Friday, December 18, 2020

Finding Small Comforts


Whether we are old or not so old, the pandemic has probably led us to think about our mortality.  Adding to the stress of the pandemic has been the daily vitriol of the election and its aftermath. The news headlines have frayed our nerves and left us worrying about whether our democratic form of government will survive a would-be dictator and his band of sycophants. 


Much has been written about pandemic baking, and we have joined that group.  Sometimes there is comfort in making something sweet or familiar.  Certainly the focus that is required to bake from scratch is a welcome distraction from the world around us.  The holidays have given us an additional excuse to bake familiar cookies for family members.  The grandkids that we can see came over last week to bake Steve’s family recipe for poppyseed cookies for Hanukkah.  Then Steve baked two more batches to send to two of our children, one in Chicago and one in Nashville.  We’d already sent the traditional box of See’s candy custom selected for each family (the milk chocolate butter is probably the most asked for, although the chocolate covered peanut brittle comes close) .  We can’t all be together, but we can still have some familiar food memories together that we can talk about when we have our family Zoom on Saturday.


We’ve also become huge fans of Goldbelly, the website that ships restaurant and bakery goods from around the country.  We’ve enjoyed the Momofuku Bo Ssam dinner, Marcus Samuelsson’s  hot honey chicken & cornbread waffles, Xi’an Famous Foods’ hand-ripped noodles, and Hattie B’s hot fried chicken, to name a few.  The first three are from New York, and Hattie B's is from Nashville, which we tried in person last year.  The hand-ripped noodles from Xi’an were particularly enjoyable because you got to pull and tear the noodles yourself, and then whack them against the counter top.  The ingredients were incredibly fresh and delicious, too.  We’ve had so much fun with it that we gave all of the kids gift certificates to Goldbelly for their Christmas present this year.  What could be better than a restaurant meal at home in these times?  


We have found that indulging in good food is a way to assuage the feeling of deprivation from not being able to travel to see our children and grandchildren.  By sharing the good food we can at least evoke memories of meals together. 


At this point some of you must be thinking that this is not healthy.  We have all been conditioned to worry about what we eat.  There is, of course, some truth to being careful about what and how much we eat.  Obesity is a major problem in our country.  It is not healthy to overdo pastries and ice cream or anything else.  But it is healthy to thoroughly enjoy a good meal or desert without guilt.  Good tasting food is good for our mood and it is satisfying.  Not skimping on ingredients is important.  We use good quality butter and good chocolate in baking, because the final product tastes better.  Food that tastes good is really satisfying.  We end up eating less, but feeling better. Eating good foods is often equated with eating too much.  But it is easier to control how much we eat when we feel satisfied.


One of the harder things to do during the pandemic is to engage in activities that we enjoy.  Like good food, enjoyable activities are important for our daily mood.  Almost everyone is interacting less in person with other people, and it is much harder or not possible to do things we used to enjoy—going to a movie or restaurant, shopping, even walking through a park.  When we begin to feel the walls closing in on us, it has been helpful to start planning activities that we enjoy.  It can be something simple, like finding a movie on demand that we want to see, or arranging a phone or video call with a friend.  The key is having something enjoyable to look forward to on most days.


We also know how fortunate we are to be able to afford to indulge our food desires.  So we have been supporting both the Greater Pittsburgh Area Food Bank and the Free Store in Braddock during the pandemic and plan to continue for the foreseeable future. And we continue to support local restaurants.


The photo shows Steve’s Poppy Seed Cookies.  You may notice one is missing from the cookie sheet.  Someone couldn't wait to try one of the cookies.


You can find the recipe in Judy’s food and baking blog, Tasty Treats, at 

https://jzcooks.blogspot.com/search?q=poppy+seed+cookies


There are two minor additions to the recipe: 


1.Put the butter and shortening in the freezer for about 10 minutes before cutting them into the dry ingredients. 


2.  When the cookies are on the cookie sheet and ready to go into the oven, put them in the freezer first for about 40 minutes.  


Keeping the butter and shortening as cold as possible will lead to lighter and tastier cookies.  Of course, they are even more addictive then.


Thursday, November 12, 2020

Is Biden Too Old or Have Other Presidents Been Too Young?


There is a column in today’s New York Times by Jennifer Senior that makes the case that President-elect Biden’s age could really be an advantage.
  She points out the positive things that can happen as we age.  Like experience and expertise.  Many people have pointed out that Joe Biden knows how Washington works and can draw on that experience to get things done.  Of course, some critics have suggested that his knowledge of Washington is obsolete, that the Republican Party and its soulless leader in the Senate will not cooperate or compromise to pass important legislation.  But is there a better idea than trying to reach across the aisle to make things happen, or a better person than Mr. Biden to try to make that work?  

 

Senior notes another quality that Biden brings to the Presidency--wisdom.  We often say that older people are wise, but then we don't treat them as wise.  Of course, not all older people are wise, and age alone does not lead to wisdom.

 

What actually constitutes wisdom was a long-standing issue in Gerontology, but a program of research conducted by Paul Baltes and his colleagues has provided a compelling framework for understanding wisdom.  One aspect of wisdom is drawn from experience—factual and procedural knowledge.  That is, a wise person has access to a lot of facts in a domain as well as knowledge about how things work and how problems get solved in that domain.  One implication is that wisdom is not a general characteristic.  Rather, people can act wisely in domains where they have expertise, but may not give “wise” counsel in other domains.

