Saturday, December 22, 2018

A Brief New Career in Movies

Marvel's The Avengers

I received a check in the mail on Thursday for $64 for work I had done a couple of weeks ago.  It was one of those opportunities that arose because I was retired. I was an extra in a movie being filmed in the area. 

It all came about several weeks earlier.  I was coming out of the gym, and a young woman asked me if I would be interested in being an extra in a film.  I said sure and she sent me upstairs to sign up with the casting agency.  They took photos, measurements, and signed me up. About two months passed by and I got a call.  Could I come to a shoot on Monday?  I couldn’t do that do, but I got another call about Wednesday and I said yes.

The filming was taking place outdoors on a former estate in the hills west of Pittsburgh.  It was still dark when I arrived, and I was bussed from the parking lot up to the production office where I filled out forms, and then bussed up to the basecamp with some of the other extras for the day who had the same start time.  At the basecamp we were directed to costume.  Costume liked the hat I brought, but had me swap out the clothes I wore for more weather-beaten pants, shirt and jacket.  A very thin jacket.  Next was a brief stop at makeup and then I went to the tent where the extras were gathering.

As I talked with the extras, it turned out I was one of the few people there who was doing this for the first time.  Many of them were regulars in the movies and TV shows that get filmed in the Pittsburgh area. Some of them had done this 100 times or more over the years.  They obviously enjoyed the work and talked about shows and movies they had done before. Several people had worked on Mindhunter, the Netflix show about the development of behavioral profiling to catch serial murderers.  I also learned that sometimes the extras get cut out of the final film.  One woman who did regular work as an extra had been in an episode of The Outsiders, which was about a family living in Appalachia.  Her role was as a nurse in a scene in a hospital, and she had to assist a patient with a wound.  All that showed up on screen was her shoulder and a little piece of the patient.  Yet like all the other people I met, she was proud of her role and looked back fondly on all the shows she had done.

Some of the people I met were retired and did it because it was interesting and provided a little extra money.  Some were unemployed or had part-time work.  One young woman had taken the day off from work.  The money was important (about $100 for a full day), but everyone came because of the excitement of being a part of a movie or TV show.  And they were proud of the work they had done. 

I was put into a group with about 15 other people, and we worked on one scene.  The scene was outdoors, the temperature was in the upper 20s and there were snow flurries.  I had the thin jacket provided by costume, but my winter coat was back at the basecamp.  The scene was set in an outdoor market somewhere in Eastern Europe about 80-90 years or so ago. We actually got very little information about the details and also signed a disclosure agreement not to reveal any details.  What I can say is that my task was to have a conversation with one merchant – no actual words, but acting like we were having a discussion – and then, after the star of the movie walked from one side of the market to the other, I was to also walk across the market following a path that crossed his.  Other people were doing similar things, talking at the stalls, walking and so on.  The shoot took about 3 hours.  There were walkthroughs, changes in the walkthroughs, minor changes in the set. There were multiple takes using about 3 different camera positions to film the scene. We were all pretty cold, but got a couple of breaks to go into a heated tent to warm up and some warm food and drinks showed up.

Finally, around 1, the scene was done.  The extras were packed up in a bus, taken to the tent that functioned as an office where we signed off on our hours, and then we were bussed to the basecamp, and finally to the parking lot.  

In the end, it was fun. The other extras were great to talk with, and I really enjoyed seeing the process of filming a movie, even if it was a single scene.  I probably would have done it for free.

The movie does not yet have a title, but when it comes out, I’ll let you all know, even if my walk across the market has been cut out.  Will I do it again?  I’m not sure. It’s tedious, but at the same time interesting.  If I get called for Mindhunter, I’ll think about it.  After all, I’m retired.  I can do what I want.

The photo is from Marvel’s The Avengers, one of the many movies filmed in Pittsburgh.

Saturday, December 15, 2018

Searching for the Fountain of Youth



Photo:  A bakery in Paris.  
Eating the pastries there may not extend your life, but will make you smile.

On the day we submitted our last blog on Steps for Successful Aging, a new article appeared in the the New York Times.  It described a well-constructed study to look at the effects of running.  A sample of middle-aged men and women who did not exercise regularly were randomly assigned either to a control group or to one of three exercise conditions: endurance training, interval training or resistance training.  So unlike much of the literature, this study was a true experiment.  Findings would not likely be affected by prior differences in people who exercised and those who did not or any other artifacts.

