Articles Posted in Aging

Subtitled “Getting Older Without Getting Old” this new book starts with the premise “…imagine bringing a whole lifetime of knowledge, experience, skills, talent, relationships, wisdom (and, let’s face it, money) to two or three more decades ahead of you in which to leverage all those assets into an ongoing wonderful experience.” With the Baby Boomer generation far outliving and “outhealthing” any prior generation, we are in the era of the “superager”, founded upon seven pillars.

Attitude: Believing in exciting new possibilities, optimism is a major life extender. Purposes and goals are a result of an active curiosity about the potential for the gift of these years. Practice a positive thinking booster program everyday. Search for “positivity apps” and get daily positive quotes. They work!

Awareness: Whereas older adults previously accepted the advice of professionals as gospel, today’s superagers are avid consumers of information. The challenge today is the approach to information gathering and the curating of the “informational torrent”. Tips and techniques for searching and filing your information are provided.

According to the New York State Bar Association, “medical aid in dying is a medical practice that has been adopted in ten US jurisdictions (WA, MT, VT, CA, CO, D.C., HI, ME, NJ, NM) that allows a terminally ill, mentally capable adult with a prognosis of six months or less to live to request from their doctor a prescription for medication they can decide to self-ingest to die peacefully in their sleep.” New York’s MAID law will be considered by the legislature this year.

Protections in the proposed law include (1) a requirement that two physicians confirm the person is terminally ill with a prognosis of six months or less months to live, (2) the individual is informed of palliative care and hospice options, (3) there is a mandatory mental health evaluation if either physician has any concerns about the person’s mental capacity, (4) the request be in writing witnessed by two people, neither of whom stand to benefit from the person’s estate, and (5) anyone attempting to coerce a person will face criminal prosecution.

MAID is inextricably tied to hospice and palliative care, of which a core value is patient dignity and autonomy. New York ranks last in the country for hospice utilization due to health providers failing to provide information and counseling on these end of life options. Options will now be required to be discussed under a provision requiring “informed consent”.

While studying the topic of dementia, your writer was surprised to learn that the single most effective preventative measure would be for more of the hard-of-hearing to wear hearing aids. Studies show that only one in six persons who needs a hearing aid actually uses one and the average person waits ten years before seeking treatment for hearing loss.

As discussed previously in this column, social engagement is the number one factor in maintaining one’s mental facilities as we age. It make sense then, that age-related hearing loss, also known as presbycusis, would diminish social engagement leading to social isolation, cognitive decline and anxiety. Quality hearing aids today may be obtained over-the-counter without a prescription. Check your hearing online by googling “free on-line hearing screening”, downloading the app Mimi, or visiting hearingnumber.org, sponsored by Johns Hopkins. A visit to an audiologist (covered by Medicare) is recommended, however, to rule out any physical causes.

Video calling, widely available today, gives you the benefit of seeing the speaker’s facial expressions and lip movements, helping listeners better understand what they’re hearing. On video you can watch the same show or movies together, even adding other parties. You can also virtually “attend” an event that you cannot make it to in-person.

New York law prevents spouses from being disinherited. Instead, a spouse who is disinherited may go to court and claim their “elective share” which is the greater of fifty thousand dollars or one-third of the estate.

Questions often arise as what the “estate” of the deceased spouse consists of. Naturally, any assets in the decedent’s name only and listed in the estate court proceeding apply. Other assets, known as “testamentary substitutes” because they do not pay by will, and is against which the spouse may make their claim are: bank accounts, investment accounts and retirement accounts with named beneficiaries other than the spouse or, similarly, those same asset if they have a joint owner other than the spouse. An exception would be if the other joint owner had made contributions to the joint account and then as to the contributions only.

Gifts made within one year of death are also available for the elective share claim. Oddly enough, life insurance is not considered a testamentary substitute however annuities are.

Published this year, “The Good Life” reports on the Harvard Study of Adult Development, the longest scientific study of happiness ever done. Tracking the lives of hundreds of participants for over 80 years, the report concludes that it is the strength of our relationships with friends, relatives and co-workers that most determine quality of life, health and longevity.

Regarding older adults, the authors note that time is suddenly very precious. Questions arise such as:

  • How much time do I have left?

