy looks at you and thinks, “How ya doing, grandma, you old coot? Are you wearing your Depends?” Actually, no, you think, you’re wearing nice underwear because you’re going to meet your beloved to see a movie, then go home and have some really delicious sex, replete with leisurely foreplay and plenty of laughter. You pass a juicy 38-year-old walking down the street with her two little kids in tow, and think, “Poor dear. She won’t have really good sex again for a good 20 years.”

This is not tabloid fantasy: “Sexually Active Septuagenarian!” It is possible. Not for everyone — but for a substantial minority, perhaps a fifth of women or more. And I’ll tell you why, based on research and my experience as a sex and couples therapist — but first, what gives? Why are we suddenly talking about this squirmy topic?

It’s because author Iris Krasnow has a new book out, “Sex After…,” subtitled “Women Share How Intimacy Changes As Life Changes.” And it includes women in their 70s and beyond who are having a glorious time, sexually. Some have partners; others have just discovered the joys of solo sex; some are having their first orgasms ever, thank to vibrators and toys now available for anyone to order online.

People have an ‘ick’ reaction to thinking that their parents are being sexual, let alone their grandparents.

Krasnow writes about the 77-year-old who “was inspired to try fellatio for the first time after watching a how-to video on YouTube.” And she shares the story of another woman in her 70s, a recent widow, who met up with a male friend she had not seen for 54 years and who went to bed with him on the first date, staying in bed having sex with him for five hours.

I’m thinking that this book excerpt is going to blow a lot of people’s minds. Even the “Granny Porn” websites have women who are ages 40 to 50. Women in their 70s?? Most of what you’ll find if you look up “sex over fifty” online talks about frail vaginal tissue, lack of lubrication and flagging erections. Those accounts are accurate but psychologically conservative.

In contrast, the denizens of Krasnow’s research don’t talk about any of the physical barriers to erotic pleasures. This is a group of women who are sexual explorers, women who want to have as much sexual pleasure as they can. They are what psychologist Dr. Abraham Maslow would probably call “sexually self-actualized.”

Krasnow’s findings, while based on a very small sample of older women, actually fit with academic research on the sex lives of older people. Surveys repeatedly find that there is a cohort of men and women, ranging in age from their 60s to their 80s and above, who are having active, enjoyable, single or partnered sex lives. They tend to be healthy and active people, and their attitude about what it is to have a sexual relationship and to be a sexual human being has flexed with age, so that standards are less perfectionistic and performance driven, and the physical changes of aging can be taken in stride.

There is a cultural stigma associated with talking about the sex lives of the elderly. People have an “ick” reaction to thinking that their parents are being sexual, let alone their grandparents. But times have changed. Continue reading

Heroism At Home: An Intimate Look At Growing Ranks Of Caregivers

Screen shot 2014-01-31 at 10.38.03 AM

If you’re an adult living in the U.S., it’s a good bet that you (or your neighbor or close friend or colleague) are caring for an elderly family member. Indeed, more than 43 million Americans — about 18 percent of adults — care for a family member or friend 50 or older, according to the Family Caregiver Alliance; 15 million of these caregivers tend someone who has Alzheimer’s disease or some form of dementia.

Currently, family (read: unpaid) caregivers are the largest source of long-term care in the U.S. and health scholars expect that by 2050 the demand for such care will nearly double — and that family caregivers will have to continue meeting the greatest part of that need.

But the statistics don’t reveal the intimacy of such caregiving relationships: the terror of a mind slipping away, the humiliation and messiness of chronic illness, the often violent and shocking ways that bodies unravel. In her new book “The Caregivers: A Support Group’s Stories of Slow Loss, Courage And Love,” journalist Nell Lake details her two years observing a caregivers support group that includes a 50-year-old botanist who moved in with her aging mother to care for her, and a survivor of Nazi Germany who devotedly tends to his ailing wife, and others in the group (some of whom are dealing with serious health problems of their own). While documenting their lives, Lake offers views into the complexities of caregiving: the profound stress, the upheaval of family roles, the slow, often excruciating grief, as well as the graceful humanity of it all.

Here, lightly edited, is my Q & A with Lake, who lives with her family in Northampton, Mass.

RZ: You begin your book on a personal note, with a memory of your grandmother. Can you tell us a bit about her and how her story moved you to write about the larger issue of caregiving in America?