The main outcome measure was telomerase activity.  For those of you who do not know about telomeres, they are ends of chromosomes that make cell division possible.  Each time a cell divides, telomeres become shorter.  The shortening process can lead eventually to cell death and are risk factors for certain types of illness and death.  Over the past several years, research has looked at factors associated with shorter telomeres (e.g., smoking, obesity, stress, and lack of exercise) and with lengthening telomeres, like diets high in antioxidants (e.g., omega-3 fatty acids), drinking green tea or red wine and exercise.

Exercise and maybe a little red wine now and then are good for us, but will they alter the aging process?  Scientists have long searched for single mechanisms—a single gene, a single substance, and now telomeres—that would slow the negative effects of aging. That is, of course, a worthwhile goal, but what the history of Gerontology suggests is that aging represents changes in multiple systems in the body that are not likely to be affected to a substantial degree by a single magic bullet.  Increases in one factor (length of telomeres) may have some positive effect, but other processes may over time limit benefits due to telomeres alone. There may also be individual differences in how we each respond to substances or activities that might affect the aging process, as well.  Think of the differences in how people respond to medications.  

There may also be unintended consequences of interventions.  In the exercise study, the results showed that endurance training and interval training led to increases in length in telomeres.  But intensive training can also contribute over time to damage to joints and other injuries. We could be adding days at the end of life when we are ill and disabled, but not extending the time when we are healthy and active.

So what is the take-home message.  We think it is to do the practical things that are likely to have benefits for our everyday functioning: moderate exercise and a reasonable but not austere diet.  Those are things that will contribute to the quality of our life, and that is what matters.

Oh, by the way, dark chocolate also contributes to telomere length.

Here is the article on exercise and telomeres in the New York Times:

For a primer on telomeres, see:    https://learn.genetics.utah.edu/content/basics/telomeres/

Here is an article that summarizes how lifestyle may affect telomeres: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370421/

Wednesday, December 12, 2018

Steps for Successful Aging


Penguins Playing Cards, from the holiday show at the Phipps Conservatory in Pittsburgh


Are you confused by the constant stream of articles about how you can stay healthy and prevent illness? It would take all the hours of a person’s life to follow the advice about diet, exercise, lifestyle and medications.  How do you make sense of it all and what is worth doing?  

The place to start is thinking about your goals.  A lot of the research focuses on what might lead to a longer life, but that’s the wrong focus.  What’s important is the quality of life.  Extra months of life may not be desirable, if it means spending more time bedridden and in a nursing home at the end of life.  The goal that most of us have is to be able to stay active and independent for as long as possible.  And we know how to do that.

It’s really quite simple: regular exercise and maintain a reasonable diet and weight—the usual suspects. The specifics are not important. What is important is sustaining your efforts, so select a program of exercise and a diet you can realistically maintain.

A couple of other steps come from our friend and former colleague, Margaret Gatz. First, be an “interested” person.  Not “interesting,” although that’s OK, but interested--staying engaged and curious. Try new things or push yourself to get better in the activities or pursuits you already have.  Doing crossword puzzles or cognitive exercises to stay cognitively active are fine if you enjoy them, but actively engaging in life will provide cognitive stimulation.  Despite all the hype, cognitive stimulation will not prevent dementia, but it will help you remain active and engaged for as long as possible. 

Dr. Gatz’s other suggestion is to build a social circle of choice.  This means to cultivate the relationships with family and friends who are supportive and you enjoy spending time with.  It’s good to have people we can turn to for the emotionally difficult times in our lives or when we need practical help.  And it’s good to put a little distance between yourself and the people in your life who are aggravating or emotionally draining.  

The specifics of your plan are not important.  Despite all the claims, the differences between various approaches to diet and exercise are small or non-existent.  Much of the so-called evidence is correlational.  Here is a recent example.  The New York Times ran a story that claimed that weight training reduced risk of heart attack and stroke.  But this was not an experiment and so cause and effect could not be determined.  The health outcomes could have been due to selection—people who used weights were in better health to start with.  Or the health benefits were due to other factors associated with doing weights.  Maybe persons doing weights are more likely to do other things that are more likely to reduce health risks.  Or it could just be artifact.  With 12,500 subjects in the study, almost anything could be statistically significant, but not very meaningful.