 

Expertise, however, is not enough.  Another aspect of wisdom is what Baltes and colleagues called “excellence in mind and virtue.”  Here, they mean that the wise person strives toward excellence and the common good.  The wise person is not focused on themselves.  They are not saying, “I did it this way, and so that’s what you should do.”  They are instead applying knowledge about a specific situation that takes into account both the situation and the people involved.  Another way to say this is the wise person has empathy, which is another finding in the research conducted by Baltes and colleagues.  


You can see in this definition of wisdom a major difference between the 74 year old outgoing President and the 78 year old President-elect. Or as Senior wrote, the voters “decided to replace a savage clown and chaos-sowing novice with a man defined by decency and nearly half a century of public service.”

 

Aging, of course, has its perils.  The older we get, the more likely something bad will happen.  But Biden’s knowledge and temperament and his concern about other people, all of which have been honed over the course of his life, indicate he is up to the tasks ahead.  

 

 

Link to “Stop Worrying About Biden’s Age” by Jennifer Senior

https://www.nytimes.com/2020/11/12/opinion/biden-age-president.html?referringSource=articleShare

 

To read more about wisdom:  Baltes, P. B., & Smith, J. (2008).  The fascination of wisdom:  Its nature, ontogeny and function,  Perspectives on Psychological Science. 3, 56-64.  doi: 10.1111/j.1745-6916.2008.00062.x


Photo:  Elephant on a stairway in Lisbon.

 

Wednesday, November 11, 2020

The Silly Science Around Alzheimer’s Continues






A week hardly goes by without a new claim about causes of Alzheimer’s disease or cognitive impairment.  The New York Times Health Correspondent, Jane Brody, has never missed an opportunity to hype a potential cause or cure, no matter how suspect the evidence is.  This past week she wrote about vision and hearing loss as possible causes.

This is an idea that has been around for awhile.  And while some scientists make a plausible argument that reduced sensory input might lead to lower cognitive abilities, that is a far step from causing plaques, tangles, strokes, or other dementia-related pathologies.  We have yet to hear a plausible explanation for the biological mechanism the connects hearing loss, which occurs within the ear, or vision loss, which occurs in the eye, to dementia, which occurs in the brain.  Hearing loss and vision loss definitely limit and distort the quality of information a person is able to take in, but they do not cause brain cells to progressively deteriorate the way we know they do in dementia. 


The most plausible explanation is that the findings are an artifact. Think about how cognitive functioning is assessed.  We show someone visual images and/or present verbal information that they are to repeat or remember.  If you can’t see or hear well, you are more prone to make mistakes on tests.  That is a fundamental premise of neuropsychological testing.  Whenever Judy saw someone for testing who had hearing loss her first priority was to be sure that conditions were optimal for hearing (quiet room, speaking in a low register and projecting her voice directly to the person), and when that wasn’t sufficient, using written materials to supplement verbal instructions.


Imagine dear old Uncle Bill, who is hard of hearing, being asked a standard dementia screening question:  “What’s today’s date?”  And Bill answers, “I haven’t been on a date in years.”  How might that answer be interpreted?  Before jumping to the conclusion that he has dementia, it’s important to consider he didn’t hear the question correctly.  Or maybe he’s just a wiseass.  Either way, it may not be dementia.


Many of the studies that have reported correlations between hearing loss and cognitive function have been conducted over the phone.  It’s hardly an optimal way to assess someone with hearing loss.  But even clinical studies may confound hearing loss and cognitive problems, if the person conducting the tests is not well-trained.  The studies are also largely correlational, and don’t show decline in cognition over time.  Brody cites two large studies, one with 3,000 people, and one with 30,000 people, that present correlations of cognition and hearing loss, but a large sample is not necessarily better.  It’s easier to find statistical significance with a large sample, but what is called “effect size,” that is, the size of the association, may be quite small. 


We would all like to know that there is something that we could do that might prevent dementia.  And if we have hearing loss that affects daily life, it would be a good idea to get evaluated for hearing aids or other hearing devices, because that could make things easier at least in some situations.  But that’s a far cry from advising someone to get hearing aids in order to prevent the development of dementia.

Friday, October 30, 2020

How Are You Doing?


 

How are you doing?  We are getting along well.  We are not seeing our grandkids as much as we’d like or traveling or doing other things we enjoy.  But we are doing all right.

 

It’s the country we are worried about.  This is the most important election in our lives.  We have had presidents in the past who lied (Nixon about Watergate, Johnson about Vietnam), but we have never had a president who lies constantly and threatens to destroy our democracy.

 

We urge you to vote, if you have not done so already.  And get your friends and relatives to vote, too.  

 

If you are still undecided, or know someone who is undecided, take a look at the excellent column by Nicholas Kristof (link is below).

 

At the beginning of the primaries, we wrote a blog suggesting that Biden (and Trump, too) were too old to be president.  Joe has shown us to be wrong during the campaign.  Instead of trying to match Trump in vitriol, he has presented a vision of what this country could become by bringing people together.  He speaks powerfully from his experiences.  He knows that more anger and bitterness will not get us anywhere.  Our country has lots of problems.  Joe promises to get to work on them, with our support.  That’s wisdom that comes with age.

 

We hope to tune back in next week to celebrate the end of this long nightmare.