Journalist and author Nell Lake (photo: Sarah Prall)

Journalist and author Nell Lake (Courtesy Sarah Prall)

NL: My grandmother was a poised woman who lived her life with great energy. She had raised three children, kept a beautiful home, was active physically and also politically—involved in environmental causes and in the nuclear freeze movement in her community. She prized her independence and physical vitality, and, as she aged, she expressed a fear of ending up frail and in a nursing home. She kept materials from the Hemlock Society in a kitchen drawer.

In the summer of 1984, when I was 18, she found out from a doctor that she might have cancer. That night, she went to her garage, sat in her car, and turned it on. A neighbor found her the next day.

While my grandmother’s suicide didn’t directly spur me to pursue a story about long-term care and family caregiving, once I was sitting in on the caregivers support group, it was clear to me that I was immersing myself in the stage of life, an experience, that my grandmother had feared and successfully avoided. It became especially moving, then, for me to follow others who were making their way through the “shadow part of life,” as I put it in the book.

My memories of her shaped my lens: I wondered, Can we find ways to embrace this part of life, to meet it with less fear? Can we also try to make it better for everyone?

How did you connect with the hospital caregiver support group?

In late 2009, I went to a dinner party, a birthday celebration for a friend. I ended up seated next to a man whom I call Ben in the book. He told me that he was the lead behavioral health counselor at our local hospital, and that he also facilitated a weekly support group there for family caregivers. I told him I was a journalist interested in healthcare and mental health issues. He suggested I might want to sit in on the group, and later he asked the group members’ permissions. Before long I was listening to their stories.

Is there any particular quality you discovered about these caregivers that you didn’t expect?

It may sound surprising, but spending two years with the support group gave me a new and better sense for what constitutes heroism. I saw heroism in Penny, who had taken her forgetful mother, Mary, into her home. Caring for Mary was not easy, but Penny met Mary’s needs as best she could, sought to provide her mother with as much comfort, care, and happiness as seemed possible. I saw heroism, too, in Daniel, a caregiver who was himself quite frail, and whose wife was bipolar and in pain. Daniel also bravely did his best to meet his wife’s needs.

Their heroism, to me, was a willingness to keep returning to difficult circumstances, to persevere and act compassionately, to try to ease others’ suffering.

This idea of heroism is similar to the notion that bravery is not the quality of being free from fear; rather, bravery is a willingness to act in spite of fear.

Some (many?) caregivers are reluctant to take on so much responsibility, but feel they have no choice. Is this true for most informal caregivers these days and how does our modern notion of caregiving differ from past generations?

In the most important sense, there was less choice a century ago. The word “caregiver” didn’t exist; the words “daughter” or “wife” or “sister” sufficed to describe a caregiving role. Continue reading

Hope For The Older Mind — Maybe Not Clueless, Just ‘Fuller’

Mr. Mo-Fo/flickr

Mr. Mo-Fo/flickr

Last week I inadvertently dropped my keys into the garbage at Starbucks.

Of course, I didn’t realize it at the time, and it took about 45 minutes of retracing — back to the baristas, who said no, they’d found no keys, back to Trader Joe’s, again no trace of lost keys, and back, once more, to Starbucks, where I sheepishly asked the pierced and rather dismissive coffee girl if I could rifle through the garbage. After going through several bags, I reached into the last one and there, covered in wet grinds and God knows what else, were my car keys.

At first, the incident made my heart heavy, and led me to this story line: I’m so very middle-aged and edging into cognitive decline, joining the ranks of my senior relatives who do clueless things like drop half-eaten apples into the mail box, forget their kids’ birthdays, tell that story about the guy with the pig farm in Montana again and again and again. But in a slight glimmer of positivity, I thought, some part of my brain remembered that I’d thrown a few things in the garbage, and another part urged me to forge ahead, into the dank underbelly of the Starbucks trash bags, until I emerged triumphant. In other words, in a tiny, distant quadrant of my brain there was cognitive crispness, or at least a murky memory that contained the location of my keys.

And lo, in The New York Times this morning, Benedict Carey bolsters my positivity with a story headlined: The Older Mind May Just Be A Fuller Mind. OK, it’s a study with no actual subjects and it’s highly preliminary, but I’ll take it:

“…the new report will very likely add to a growing skepticism about how steep age-related decline really is,” he writes.

And here’s a little background:

Scientists who study thinking and memory often make a broad distinction between “fluid” and “crystallized” intelligence. The former includes short-term memory, like holding a phone number in mind, analytical reasoning, and the ability to tune out distractions, like ambient conversation. The latter is accumulated knowledge, vocabulary and expertise. Continue reading