In the midst of all the nonsense that appears about health in the New York Times and other places, one reliable source is Aaron Carroll, who is a Professor of Pediatrics at Indiana University and a specialist in health outcomes and health policy.  Dr. Carroll writes an occasional column in the New York Times and provides a thoughtful commentary on emerging trends in health care.

Reference:


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Sunday, October 28, 2018

A Terrible Day in Squirrel Hill



If you read our recent blog, “Famous Movies Made In Pittsburgh,” you know that we live in the Squirrel Hill neighborhood, which was the site yesterday of the horrific shootings at a local synagogue.  Unfortunately, attacks like this occur at an appalling rate in this country.  It’s a sickness that leads (mostly) men to take out their rage on defenseless people.  No other economically advanced country has recurrent mass killings like we do.

Each time this happens we all say it has to stop, that we have to take away automatic weapons that have only one purpose, killing people.  Then after a few days, we move on to other things.  

Let’s see if we can make this time different.  Like us, you want to leave the world a better place for your children and grandchildren. Gun reform is a good place to start. And we have the time to work on the issue.

The steps that we need to take are obvious.  With the election coming up, we need to do what we can to make a statement by voting only for candidates who support gun control.

A second step is to give money to candidates and organizations that support gun control. We have been giving regular donations to Senator Chris Murphy from Connecticut, who since the Sandy Hook school shooting has been a relentless advocate for gun control.  The NRA spends tons of money on its message.  We need to be part of a movement that provides a counter-balance to the NRA.

Third, if the House of Representatives does turn Democratic in this election, we need to hold them to passing a gun reform bill.  Even if the bill doesn’t get through the Senate, it would create a framework for future actions at the state level and hold Senate Republications and any Democrats who vote against the bill accountable for failing to do anything to prevent the recurrent mass killings.

We don’t know what we will say to our 6 year old grandson about these events when we pick him up at his school in Squirrel Hill.   What do we say to him so that he is not fearful, but maybe wary?  It would be nice to be able to say that good people are making progress to take guns away from people who shouldn’t have them.

There was one humorous moment yesterday in all the sad coverage on TV.  Our local congressman, Mike Doyle, was being interviewed.  In the banner at the bottom of the screen, Rep. Doyle was listed as “R-PA.” Republican from Pennsylvania.  We thought he was a Democratic, but there it was, R-PA. When he was asked a question about what could be done to prevent situations like this, he eloquently spoke about the need for responsible gun control, including restricting automatic weapons.  We looked at each other and said, “Is he really a Republican?”  It turns out he’s not.  It’s really a shame that public safety should be a partisan issue.  It’s a shame that a political party would be so craven as to use an issue like gun control to gain power.  

And for you, Mike Doyle, you’ve got our votes!

Sunday, October 21, 2018

It’s Time to Vote


The Pittsburgh Post Gazette carried a story today on a familiar theme--older people vote at proportionately higher levels than other age groups.  We want to add our voice to encourage you to vote, whether you are old or young, or somewhere in between.

The news each morning should be enough to get you out to vote.  But if that is not enough, there are issues that affect you directly.  

For us old folks, there are direct threats to Social Security and Medicare.  The tax cuts that Congress enacted last year are producing massive deficits in the federal budget.  Current law allows Congress to respond to large deficits by making cuts in Social Security and Medicare.  This is not a liberal fantasy.  Paul Ryan and other leading Republicans have stated that this is their goal. 

If that is not enough to get you out to vote, consider the environment.  The recent report by the Intergovernmental Panel on Climate Change worries that we are already too late to avoid significant degradation to the climate due to global warming.  We worry about the kind of world our grandchildren will live in.

So vote, and get your friends to vote.   Get your children to vote.  Get your grandchildren to vote, too, if they are old enough.

You may be telling yourself your vote doesn’t make a difference.  But even if the important statewide and local races in your area look lopsided in the polls, we know now the polls can be wrong.  

And if you happen to be in the area, stop by at our polling place.  Some of Judy’s cookies and cakes will be on sale at a fund-raiser organized by the pre-school our granddaughter attends.


Read about the Intergovernmental Panel on Climate Change at https://www.nytimes.com/aponline/2018/10/07/science/ap-us-sci-climate-ambitious-goal.htm

Thursday, October 4, 2018

Famous Movies Made in Pittsburgh and Other Retirement Musings

The Manor Theater in Squirrel Hill

Pittsburgh is currently carrying out celebrations of the 50thAnniversary of the release of one of the most famous movies made here, George Romero’s Night of the Living Dead.  It’s an example of what we are finding out about Pittsburgh.  It has a strong feeling of community and honors the people who lived and worked here and who have made substantial contributions in their fields.  Downtown bridges are named for Roberto Clemente, the outstanding Pirates outfielder, painter Andy Warhol, and Rachel Carson, author of the book, Silent Spring, that made people aware of the harm that pesticides were doing and led to the environmental movement. 