 

 

Link to Nicholas Kristof’s column:

 

https://www.nytimes.com/2020/10/30/opinion/donald-trump-polarization.html?campaign_id=45&emc=edit_nk_20201030&instance_id=23642&nl=nicholas-kristof&regi_id=60761850&segment_id=42887&te=1&user_id=98f3fcf260219e79a11053d8948e41ec

 

Photo:  Fall colors. Frick Park, Pittsburgh

Saturday, September 19, 2020

The Vote is in!

                                                                    
Not that vote.  But an important vote in our family.  As a diversion from the corona virus, election and other upsetting stories in the daily news, we have been finding wonderful food that can be ordered on-line.  A few weeks ago we ordered babkas from Zabar’s in New York for ourselves and our kids.  They were wonderful.  Even our grandkids were thrilled.  We had tasted Zabar’s babka in the past, but it has been awhile, and we had forgotten how good they could be.

 

But then the question came up—is the chocolate babka better than the cinnamon babka?  You may remember the Seinfeld episode about babkas.  Jerry and Elaine were standing in line, waiting to buy a chocolate babka as hostess gift for the dinner party they were going to.  But the couple a head of them buy the last chocolate babka.  The baker offers to sell them a cinnamon babka, which Elaine calls “the lesser babka.”

 

We thought a taste test of our own was appropriate.  Jerry and Elaine went to Royale Bakery for a babka, but it has closed.  A New York friend of ours said the place to go when you are bringing a babka as a gift is Green’s Bakery in Brooklyn.  So we placed our order.

 

The vote is in.  The winner is (drum roll)  -- the cinnamon babka from Zabar’s.  The consensus was that Green’s chocolate babka was better than Zabar’s, but Zabar’s cinnamon babka was the best overall.  Not the lesser babka at all.

 

FYI.  The Seinfeld episode, “The Dinner Party,” is Season 5, Episode 13, and is available on Prime Video.


  

Saturday, September 5, 2020

What’s in a Name? Could COVID-19 Be too Mild a Name to Gain Compliance with Preventive Approaches?


Why has it been so hard to get people to comply with simple protective approaches that reduce the spread of the COVID-19 virus?  It is a simple matter to wear a mask outdoors and in shops.  It is simple to maintain a safe distance.  Yet go almost anywhere and you see someone with the mask below the nose or hanging below the chin.  Or someone who gets far too close to you.  People complain bitterly that these restrictions are trampling on their freedom. Freedom to infect others?

 

Part of the problem, of course, is due to the politicians, starting at the top, who have minimized risks from the beginning and encouraged people not to take any precautions.  But maybe the problem is partly due to the name, COVID-19 Pandemic.  The word “COVID” does not sound threatening.  It doesn’t carry any meaning.  Would a different name be more motivating for people to take precautions?

 

Looking back in history, plagues had more evocative names.  The Great Plague, also called the Black Death or Bubonic Plague, swept across Europe and Asia several times.  In the 14th century, the Great Plague wiped out between two thirds and three quarters of the population in parts of Europe.  Those names carry some heft to them.  Likewise, other illnesses that led to widespread infection and death had names that conveyed threat:  Small pox, typhus, typhoid, cholera, malaria.  Or more recent names—Ebola and Zika.  And of course, Human Immunodeficiency Virus (HIV/AIDS).  They sound ominous.  Even “Spanish flu” sounds more serious than just ordinary influenza or H1N1 flu.  

 

And why call it a pandemic?  Plague is more dramatic.  It’s something people react to.  The term “plague” calls to mind all those apocalyptic paintings of victims from the 14th century and later plague outbreaks.  New York Times columnist Roger Cohen recently quoted Camus, who wrote that the plague “never goes away. It is waiting to exploit stupidity.”  That fits our response. 

 

What, then, should we call it that would better get attention?  President Trump started calling it the China Virus, which everyone saw as just another attempt to divert attention from his incompetence in letting the virus spread in the US, even as much of the world was implementing shutdowns and other efforts to control the virus. Such as wearing masks.

 

But it is not just that COVID-19 originated in China.  Viruses have regularly been making the jump from animals to humans in China.  The source is believed largely to be markets where wild animals are sold for food.  For years, the US and other countries have been talking with China about closing these markets, and there is some indication that they may be willing to do so. That would be an important step that could reduce the annual flu epidemic and prevent other novel viruses such as COVID-19.

 

To further that goal, we thought that COVID-19 should be re-named for one of its animal hosts, bats.  Bats are ugly.  We use their images for decorations for Halloween.  But Bat Virus is not strong enough.  Bats play an important role in eating mosquitoes in this country, and, after all, they are not responsible for the virus.  So we propose instead that COVID-19 be renamed the Bat Shit Plague.  There’s nothing nice or comfortable about that.  The bat isn’t being blamed directly.  And the name conveys how terrible the virus has been.  Maybe people unwilling to take precautions for COVID-19 will take steps to avoid the Bat Shit Plague. It’s a thought.

 

 

  

  

Wednesday, September 2, 2020

In the Midst of the Covid19 Crisis, Ageism Raises Its Ugly Head








Ageism been there all along during the COVID pandemic.  There was the quote a few months ago from Dan Patrick, the Lieutenant Governor of Texas, “Lots of grandparents would rather die than see health measures damage the US economy.”  It was only a matter of time before a national politician would raise that argument.  And there it was last week.  President Trump passed along a tweet claiming that only 6% of all deaths attributed to COVID 19 were actually due to the virus, and “the other 94% had 2-3 other serious illnesses & the overwhelming majority were of very advanced age.”  So they don’t matter.  The figures are, not surprisingly, also wrong.  But the truth is that many people are willing to write off the deaths of older people.