Each one of us experience countless injustices in the course of everyday living. Like other experiences, it is not the experience itself so much that counts, but how you process it. The Mayo Clinic addresses the health benefits of “forgiveness” which they define as “an intentional decision to let go of resentment and anger”. Letting go of grudges and bitterness can lead to:

  • Healthier relationships
  • Improved mental health

In his best-selling book, “Successful Aging”, Daniel J. Levitin, Professor Emeritus of Psychology and Neuroscience at McGill University (your writer’s alma mater), shows how the brain is formed and how it changes, in surprisingly positive ways, as we age.

The author notes that Freud said that the two most important things in life are healthy relationships and meaningful work.

Socialization is crucial to maintaining our mental acuity. “Navigating the complex mores and potential pitfalls of dealing with another human being, someone who has their own needs, opinions, and sensitivities, is about the most complex thing we humans can do. It exercises vast neural networks, keeping them tuned up, in shape, and ready to fire. In a good conversation, we listen, we empathize. And empathy is healthful, activating networks throughout the brain.”

In order to contest a will, the objectant must have “standing”, meaning they would legally be entitled to a share or a greater share of the estate if the will was declared invalid. “Standing” alone, however, is insufficient. There must also be grounds for contesting as provided below.

1. Undue Influence: Independent caregivers and caregiver children who end up being named primary beneficiaries under the will are often scrutinized for having prevailed upon the decedent to leave them the lion’s share of the estate. The various means alleged may be physical or mental abuse, threats and isolation of the disabled person. Even non-caregivers who had influence over mom or dad may be challenged where they end up with more than their fair share. As with any court proceedings, proof of the claim will need to be made.

2. Improper Execution: The formalities for executing a will must be strictly observed. The formalities include that the witnesses believed the decedent was of sound mind, memory and understanding. There must be two witnesses who signed in the presence of the testator and of each other. The testator must declare in front of the witnesses that they read the will, understood it, declare that it is their last will and testament and approve of the two witnesses to act as witnesses to the will.

According to the National Institute on Aging (NIA) polypharmacy is the use of multiple drugs to treat diseases and other health conditions.  Polypharmacy is common in older adults, many of whom have two or more chronic conditions, and about a third of whom take five or more prescription drugs. Often, these different powerful drugs have been prescribed by different doctors.  Some drugs mask or neutralize others, some are dangerously incompatible with others and some may worsen conditions that naturally occur in the aging population — such as loss of appetite, less efficient digestive systems and increased cardiovascular risk.

Inappropriate polypharmacy — the use of excessive or unnecessary medications — increases the risk of adverse drug effects, including falls and cognitive impairment.  Harmful drug interactions and drug-disease interactions may also occur, where a medication prescribed to treat one condition worsens or creates a new one.

Enter the new field of “deprescribing”.  The NIA is developing a network of scientists to advance the field of deprescribing to improve the quality of care and health outcomes for older adults. According to Parag Goyal, MD, “despite its role as an integral part of patient-centric and goal-concordant prescribing practice, deprescribing is not frequently incorporated into routine clinical practice”.

The recent announcement by 98 year old Jimmy Carter, our long-lived president, that he was opting for hospice care at home instead of additional medical intervention, is in keeping with the trend towards dying with dignity. Hospice care arises when an illness is either no longer responding to medical treatment, no medical treatment is available, or the patient has decided they want to transition from treatments intended to prolong quantity of life to treatments intended to improve quality of life.

One of the great misconceptions about hospice care is that it is the cessation of medical care. Dr. Sunita Puri, author of “That Good Night: Life and Medicine in the Eleventh Hour” defines hospice care as “intensive comfort-focused care, provided with the goal of minimizing the physical, emotional and spiritual suffering that patients and their families experience when somebody has possibly six months or less to live.” While hospice can usually take place at home it can also be in a facility and is paid for by Medicare Hospice Benefit.

The hospice “team” consists of (1) a nurse to assess and manage pain and provide hands-on-care, (2) a social worker, to offer emotional support and help with planning, (3) a physician to interface with the patient’s primary physician and consult on pain and symptom management and make house calls, (4) a hospice aide to help with personal care needs, such as bathing, (5) clergy to offer spiritual support, (6) volunteers to help in a variety of ways, and (7) a bereavement specialist to provide grief and loss counseling.

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