A movie currently filming here is about another Pittsburgher, Fred Rogers.  An excellent documentary about him was released earlier in the year, Won’t You Be My Neighbor.  In the forthcoming movie, Mr. Rogers is played by Tom Hanks, who dressed up in a Rogerian red cardigan sweater and a wry smile, looks very much like Mr. Rogers.

We actually live in Mr. Rogers’ neighborhood, an area called Squirrel Hill.  Mr. Rogers owned a home about a mile away from us, and would often walk to the local shops and restaurants.  There is a feel to the neighborhood, too, that is very much like Mr. Rogers.  Although it is in the middle of the city, the area feels like a small town, with lots of restaurants and local stores, many of which have been here for years.  There is also a great deal of diversity in age and ethnicity.  When we walk down the shopping streets we see infants and young children, teenagers going to and from school, college students who make a short commute to University of Pittsburgh or Carnegie Mellon, working age persons, and older people, some who appear to be doing quite well and others who need help to get to get around.  It is really a refreshing change from State College.  

In terms of ethnic diversity, the Jewish population is probably the largest in the area.  We live within a mile of 8 synagogues.  Many of the college students in the neighborhood are Asians.  As a result, there are numerous Asian restaurants in the area.  We are still working our way through all the restaurants. There are smaller numbers of Hispanics and African Americans, but there are some.  We pick up our grandson from school a couple of days a week, and see the diversity in his classmates.  It is perhaps not surprising, but kids don’t make distinctions about race or ethnicity unless they are taught to do so.  We are enjoying being part of a much more heterogeneous neighborhood than we have been in since we left Los Angeles.

Of course, there are a lot of things to see and do in Pittsburgh beyond our neighborhood.  Like everywhere else, however, Pittsburgh is not perfect.  There are still neighborhoods that remind you that there was a terrible economic disaster here several decades ago, when one third of the population left.  While the influx of tech workers (brought here by companies like Google, Uber and DuoLingo) has spawned a building boom in the Bakery Square area, there still needs to be more affordable housing and better paying jobs at the lower end of the wage spectrum.  

And grocery shopping here has been a challenge for us.  We bounce between Giant Eagle Market District, Whole Foods, and Target, with occasional trips to the Strip to find Asian ingredients.  When all else fails, we order from Amazon.  So we really, really miss Wegmans. 

On balance, the move here has been everything we’d hoped it would be.  We are becoming a part of the fabric of the everyday life of our grandchildren, we’re experiencing a kind of diversity that we’d missed, and we’re being forced to move out of our comfort zone at times to try new things or be more creative in solving problems.  So, six months in, we’re finding Pittsburgh to be a great place to live in retirement.

Monday, September 24, 2018

Students’ Questions

This photo was taken by our artist-friend Barb Pennypacker in Italy

Our friend Karen Fingerman asked students in her class on adult development and aging at the University of Texas—Austin to look at our blog, and ask us questions that they would like us to answer.  Her teaching assistant, Jacqueline DeAnda, selected 7 questions and sent them to us.  Here are the questions and our answers. 