 

This is particularly the case of older people from disadvantaged groups.  Scholars who study age prejudice often talk about “double jeopardy,” that ageist beliefs and behaviors have an even greater impact on minorities.  Infections and death rates are higher among African Americans.  That’s not surprising, given long-standing disparities in income and access to health care.  African Americans are also more likely to hold jobs that could expose them to COVID 19 and less likely to be able to work remotely.

 

It’s not only despicable politicians and social media trolls who are saying ageist things.  Ageism has been part of the response to COVID 19 in the mainstream media, as documented in a recent article by Bronwen Lichtenstein in The Gerontologist.  Examining the media in the US, United Kingdom and Australia, she found that the vulnerability of older adults was frequently described with name-calling, blame, and “so-be-it” reactions.  There was also considerable debate in the articles she reviewed herd immunity.  Like the Lieutenant Governor of Texas, proponents argued that the herd immunity approach was the best way to support the economy, even though it would likely increase mortality substantially among older people.

 

The country that went full speed ahead to try to reach herd immunity was Sweden.  Their approach of minimizing restrictions had the expected effect of higher rates of illness and mortality, with older people paying a disproportionate price.  Drawing on recent data in the Washington Post, Sweden has a death rate of 575 deaths per million people in the population.  That compares to 610 deaths per million in the UK (which also took a herd immunity approach initially but has since pulled back on it), 545 deaths per million in the US, 111 deaths per million in Germany, and 9 deaths per million in Japan.  Likewise, Sweden is at the high end of countries for deaths in care homes.  Forty-seven percent of all deaths in Sweden occurred in care homes, compared to 45% in the US, 39% in Germany and 14% in Japan.  

 

But despite the expectation that the economy would not suffer if businesses and social interactions continued as usual during the pandemic, Sweden’s economy is not doing particularly well, and certainly not better than its Nordic neighbors, which have much lower rates of infections and mortality.  For example, Denmark has 623 total deaths (107 deaths per million), Norway has 264 deaths (48 deaths per million), and Finland has 335 deaths (60 deaths per million).  

 

The throw away attitude toward older people is most apparent in the death rates in care homes.  Basic procedures for containing infection were woefully inadequate in some facilities in the US and in other countries.  And then there is Japan, which stands out for its very low rate of deaths in care facilities.  It’s not because of a smaller proportion of the population in care facilities. Japan has a universal long-term care insurance program and the number of people in care facilities has grown steadily, and is now about equal to the US, according to the Washington Post article.  The article went on to speculate on what led to the low rates of deaths in care facilities.  One factor was that rates remained low in the population as a whole.  Beyond that, three other factors played a role:  implementation of stronger measures to prevent infections, higher standards of hygiene, and perhaps not surprisingly, the traditional importance of elders in Japanese culture.  

 

Photo:  We found the graffiti message on this old viaduct to be intriguing.  Is it a comment on our times?

 

Source of Statistics for the Nordic countries:  Statista:  https://www.statista.com/statistics/1113834/cumulative-coronavirus-deaths-in-the-nordics/

 

Washington Post, Japan Has the World’s Oldest Population. Yet It Dodged a Coronavirus Crisis at Elder Care Facilities.  https://www.washingtonpost.com/world/asia_pacific/japan-coronavirus-elderly-death-rate/2020/08/29/f30f3ca8-e2da-11ea-82d8-5e55d47e90ca_story.html


https://www.boomlive.in/world/donald-trump-endorses-false-claim-that-cdc-cut-covid-19-death-toll-9580

 

 

Sunday, August 23, 2020

A New Diagnostic Tool for Alzheimer’s Disease: What Does It Tell Us?



You may have read recently about a new, more accurate test for identifying people with Alzheimer’s disease (AD).  Finding a reliable marker of the disease has long been a goal of researchers.  The ability to confirm diagnosis would help improve research of all kinds, but especially drug trials, because there would be more certainty that participants in the trials had Alzheimer’s and not another form of dementia.  An early marker of AD would also be enormously helpful for designing prevention studies.  We know, however, that many stories about Alzheimer’s disease in the media exaggerate or misinterpret the findings of studies. So we decided to take a look at the article about the new diagnostic tool, which has been published on-line in JAMA.

 

The paper reports on findings from three studies of people with and without Alzheimer’s.  The goal of the three studies was to test how well a marker found in blood samples, P-tau217, distinguished between people with a confirmed diagnosis of Alzheimer’s disease and people without the disease. Tau, as you may know, is a protein normally found in nerve cells that can become twisted, forming one of the primary markers of Alzheimer’s disease, neurofibrillary tangles.  P-tau217 is a marker of those abnormal cells.  

 

Study 1 consisted of people with and without dementia who had volunteered to be followed over time until their death.  Plasma samples of P-tau217 were obtained prior to death and compared with postmortem findings in the brain as well as with prior diagnosis.  

 

Study 2 was part of a large Swedish study that was following people with Alzheimer’s Disease and other neuropathological disorders and well as persons without dementia.  Amounts of P-tau217 were compared to other markers of the disease as well as to diagnosis.

 

Study 3 used a sample from an ongoing study in communities in Colombia, where many people have an autosomal dominant gene for Alzheimer’s disease that leads to the disease at early ages, typically when carriers of the gene are in their 40s.  Blood samples were obtained from people with and without the gene who were part of the study.