Two questions on death and dying --Answered by Judy
Question 1:  How do you feel about death, and has that changed over time? How do you learn to stop fearing death and accepting it as a reality of life?
Right now, as a fairly healthy 72-year old, I see death as something that inevitably will occur in the next ten to fifteen years.  In part that is because that is what was true for my parents and grandparents, but I also know it to be statistically true. In the past few years, my perspective has changed, as the years ahead have shrunk and the years behind have grown.  Before, if I thought about death in relation to myself, I wanted to live long enough to see my children grown and well-established in their lives.  Once that was achieved, I wanted to live long enough to enjoy our grandchildren, and we are living that life right now. Because grandchildren came relatively late in our lives, (I was 62 and Steve was 63 when our first grandson came to us), we cannot count on seeing great-children, so our hopes are to see most of them graduate from high school, maybe some from college. 
During my clinical practice I worked with many elderly individuals, and I followed them from my outpatient practice to assisted living, to skilled nursing, and in some cases was present at their death.  As their psychologist, they confided their inner-most thoughts about aging and death to me, and I learned a great deal from them.  I can say that most of my clients did not fear death itself, they had long ago come to terms with that.  In fact, if you live to be 75 or 80 you have inevitably lost many people along the way.  But they did fear how they would die.  Most people will say that they hope they will just go to sleep one night and not wake up in the morning.  Not many people have exactly that experience, but I came to understand that because prior to dying, consciousness diminishes (either suddenly or gradually), the experience of death may indeed feel like this.  
What I can say from my own personal experience and my observations of my clients, is that the experience of aging is a combination of the body very gradually becoming less efficient and the accumulation of physical limitations brought on by injury or illness.  Thus, by the time you are 70, you can expect to slow down somewhat, to have some everyday aches and pains, and to take longer to recover from over-exertion.  As this process goes on, I think we gradually accept the idea that there will be a natural end point, even if we can’t completely grasp what that will mean.
When I was young, I rarely thought about death, certainly not in relation to myself.  As the years have gone by, I have moved from a position of bargaining (“Just let me live long enough to see my children launched”) to a position of curiosity. Now if I think about death in relation to myself, I wonder about the when and the how, but I am really curious to know what that experience will be.  I do make a point of letting my family know my wishes on my end of life, to control the things that I can, but, in the end, death will come when it is my time, and I hope I will greet it familiarly, something like, “Oh, it’s you after all these years.”

Question 2:  When an old-age person finds themselves incapacitated, in a coma and on life support, what is a sufficient length of time for the family to leave them on life support to see if they will recover before pulling them off life support?
There really isn’t a rule of thumb about how long to wait to see if someone who is on life support will recover, as circumstances vary tremendously. However, there are several important factors to consider.  It is important to listen to what the medical team is telling you about the chances of recovery, and what would that recovery look like.  Based on their tests, will the person ever be able to regain consciousness, breathe independently, or be able to perform any activities of daily living for themselves?  What would the quality of life be likely to be?  Does the family know the wishes of the patient?  

If the person has advanced directives, they should address this very situation.  If there are no advanced directives, but there are one or more family members who know what the patient’s thinking was, they should convey those wishes to the medical team.  My experience is that the medical teams that work in hospitals and skilled nursing homes are in the best position to give you a realistic idea of what will happen when life support is withdrawn.  

The next question is about caregiving stress and its effects
3.  What are the physical effects of taking care of a spouse with dementia or Alzheimer’s disease? Does it shorten life expectancy or potentially cause a late onset of mental illness?

Chronic stress takes a toll on physical and emotional health.  When we encounter a stressor in our daily life, we have a physiological response that prepares us to respond to threat.  This is the well-known “fight or flight” reaction.  Heart rate increases, our hands sweat, our attention is focused. Hormones such as adrenaline and cortisol fuel this process.  In the short run, the physiological changes with stress do not result in any harm, but repeated exposure to stressors over time can lead to dysregulation of these hormones—either too much or too little of a hormone.  These changes, in turn, affect our cardiovascular and immune systems and make us more vulnerable to illness and to emotional distress.  And chronic stress may increase risk of dying.

Given the effects of chronic stress, it is not surprising that caregivers of persons with dementia have more health problems and greater emotional distress than people of the same age who are not caregivers.  Caring for someone with dementia is one of the most stressful activities we encounter. People with dementia need ongoing care and supervision so that they do not harm themselves or someone else. They may become agitated and restless and caregivers can have difficulty calming them down.  They may mix up day and night and keep caregivers awake at night. Caregivers feel like they are always on call and must be vigilant all the time.  The most popular book about caregiving is aptly titled, The 36-Hour Day.

It is also important to recognize that there are factors that mitigate the harmful effects of stressors.  My research team has shown that caregivers who use adult day care have improved regulation of key hormones and reduced emotional distress on days their relative attends an adult day program.  Other research shows that caregivers who engage in enjoyable activities show less distress and lower levels of markers of risk for cardiovascular disease and stroke.  Caregivers also may lower stress by placing their relative into a care facility, although they may encounter new stressors associated with placement.

Finally, we want to emphasize there are considerable individual differences in how caregivers react to stressors.  Some people have good coping responses or find ways to get regular breaks from providing care.  Helping more caregivers to cope in more effective ways with predictable stressors and to access services such as adult day care may be able to reduce the health and emotional problems they experience.

Next, we turn to two questions on perceptions of old age -- Answered by Steve
4.     Is there a common age range when people begin to perceive themselves as “older people”?  If so, has this age range changed throughout the past century and what could have accounted for the change in this age threshold?

5.     With all of the experience and knowledge of old age shared between the two of you, at what age do you consider someone old?
The stock answer is to say that someone who is 10 years older than you is “old”. 
The serious answer is that your perception of age depends on health, functioning and appearance.  Most mornings Judy and I go to the gym and work out for about 45-50 minutes.  We feel good afterwards.  Of course, there are things we cannot do that we did 30 or 40 years ago, but most days we don’t say, “I feel like 72 today.”  We are chronologically old, but the term “feeling old” refers to frailty and illness.  In that sense, we are fortunately not old.  
When researchers have examined subjective age, they typically found that people compare themselves to others they know who are about the same age.  If they see that they are doing better in terms of health and everyday functioning compared to their friends or relatives, they report feeling younger than they are.  Going to the gym has been very helpful to our own perceptions of age.  We look around and think we are not doing badly at all.
For people whose physical appearance is a key part of their self-esteem, old age is harder.  Standards of attractiveness are based on features of young adults.  This is particularly the case for women.  More positive images of older people in the media are helping with this issue.
Whether the age range where people see themselves as “older” has changed is a really good question.  I don’t know if there is definitive information to answer this question.  As you know, more people live to 65 and older than ever before, as well to 75, 85 and beyond.  And on average they are in better health than in the past.  So while the social definition of “older” is 65, it’s likely that people don’t perceive themselves as old at 65 or even 75.  
What age do we consider “old?”  After 80 and particularly after 85, nearly everyone has one or more chronic illness and physical limitations become more common, not to mention dementia. In research I conducted with colleagues in Sweden, we found that decline in health and functioning accelerated after 85.  But our research also showed that there were some “successful agers” at every age who were doing quite well.  The proportion of these successful agers, however, declines with advancing age.
Then there is the perspective of our 6-year-old grandson who told a friend of his, “My grandparents are really old.”

We end with two questions concerning the negative stigma associated with old age --answered by Steve

6.     What are some ways we can get rid of negative stigmas about older people in a society where aging is constantly associated with physical and mental decline?
7.     How did you manage to self-actualize your own lifestyle choices and habits after breaking apart the stereotype of ageism?
Negative stereotypes, whether about race, ethnicity, gender, age or anything else, can have harmful effects.  Some of the efforts to combat age stereotypes have been to emphasize the possibility of successful aging and to highlight the contributions that older people make to their families, communities and society as a whole.  
But presenting positive images of aging is not sufficient.  Illness and death are part of life, but they frighten a lot of people, and that contributes to negative feelings about aging. This translates to pushing people away, so we don’t have to think about illness or death. 

One place to start is to improve how we treat people with chronic illnesses, whether in their homes or in care facilities.  There are many excellent models of care that promote quality of life, but all-too-often programs settle for mediocrity or worse.  When we think of being old, we often think about ending up in a nursing home with not enough staff, low quality food, and rows of patients lining the halls strapped into their geri-chairs.  And, yes, that is a frightening and disheartening sight.  But it simply does not have to be the norm.  We have seen programs in different parts of the U.S. and in the world that counter that stereotype, with clean, well-lit facilities, high quality and comforting food, and staff who are devoted to the well-being of the residents.  The irony is that it does not have to cost more, it just takes a vision on the part of the program director to implement it.  

How have we managed to self-actualize in the face of negative stereotypes?  We both worked in fields, Judy as a psychotherapist and me as a professor, where experience was valued.  By being in the Gerontology field, we also know that what matters is quality of life, not quantity.  We try to make our choices, whether about where we live, what we do, or what we eat, based on what contributes to quality of life. 
There is a great deal of emphasis in the research literature and media on how to extend life or prevent specific ailments like heart disease or Alzheimer’s disease.  Unfortunately, many of these studies are flawed and make claims that go beyond what their data support.  We try to set a balance—regular exercise, reasonable diet, and staying involved, but we don’t become frantic trying to do everything.  We don’t want our last years to focus on doctors, medications, or detailed diet and exercise plans.   We feel that’s the key—the negative model of aging would have us focus on all the things that could go wrong.  We try instead to enjoy the gift that we have been given of a long life.