 

What did they find?

 

Across the three studies, P-tau217 from blood and plasma differentiated between cases of Alzheimer’s disease and non-disease subjects better than or as well as other markers, including findings from PET and MRI scans and samples of P-tau217 from cerebral spinal fluid.  P-tau217 was highly correlated with the amount of tau (tau density) found in the brain at autopsy in Study 1 and with estimates of tau in the brain from PET scans in the other two samples.  In Study 3, people with the dominant gene for Alzheimer’s disease began showing increased P-tau217 in their mid-20s, or about 20 years before symptoms typically occur.

 

What are the implications?

 

            The main take away from the study is that P-tau217 is a reliable marker of Alzheimer’s disease and of one of the main pathologies in AD, neurofibrillary tangles.  The blood test for P-tau217 is easier to administer and less painful than tests using cerebral spinal fluid, and more readily available and less expensive than PET scans, but just as accurate for determining diagnosis as either of the other methods.

 

            But does P-tau217 predict Alzheimer’s among people who are not symptomatic?  Here the media loudly proclaimed that P-tau217 could detect AD up to 20 years prior to symptoms.  This was based on the finding that people in their 20s in the Colombia sample who carried to dominant gene for AD and could expect to become symptomatic in their 40s had elevated levels of P-tau217.  It remains to be determined higher levels of P-tau217 are found years before onset of symptoms only in certain genetic variants of the disease, or if they can be detected early across most or all cases of AD.  That’s a big “if.”

 

Is P-tau217 ready for widespread use for diagnosis?

 

            No.  There are two hurdles that are by no means easy to overcome.  First, there needs to be a reliable cut-off score, that is, how much P-tau217 indicates a disease process.  The cut-off used in this research worked well in differentiating people already characterized as having AD from controls without the disease, but whether that score would work as well in community samples where people may have early symptoms remains to be seen.  Every effort to push diagnosis earlier in the disease process runs the risk of increasing false positive diagnoses.    

 

            The second hurdle is how far ahead can P-tau217 reliably predict AD.  P-tau217 may predict in a sample with a strong genetic determinant, where we know that people holding the gene will develop the disease, but may not do as well as a predictor for other forms of the disease.  Studies to determine how far ahead a P-tau217 score might predict symptoms would take considerable time to conduct—doing the test today and waiting a few years or more to find out who gets the disease and who does not.

 

Do you want to know your risk for Alzheimer’s?

 

            This is, of course, the key question.  Would you want to know?  One reason to consider the test is if one of the rare, dominant gene forms of AD runs in your family.  In that case, getting a genetic test would be more definitive than the P-tau217.  For cases that occur in later life,  60+,  the APO E4 allele has been linked to AD.  The APO E4 is not a dominant gene so having one copy of it does not mean you will get AD, and even having two copies may not result in AD.  Genetic tests can identify if you have one or two copies of the APO E4 allele. 

 

            The other reason to consider the P-tau217 test is if you think you are having symptoms.  Having occasional memory lapses is not reliably a symptom of AD.  Everyone forgets.  But if memory and other cognitive abilities seem to worsen, then the P-tau217 test could help clarify what is behind the cognitive problems. 

 

            But the question still remains – would you want to know?  If you tested positive for a gene associated with AD or for P-tau217, what would you do differently?   What changes would you make in your life?

 

            Growing older has been described by our friend Bo Malmberg as “sooner or later.”  Sooner or later, something bad will happen.  The implication is to live a full life now.  

 

            

 

Reference:  Palmqvist, S., et al. (2020).  Discriminative Accuracy of Plasma Phospho-tau217 for Alzheimer Disease vs Other Neurodegenerative Disorders.  JAMA, doi:10.1001/jama.2020.12134 (published on-line with free access).  

 

 

 

 

            

 

 

 

 

 

 

Wednesday, August 12, 2020

Celebrating National Chocolate Chip Cookie Day

 


You may have missed it but Tuesday, August 4, was National Chocolate Cookie Day.  What a wonderful idea!  Our grandson Sam was spending the day with us, and Judy decided that some Grandma-Grandson baking was in order.  They had great fun and the cookies turned out perfectly.  The bowl they were using is the same one Judy used with the kids when they were young, too.  And as you can see in the photos, Sam and Judy were able to be safely masked during the baking.  Just so you know he wasn’t left out, Steve was also safely masked during the cleanup.  

 

Cooking and baking are ways we have connected with our grandkids.  They all like to help out, and they all love eating the results.  

 

While helping Sam, Judy realized she has been making this recipe for chocolate chip cookies for 53 years.  The only change has been to use better quality ingredients which she couldn’t afford or weren’t available when she was young—Penzey’s Vanilla, Kerrygold Irish butter, and Guittard chocolate chips.  Our kids have their favorite recipes from when they were growing up, and that led Judy to put many of the family favorites on her cooking blog.  Steve also makes a few recipes from his mother, including a very tasty Poppy Seed Biscuit.  Making family favorites for our children and grandchildren helps us convey something about the past to our family. 

 

You can find the recipe for chocolate chip cookies on Judy’s blog at http://jzcooks.blogspot.com/2012/09/   The recipe follows the section on baking and cooking measures.  Or browse through for other recipes for cookies and brownies.