Monday, July 9, 2018

We'll Always Have Paris

Chocolate almond and plain croissants
from Gontran Cherrier

We are in Paris again, after a few pleasant days in Lyon. We have been to Paris several times now and feel quite comfortable here. As Judy wrote, sometimes we like to travel to revisit places we love. San Francisco and Paris are at the top of that list. 

Here are some of the things that make travel in France special. 

  • The food, of course. It is the best anywhere. Italy comes close but can’t match French breads and pastries. The croissants in the photo are unbelievable!
  • The trains. They are fast, clean and comfortable. You can travel easily almost anywhere in the country. Lyon is about 300 miles from Paris. The trip took us 2 hours on the high speed TGV train. 
  • Paris is beautiful, filled with great sites and museums, and it is easy to get around. The Metro is crowded, but it is fast and efficient. There’s even an app to plan your route on the Metro. The crumbling systems in New York and Washington can’t compare. 
  • The French people. You’ve probably heard all the stores about rude or haughty French who refuse to speak English. (Of course Americans learn the languages of tourists in our country. Right?). But that’s the old France and it hasn’t been that way in a long time. The people we meet are friendly, helpful, and switch to English when our limited French proves insufficient. Paris is certainly a friendlier city for visitors than New York, Philadelphia or Boston. Or London, for that matter. There are unhelpful and rude people everywhere and it’s possible to have a bad experience anywhere but you can have an enjoyable time here. 
So here's what we did on this trip:  We had lunch at La Cambodge, an authentic Cambodian restaurant with very tasty food.  It was one of places targeted by terrorists on November 13, 2015. From there we went to the Galleries Lafayette, which was packed on a Sunday afternoon.  We did happen to hit one of the two periods of the year when there are sales.  We replenished our travel wardrobes (in lieu of sending laundry out).  Since we had a substantial lunch, we decided to just have something light from Pret a Manger, a chain that is ubiquitous in London, fairly easily found in Paris and other large French cities, and now shows up in DC, Boston, and NY.  What we like about it is that everything is organic and fresh, guaranteed because at the end of the day anything left is donated.  Judy's pretty addicted to both the hoisin duck wrap and the mango with lime.  Steve's a fan of the chicken and avocado sandwich.  

Later in the week we ate at La Fontaine de Mars, an old-fashioned bistro near the Eiffel Tower, famous for being a go-to place for the Obamas when they're in Paris.  Their duck confit and sole meunière are just amazing.  On our list for this trip was also a take-out window, the "boutique" part of Yam'tcha, where we got an assortment of bao (buns) of the day (duck, stilton cheese, onion confit, meat, and vegetarian) and steamed shrimp dumplings.  Judy was excited to see the chef and her husband and children, who she recognized from the "Chef's Table" series on Netflix.  We took the food to the Tuileries Garden next to the Louvre for a picnic. We also discovered that our hotel was literally around the corner from a lively neighborhood, Abbesses, and we enjoyed shopping and eating with the locals.  Sadly, our favorite eclair from our last trip is gone, but we did have some from Eclair du Genie, the runner-up in our search for the best eclair in Paris.

On our last day in Paris, we strolled through the Cimitiere de Montmartre (cemetery of Montmartre), which was the view we enjoyed from our hotel.  It's a wonderful, almost whimsical place, with little memorial houses and many statues.  Many famous artists, musicians, and writers are buried there, along with generations of families.  It's huge, and they have laminated maps you can use to locate the graves of famous people.  

In all, this was a very relaxed trip, with a lot of strolling through neighborhoods, traveling around Paris to find amazing food, and enjoying the gift of time that we now have.


So we hope to continue coming here from time to time, and perhaps even bringing grandkids when they are old enough. After all, our 3 year old granddaughter, Lucy,  can already say, “I want another croissant.”

Dementia Studies


The Bronte parsonage in Yorkshire

The impetus for our journey was an invitation from our old friend, Murna Downs, to give a couple of talks and meet with faculty and students in the Centre for Applied Dementia Studies at Bradford University. Bradford has long been a center for innovative work in dementia, and for the past several years has offered a Ph.D. In Dementia Studies. The more we talked with Murna and her colleagues and students, and with two other friends, Linda Clare and Siobhan O’Dwyer who are researchers at Exeter University, the more it seemed that Dementia Studies was an idea that’s time had come. 

What became apparent in our discussions is how little progress there has been in care of persons with dementia and their families in both the UK and US and probably other places. Problems that were endemic and easy to fix, like making sure people with dementia aren’t overmedicated, have not been fixed. And it is still true that hospitals do on average a poor job of treating persons with dementia. Also still true is that when there are sudden changes in a dementia person’s functioning, doctors and nurses automatically assume it is due to the underlying dementia, but don’t look for possible treatable illnesses. And beyond that, despite notable exceptions, care facilities offer lackluster and sometimes cruel care.

These are problems that can be fixed but somehow it doesn’t happen. We don’t need to wait for an effective medication for dementia. We can make these problems better now. Over the years, Judy and I have visited wonderful programs and known health care providers who knew how to provide high quality care. They understood, for example how to talk to persons with dementia with respect, how to work around cognitive difficulties, and how to manage behavior problems. We have known excellent care facilities in The US and abroad. What is frustrating is how little progress there has been in implementing this practical knowledge widely. We have trained geriatricians, geropsychologists, geriatric social workers and nurses, but there simply are not enough people with training and not enough transfer of the knowledge from the truly good programs to the rest of the field.

So maybe we need Geriatric Studies to light a fire, to train bright and committed students who can advocate for better standards of care and to do the research that shows that good care is good for both patients and families and maybe even costs a little less. There has been a tremendous effort in the US and UK to increase research funding for basic biomedical work on dementia. Finding an effective treatment is a worthwhile goal, but in the meantime, we need to gather all the clinical wisdom that has accumulated in the stellar programs that have treated persons with dementia over the years. These are terrible diseases, yet we can reduce suffering with techniques that have been around for a long time and with new approaches. We can’t focus just on the biomedical aspects of dementia in research. Rather, There needs to be appropriate funding for people who have dementia now and their families, both in terms of implementation of what we know and expanding the knowledge base around care.

There is much work for Dementia Studies, and the bright and motivated students we met at Bradford University may be on the right track to begin making a difference.

Beyond the Bucket List

The Globe Theatre

Judy and I have begun travels in the UK and France. Our first stop is London. It’s a place we have been to many times and we are staying in Bloomsbury, which after several stays feels quite familiar and comfortable.  It is nice to be in a place like this. We know how to get around and don’t feel pressure to see the sites. We can move at a leisurely pace, going back to favorite spots and exploring new places and restaurants. A bucket list has it’s place, but so does returning to a city we enjoy. 

London has changed a lot since we first visited. I was first here in 1967 and Judy was here in the early 70s. England was fairly poor then, at least most ordinary people were. In B&B’s, you had to put a shilling into a heater to get some heat and hot water was at a premium. There was still rubble in places bombed during the war and many of the great buildings like Westminster Abbey were coated with a century of grime. The only relief from the drab food was an Italian restaurant, though they were usually not on the Europe on $5 a day list. 

Now London is a lively, exciting, international city, with, of course, a wonderful heritage. One major difference is how many people of different nationalities and races are here now. Just like closed minded people in the US, there are many people here who resent immigrants, but like the US, immigrants bring energy, intellect and innovation. We have eaten in two wonderful restaurants on this trip so far, one Asian Fusion, Wagamama, and the other Mediterranean, Moro. On all our recent visits, the hotel and restaurant staff have been international, mostly from other EU countries, but sometimes from further away. They have been cheerful and helpful.  And like in the US, immigrants have gone into many different professions and occupations. There’s bound to be a loss to the vitality and variety of London when the UK leaves the EU, just as there will be in the US as we close our doors to the world. 

Something we had not done on previous trips here was to attend a play at the Globe Theatre, the re-creation of the theatre where Shakespeare’s plays were first performed. Appropriately, we saw Hamlet. It was very special to see a play in that setting. This was a very contemporary Hamlet, with gender not taken into account in casting. Hamlet was played by a woman, as were some of the other male characters in the play. Ophelia was played by a man. Nonetheless, the play had the same power.  That’s what makes London fun for us, a mix of old and new. One piece of advice if you go to the Globe—the wooden seats are hard, even with the cushions you can rent when you buy tickets. 

On the rest of our journey, we will re-visit three places we have been before—Yorkshire to visit with friends Murna and Chris (and for me to give two talks), Exeter to visit our friend Linda, and Paris, where we plan to continue our search for the best croissants and eclairs. We will also travel to Lyon for the first time. It’s a mix of old and new.