 

Wednesday, August 5, 2020

Is the Pandemic an Opportunity for Improving Support to Caregivers

 







The New York Times recently ran an opinion piece titled “Biden’s Quietly Radical Plan.”  The column by Bryce Covert describes plans announced by Mr. Biden that would provide universal pre-school and improve long-term care services for older people.  

 

The COVID pandemic has brought into the open how important caregiving is to our society, whether it is care for young children or for older adults.  As COVID restrictions were gradually being lifted, parents of young children could not return to work because child care and pre-school programs remained closed.  With the school year approaching, parents are facing the dilemma of what to do with their school age kids if their schools go to remote learning.  

 

For older adults, the pandemic revealed how poorly prepared many nursing homes and other residential facilities are for protecting the health of residents.  But trying to keep someone at home where they may be safe poses its own problems, particularly, difficulties finding and retaining qualified caregivers who are virus-free to help out in the home.  Mr. Biden’s proposal would improve wages for home care workers and also improve their work situation.  

 

We need to remember that life before the pandemic was already hard and getting harder for many people.  Needs such as affordable child care and services to support older people to remain at home are routinely addressed in almost all other advanced economic countries, but the US has remained mired in outdated beliefs about care.  There was a time when most women didn’t work outside the home and could care for children or parents at home.  And that was a time, too, when most people did not live to advanced age, so there were not as many older people who needed care.  The idea that families should do it all is as antiquated as a statue of Robert E. Lee. 

 

So maybe we have an opportunity.  The impact of the COVID pandemic and the utter incompetence of the Trump administration have made people more aware of how backward our country has become in so many ways.  This can be the time when we start taking the steps to make caring for young and old more manageable and humane.  We are not likely to become Denmark overnight, but there is much that we can borrow from the Danes and other countries about providing for basic needs for children and older adults and other individuals with special needs.

 

You can find Bryce Covert’s article, “Biden’s Quietly Radical Plan,” at this link:

https://www.nytimes.com/2020/08/02/opinion/biden-child-care.html?action=click&module=Opinion&pgtype=Homepage

Monday, July 13, 2020

Keeping Sane in an Insane World


Southern Oregon Coast


We find it hard to stay focused with all the chaos around us—the dramatic upswing in Covid 19 cases, the relentless incompetence in Washington, the unceasing anxiety about the election.  So while it is hard to have any insights about the aging process, we do find occasional tidbits that bring a smile.  Here are a few recent ones:

You probably read that Carl Reiner died recently at age 98.  He was one of the great comedians of early television, and continued his career over the years as a writer, director and performer. We liked this observation that he made a couple of years ago on living a long life:  “If you are not in the obits, eat breakfast.”  In other words, just keep going and hold onto your sense of humor.  That's a good message for what we are all going through.

If you haven’t seen Carl Reiner perform, the New York Times provided links to some of his work, including a clip of him and Mel Brooks doing their 2000-Year-Old Man routine.  Or try to see clips from “Your Show of Shows,” which was perhaps the pinnacle of tv comedy in the 1950s.  Many of the movies he directed are quite good, too. 


Another comedian who lived to 100, George Burns, also had a comical view of his own aging.  In his 90s, he was quoted as saying that he was so old he would no longer buy green bananas.  He made a comeback in his career beginning in his late 70s, appearing in several movies, and winning an Oscar for best supporting actor in The Sunshine Boys.  He also played God in three movies (“Oh God,” and “On God Book II,” and Oh God! You Devil), which he did with his trademark cigar and a wry sense of humor.  At a time when there was little attention to the possibility of living well in old age, he presented a very positive image. 

We are both reading more widely than in the past.  I (Steve) previously mentioned I was working my way through the epic trilogy by Rick Atkinson on World War II in Western Europe.  The books are amazing, particularly in using quotes and letters to describe the experience of ordinary soldiers.  Modern warfare is horrible and everyone should know that.  

The books also have their share of odd anecdotes.  One I just came across involved the decisive battle in the West, the Battle of the Bulge.  In preparation for their attack, the Germans pulled together a unit of soldiers who spoke some English.  The plan was to dress them in uniforms taken from American prisoners and have them infiltrate American units, where they would carry out acts of sabotage.  Although the soldiers spoke some English, their trainers recognized that they didn't seem very American.  So the trainers came up with a plan--the soldiers were taught to mimic American cigarette-smoking techniques and other mannerisms by studying Humphrey Bogart in Casablanca. 

It didn’t work.  Most were caught, or made their way back across the German lines.

One more oddity:  For those of you who live in or near Pennsylvania, you will be interested in the following.  The governor’s office has released information about UFO sightings in the state in the last 6 months.  You can view the locations using the link below.


I guess the governor likes a good laugh, too.

Thursday, May 7, 2020

Small Pleasures

Blondies


Like all of you, we are staying mostly at home these days, and have found that simple, unexpected things sometimes brighten up the day.

Like receiving face masks in the mail.  We had other masks but this batch made us smile.  The masks were from a tailor who prior to the shutdown sold custom-made suits.  The masks are well-made, the material used is comfortable, and on the front is written: “We’re all in this together.”  And best of all, for every mask sold, a donation goes to the Coronavirus Relief Fund to support immediate and long-term relief and recovery in vulnerable communities during one of the most challenging times we have collectively faced.  Getting a big box of toilet paper delivered also made us smile, but the masks were cooler.

You can order through this site:  https://davidalanmasks.com

Like baking.  Judy has been on a tear—cookies, scones, cupcakes, brownies.  We take part of each batch over to our son, daughter-in-law and grandkids.  The last delivery was blondies.  Our grandkids had previously ignored blondies, but this time they became enthusiastic fans.  We smiled hearing that they liked the blondies, which have always been a special treat in the family.    

You can find Judy’s blondie recipe at:  https://jzcooks.blogspot.com/2012/08/blondies.html

Like contributing to the Pittsburgh Food Bank.  Like other places in this country, there are lots of people who do not have enough money for food, and the food banks have been overwhelmed.  We have been making regular donations to the food bank, but on May 5 we made an extra donation.  Bank of America had arranged to match all the donation for that day.  When we lived in California, Bank of America was neither community nor customer friendly.  It was a long time ago, but it gave us pleasure to help get the matching funds from Bank of America.

Like discovering Schitt’s Creek.  Have you seen it?  It’s a bit hard to get into, because the characters can be annoying, but the show becomes addictive.  I’m in the fifth season and Judy is at the end of the sixth and final season.  I watch at the end of the evening.  It makes me laugh and leaves me relaxed.  

Like having baseball to watch.  Baseball is back.  Not in the US, but in Korea.  ESPN has begun broadcasting games from the Korean Baseball Organization (KBO).  According to the articles I have read, the quality of the games fall somewhere between A and AAA minor leagues in the US.  I went to State College Spikes games for many years, which were an A league team. Games were quite entertaining.  The play in the Korean league is described as traditional, with lots of bunting and base stealing.  There are some different customs, too.  Bat flipping after a home run is fine, but spitting is not allowed.  When I read that, all I could think of is the hilarious spitting scene in the movie Naked Gun.  Games are broadcast live early in the morning, but rebroadcast in the afternoon.  Here’s more information about the KBO.


Like having time to read.  I have always been a reader, usually finding time at the end of the day or when on vacation, but now I can sit down with a book whenever I feel like it.  I have read a lot of light, entertaining books—spies and sleuths mainly, but I also like history.  

A few weeks ago I picked up a book that had been on the shelf for ages, An Army at Dawn by Rick Atkinson.  It is the first book of a trilogy of the history of US involvement in North Africa and Europe during World War II, and I am now nearly done with the second book, The Day of Battle.  Atkinson is a very good and engaging writer.  The biggest surprise for me has been how inept many of the US and British generals were.  They seemed to have learned nothing about tactics, but often just pushed ahead against heavily fortified positions.  Didn’t any of them study the Civil War and Robert E. Lee?  It’s always better to be on high ground than to try to attack from below.  

We won the war because of the great courage and sacrifice of our soldiers, and because we could overwhelm Germany and Japan with our resources.  For four years, the country built almost no new cars, but tens of thousands of jeeps, tanks, planes, ships, guns and so on.  There was rationing, shortages, and other privations, but President Roosevelt’s leadership brought the country together and helped everyone accept the need to put all our resources into the war effort.  It’s a big difference from today with people whining about not being able to do whatever they want, even if it means spreading the COVID-19 virus.

There is a quote I love in An Army at Dawn.  During the battle for Tunisia in 1943, the chief of staff for the commander of the German forces wrote about the irrational demands being made by Hitler: “Hitler wanted to be stronger than mere facts, to bend them to his will.  All attempts to make him see reason only sent him into a rage.”   Does that sound a bit familiar to you?  

Postscript.

I have now completed The Day of Battle.  There was at least one American, Major General Fred Walker, who had studied Robert E. Lee.  Walker was ordered to make one more frontal attack on a critical high point in the Anzio area of Italy held by the German army, Colli Laziali, after several frontal attacks had already failed.  Walker laid awake that night wondering what General Lee would have done.  He remembered that army patrols had reported there was an old cart path that led up the mountain that led up to unfortified areas between two German units.  He convinced his commanding officer to attack up this path.  The result was a breakthrough that led the German units to withdraw and contributed to the collapse of the whole German defense in that part of Italy.  

Interestingly, General Walker was the oldest division commander in the field.  Perhaps it was the perspective of age that led him to look to the past for a solution

Sunday, April 26, 2020

What Does a Starfleet Captain Do in Retirement?



Jean-Luc Picard, the former captain of the Enterprise, retired to his family vineyard in France.  It is a beautiful setting and a quiet life for someone who previously explored the far corners of the universe.  Like many people who are retired, however, Picard looked back at his work and was troubled by the things he regretted and had left undone.  So when he is approached by a young woman seeking his help, he jumps back in to find redemption for a terrible set of events that he felt responsible for.

That’s the starting point for the new series, “Picard.”  It’s built around a prototypical retirement story, except maybe for the space travel and phasers.  The young people in Starfleet don’t want Picard back, and view him as a relic.  He can’t climb stairs or run any distance without getting winded, and he’s not up-to-date on the latest technology.  But with the help of some old and new friends, he throws himself into the midst of events that threaten the known universe.  A fun task for retirement.

Picard was always the most thoughtful and reflective of the Star Trek captains.  Captain Kirk would talk about the “Prime Directive,” which prohibits Starfleet missions from interfering with the development of alien civilizations, but which in the end Kirk often ignored.  Ethical dilemmas, however, were at the heart of many of the conflicts that Picard and his crew faced on the Next Generation series and play a prominent role in the new Picard episodes.  Luke Skywalker had a contrasting retirement, sulking on a remote island seeking enlightenment that he didn’t seem to have found.  Where the Star Wars franchise has relied on special effects and cartoonish battles to make up for a lack of new ideas, Picard has gone forth boldly, though a bit more slowly than in the past.  He’s not an action hero.  Rather, he is a wise person who has an unfaltering understanding of the importance of doing the right thing.  It helps that Patrick Stewart, who plays Picard, is such a fine actor.  

The series has been great fun to watch, a nice diversion in our current dilemmas.  I’m now enjoying the other new Star Trek show, Discovery.  It’s entertaining, though you have to get past the first two episodes.

And if you are really serious about Star Trek, and who isn’t, I just read that Tribbles are available on e-Bay.




Friday, April 17, 2020

Covid-19 Deaths in Nursing Homes: Why It Is Important to Consider Causes and Solutions

Sunset over Lake Vattern in Sweden

This headline in yesterday’s Washington Post caught our eyes: “Covid-19 is ravaging nursing homes.  We’re getting what we paid for” (see link below).  There’s no question that clusters of infections and deaths have been common in nursing homes across the country, as well as other countries such as the UK where statistics on prevalence of Covid-19 has been reported.  Half of the deaths in Pennsylvania have been among nursing home residents and staff.

We should not be surprised.  Nursing home residents constitute the most vulnerable group in society.  But it’s not just that residents are old and frail.  Rather, the articles we have seen report that the nursing homes and assisted living facilities that had clusters of cases did not take the steps needed to protect residents and staff.  We want to be clear that there are excellent, well-run residential facilities for older people that have done a good job of protecting residents and staff.  The point raised in the Post article is that inadequate funding for nursing homes is a long-standing issue and so it should not be surprising that there are deficiencies in responding to a crisis like Covid-19. 

Nursing homes are not the only problem area.  The Covid-19 crisis has revealed many weaknesses in our health and public health infrastructure.  Federal and state governments have spent the last few decades cutting back public services and investments in health, education and most everything else.  With all the people who still have no health insurance or lost their insurance when they lost their jobs, it’s clear that we need universal health care.  We also need the state and federal government to have the infrastructure to respond in a crisis, for example, with more efficient ways of delivering unemployment benefits.  And then there is testing and tracking of the virus.

But once the crisis is past and there are discussion about building our infrastructure, let’s not forget long term care. The US alone among economically-advanced countries has no program of universal long term care.  Instead, we have a rickety system of funding.  People who can pay privately for care can often, but not always, receive good care.  But the typical nursing home that depends primarily on Medicaid will, despite good intentions, struggle to provide a high quality program.  

Here is a modest list of what we need, or at least where to start.

1.     Along with discussions of universal health care, we need to advocate for a national program of long term care insurance that will assure that people get good quality care when they need it.  We could follow the model instituted in Japan and South Korea, where the tax funding long term insurance goes into effect when people turn 40.  That way, the tax burden does not fall on young workers, who tend to have lower earnings.  And by 40, most of us have realized we may need to help aging parents, and indeed, that we may need help for ourselves.

2.     Long term care programs, and indeed, all of health care, should be run either by government or by non-profit organizations.  Simply put, when there is a choice between paying for improved care or maximizing profits, it is too easy for administrators and owners to cut corners that improve their bottom line.  We have seen that happen over and over.  Some of the worst clusters of Covid-19 have been in for-profit nursing homes.  They didn’t pay for adequate staffing or for taking the steps to protect residents and staff.  When owners of these programs have been identified by the press, they often hide or refuse to comment.  

The perversions caused by using a business model that prioritizes profits over care affects all of health care.  With nursing homes, however, the effects are particularly pernicious because residents are the least able to advocate for themselves and because we have such low expectations for quality of care.

3.     We need stronger programs for helping older people remain at home.  Almost no one wants to end their life in a nursing home.  But while we have given lip service to supporting people to remain at home, the system of community services remains fragmented and inefficient, and workers are typically poorly paid and trained.  All-too-often, community service agencies make excuses instead of delivering the type of help that people need that will keep a frail person at home.     

4.     The people who work in aging services need better training.  We have each been in this field for over 40 years, and it is frustrating to say that we have not made much progress in training the front-line people better.  Everyone from administrators to nurses to the aides that deliver the care needs specific training in aging and long-term care.  All too often, the training people receive involves how to meet various state and federal requirements and not how to provide optimal care.

In the US, a certified nursing assistant receives 75 hours of training.  By contrast, in Sweden where nursing home care as well as community services are generally quite good, care assistants (vardbiträde) receive one year of training, and nursing assistants (undersköterska) complete three years training.  Pay is not great, but it is relatively better than in the US, and everyone—employees and their families—are covered by the Swedish national health care.  As a result, they can live on their salary.  Workers can also gain the training needed to move up, from care assistant to nursing assistant to nurse.  Tuition is free. We saw one recent article that proposed extending the GI bill education benefits to health care providers working with Covid-19 patients. That would be quite a nice step forward.

5.     The best facilities we have visited over the years in the US has someone in charge, either the administrator or director of nurses, or both, who has a vision of what good care means.  They pay attention to the details of everyday care, and make sure that all staff share the same values around good care.  We need to find more people like that, reward them, and make sure their voices are heard. 

There are likely to be shakeups in how we do things in this country, once the immediate crisis diminishes.  We need to make sure that long term care gets included in the discussion.  

Reference: