tag:blogger.com,1999:blog-62639585045483661182024-02-19T07:24:52.826-08:00The Gift of AgingThe Baby Boomer's Guide to Midlife and BeyondJudy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.comBlogger117125tag:blogger.com,1999:blog-6263958504548366118.post-24002764830658238212021-06-26T10:54:00.000-07:002021-06-26T10:54:05.615-07:00Old People Have a Drug Problem<p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; text-align: center;"><br /></p><p style="font-family: Helvetica; font-size: 12px; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px; text-align: center;"><br /></p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px;"><span class="Apple-tab-span" style="font-size: 12px; white-space: pre;"> </span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxIf_I4NLjSKlLBQTgRZpX5FcvWK9yGUW7cgk2zm96Bdcfe43WOXD9-SNTahEadMjZdD8sj30SfBMPgWJ79-vg5PFPWRbn0wyPZlr3fh6sINUBI_pJzejdp2ip-5xfv255L30JrujmISw/s2048/IMG_8609.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1365" data-original-width="2048" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxIf_I4NLjSKlLBQTgRZpX5FcvWK9yGUW7cgk2zm96Bdcfe43WOXD9-SNTahEadMjZdD8sj30SfBMPgWJ79-vg5PFPWRbn0wyPZlr3fh6sINUBI_pJzejdp2ip-5xfv255L30JrujmISw/s320/IMG_8609.JPG" width="320" /></a></div><p></p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px; text-align: center;">Blood Moon 2021</p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px; text-align: center;"><span class="Apple-tab-span" style="font-size: 12px; white-space: pre;"> </span></p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px;"><br /></p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px;">There is a new drug problem that affects older people directly, but really also everyone else. It is the drug that the FDA recently approved, Aducunumab—or Aduhelm, which is its brand name. It is a drug designed to treat Alzheimer’s disease by reducing the size of one of the pathologies associated with the disease, amyloid plaques. The problem is—the drug may have only a minimal benefit.</p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><span class="Apple-tab-span" style="white-space: pre;"> </span></p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px;"><span class="Apple-tab-span" style="white-space: pre;"> </span>Many of you have probably been following the controversies around Aduhelm. Two trials by the drug company, Biogen, failed, but then the company conducted a re-analysis and found that one arm of the trial had positive results. The benefits, however, were fairly minimal—a 4 month period during which cognitive decline of participants slowed and some reduction of the amount of amyloid in the brain. </p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px; text-indent: 36px;"><br /></p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 36px;">There are three problems here. First is the research is flawed. As two researchers, Aaron Kesselhelm and Jerry Avorn wrote in <i>The New York Times</i>, this was the worst example of how the FDA has been lowering research standards. Conducting a re-analysis can be warranted, because benefits might be found in a specific subset of participants or with some other combination of dosage and other variables, but any time you reanalyze data it increases the possibility of a chance finding. In other words, this type of positive outcome that was found searching through the data needs to be confirmed in a new, independent study, and not used as evidence of efficacy of the drug. </p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px; text-indent: 36px;"><br /></p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 36px;">Second, the benefit of the drug is fairly minimal. The cognitive benefits—a slowing of decline for a short period of time—are not as good as results of cognitive stimulation studies conducted in the UK and other European countries or the results of the excellent cognitive rehabilitation training study conducted in the UK by Dr. Linda Clare and her colleagues, who showed that both cognition and brain activity increased with training. As for Aduhelm’s effect on amyloid, other drug trials have shown that reducing the amount of amyloid does not necessarily have clinical benefits for cognition. In other words, removing amyloid does not change the underlying damage done by the disease.</p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px; text-indent: 36px;"><br /></p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 36px;">Third, the drug was tested mainly on persons with mild dementia symptoms, but the FDA approved the medication for use by anyone with dementia. It is not obvious that persons with more pronounced symptoms will benefit and the risk of harm is likely to be greater. The medication can result in brain swelling or hemorrhaging. To monitor those risks, patients need regular MRI scans, which could be difficult for persons with more advanced Alzheimer’s disease. Treatment, which consists of a monthly infusion, may also be a challenge for anyone, but particularly persons with significant cognitive decline.</p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px; text-indent: 36px;"><br /></p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 36px;">So why was the drug approved? We are sure you have guessed. Money. The FDA was heavily lobbied by the drug companies. According to an analysis in Upshot section of <i>The New York Times, </i>the estimated annual costs for treatment will be $56,000 for the drug alone, <span class="Apple-tab-span" style="white-space: pre;"> </span>plus additional costs for MRIs to monitor for brain swelling. That works out to somewhere between $5.8 billion and $29 billion in annual costs for Medicare and its enrollees. It means that everyone on Medicare will likely face substantial increases in their premiums to pay for this overpriced and largely ineffective drug.</p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px; text-indent: 36px;"><br /></p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px; text-indent: 36px;">Another factor in the approval was lobbying from the Alzheimer Association and other advocates. The argument they make is that we need to offer hope for people with an Alzheimer diagnosis. Doctors and other health care providers will argue that they need to have something to offer a patient when the diagnosis of Alzheimer is made. This was one of the arguments put forward for the previous Alzheimer medications that were approved. These medications (Aricept, Exelon, and Razadyne) have little or no benefit, other than placebo effects, but at least the side-effects are fairly minimal. We should have compassion for people with Alzheimer’s and other neurodegenerative diseases, but it is not compassionate to make false promises. Instead of filling the coffers of the drug companies, why don’t we for once follow the research, and make the behavioral and cognitive programs that have been shown to be effective more widely available to persons living with dementia and their family members.</p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px;">References:</p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px;">Claire, L., et al. (2018). Cognitive rehabilitation, self-management, psychotherapeutic and caregiver support interventions in progressive neurodegenerative conditions: A scoping review. <i>NeuroRehabilitation, DOI:10.3233/NRE-172353.</i></p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px;">Katz, J., Kliff, S., & Sanger-Katz, M. New drug could cost the government as much as it spends on NASA. <i>The New York Times, </i>June 23, 2021.</p><p style="color: #0b4cb4; font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px;"><span style="text-decoration: underline;"><a href="https://www.nytimes.com/2021/06/22/upshot/alzheimers-aduhelm-medicare-cost.html?searchResultPosition=5">https://www.nytimes.com/2021/06/22/upshot/alzheimers-aduhelm-medicare-cost.html?searchResultPosition=5</a></span><span style="color: black;">.</span></p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px;">Kesselhim, A., & Avorn, J. The FDA has reached a new low. <i>The New York Times, </i>June 15, 2021.</p><p style="color: #0b4cb4; font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px;"><span style="text-decoration: underline;"><a href="https://www.nytimes.com/2021/06/10/health/aduhelm-fda-resign-alzheimers.html?searchResultPosition=4">https://www.nytimes.com/2021/06/10/health/aduhelm-fda-resign-alzheimers.html?searchResultPosition=4</a></span><span style="color: black;">.</span></p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><br /></p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px;">Woods, B., Aguirre, E., Spector, A. E., & Orrell, M. (2012, Feb). Cognitive</p><p style="font-family: Helvetica; font-stretch: normal; line-height: normal; margin: 0px;">stimulation to improve functioning in people with dementia. <i>Cochrane Database Systematic Review, </i>DOI: 10.1002/14651858.CD005562<i>.</i></p><div><i><br /></i></div>Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com1tag:blogger.com,1999:blog-6263958504548366118.post-39684939178524684852020-12-18T11:55:00.001-08:002020-12-18T11:55:45.945-08:00Finding Small Comforts<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjomZTfskrxWMgD6frEiFPztp-iQ9pNG7RTYuZaNMTbpoS9PfMs1H-BSSgszhyPTFTLRl0XkUzY5pCqG3-xno7GHCDvvwSvpn3IBpxaGYsfWJ4dmY0cVtW82kwPzDUvgzGeak6aqITsdvw/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="1288" data-original-width="2048" height="201" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjomZTfskrxWMgD6frEiFPztp-iQ9pNG7RTYuZaNMTbpoS9PfMs1H-BSSgszhyPTFTLRl0XkUzY5pCqG3-xno7GHCDvvwSvpn3IBpxaGYsfWJ4dmY0cVtW82kwPzDUvgzGeak6aqITsdvw/" width="320" /></a></div><p></p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px; min-height: 12px;"><br /></p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;">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. </p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px; min-height: 12px;"><br /></p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;">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.</p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px; min-height: 12px;"><br /></p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;">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? </p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px; min-height: 12px;"><br /></p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;">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. </p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px; min-height: 12px;"><br /></p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;">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.</p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px; min-height: 12px;"><br /></p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;">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.</p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px; min-height: 12px;"><br /></p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;">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.</p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px; min-height: 12px;"><br /></p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;">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.</p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;"><br /></p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;">You can find the recipe in Judy’s food and baking blog, Tasty Treats, at </p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;">https://jzcooks.blogspot.com/search?q=poppy+seed+cookies</p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;"><br /></p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;">There are two minor additions to the recipe: </p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;"><br /></p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;">1.Put the butter and shortening in the freezer for about 10 minutes before cutting them into the dry ingredients. </p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;"><br /></p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;">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. </p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;"><br /></p><p style="font-family: "Helvetica Neue"; font-stretch: normal; line-height: normal; margin: 0px;">Keeping the butter and shortening as cold as possible will lead to lighter and tastier cookies. Of course, they are even more addictive then.</p><p><br /></p>Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com0tag:blogger.com,1999:blog-6263958504548366118.post-86225286273615922232020-11-12T13:14:00.000-08:002020-11-12T13:14:38.596-08:00Is Biden Too Old or Have Other Presidents Been Too Young?<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhey9Ncc1v4a-C6UuDGYiLWneHG-d_98wPm6KT-V8Vw7vtDjKXcAAsa1EomR1hY6Ny_gG404ETi3xdDcPxofiLYoutm66_v9wlgjhZWplMelp9yO_Zfs0m0mGnzuAVxXrTgWdFqBsmjcLw/s2048/IMG_6813.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2048" data-original-width="1370" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhey9Ncc1v4a-C6UuDGYiLWneHG-d_98wPm6KT-V8Vw7vtDjKXcAAsa1EomR1hY6Ny_gG404ETi3xdDcPxofiLYoutm66_v9wlgjhZWplMelp9yO_Zfs0m0mGnzuAVxXrTgWdFqBsmjcLw/s320/IMG_6813.jpeg" /></a></div><span style="font-family: Calibri, sans-serif;"><p><span style="font-family: Calibri, sans-serif;"><br /></span></p>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.</span><span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;">She points out the positive things that can happen as we age.</span><span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;">Like experience and expertise.</span><span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;">Many people have pointed out that Joe Biden knows how Washington works and can draw on that experience to get things done.</span><span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;">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.</span><span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;">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?</span><span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;"> </span><p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">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.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">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.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">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. </p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><br /></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">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.”<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">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. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Link to “Stop Worrying About Biden’s Age” by Jennifer Senior<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.nytimes.com/2020/11/12/opinion/biden-age-president.html?referringSource=articleShare" style="color: #954f72;">https://www.nytimes.com/2020/11/12/opinion/biden-age-president.html?referringSource=articleShare</a></span><o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">To read more about wisdom: Baltes, P. B., & Smith, J. (2008). The fascination of wisdom: Its nature, ontogeny and function, <i>Perspectives on Psychological Science. 3, </i>56-64. doi: 10.1111/j.1745-6916.2008.00062.x<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><br /></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Photo: Elephant on a stairway in Lisbon.</p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p>Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com1tag:blogger.com,1999:blog-6263958504548366118.post-4287542277284076432020-11-11T09:55:00.000-08:002020-11-11T09:55:40.836-08:00The Silly Science Around Alzheimer’s Continues<p><span style="background-color: white; color: #262626; font-family: Calibri;"><br /></span></p><p><span style="background-color: white; color: #262626; font-family: Calibri;"><br /></span></p><p><span style="background-color: white; color: #262626; font-family: Calibri;"><br /></span></p><p><span style="background-color: white; color: #262626; font-family: Calibri;"><br /></span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9H6vXsYosRVEtNiMldnkzbR_SEpNjH-vffq2lIO-jYfDfjvMJz09t-4QwzaiNt68DVa0jiEtLhFzUFsFszRrgqyLn3mN59DsHtNdNZPOIaE3PmDGNgplxqcRMZv3d6HlKUKwdol3odrU/" style="margin-left: 1em; margin-right: 1em;"><img alt="" data-original-height="1365" data-original-width="2048" height="368" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9H6vXsYosRVEtNiMldnkzbR_SEpNjH-vffq2lIO-jYfDfjvMJz09t-4QwzaiNt68DVa0jiEtLhFzUFsFszRrgqyLn3mN59DsHtNdNZPOIaE3PmDGNgplxqcRMZv3d6HlKUKwdol3odrU/w553-h368/IMG_8278.jpeg" width="553" /></a></div><p></p><p><br /></p><p><span style="font-family: arial;"><span style="background-color: white; color: #262626;">A week hardly goes by without a new claim about causes of Alzheimer’s disease or cognitive impairment.</span><span style="background-color: white; color: #262626;"> </span><span style="background-color: white; color: #262626;">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.</span><span style="background-color: white; color: #262626;"> </span><span style="background-color: white; color: #262626;">This past week she wrote about vision and hearing loss as possible causes.</span></span></p>
<p style="background-color: white; color: #262626; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-family: arial;">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 <i>cause</i> brain cells to progressively deteriorate the way we know they do in dementia. </span></p>
<p style="background-color: white; color: #262626; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><span style="font-family: arial;"><br /></span></p>
<p style="background-color: white; color: #262626; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-family: arial;">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.</span></p>
<p style="background-color: white; color: #262626; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><span style="font-family: arial;"><br /></span></p>
<p style="background-color: white; color: #262626; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-family: arial;">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.</span></p>
<p style="background-color: white; color: #262626; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><span style="font-family: arial;"><br /></span></p>
<p style="background-color: white; color: #262626; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-family: arial;">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. </span></p>
<p style="background-color: white; color: #262626; font-stretch: normal; line-height: normal; margin: 0px; min-height: 14px;"><span style="font-family: arial;"><br /></span></p>
<p style="background-color: white; color: #262626; font-stretch: normal; line-height: normal; margin: 0px;"><span style="font-family: arial;">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.</span></p>Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com0tag:blogger.com,1999:blog-6263958504548366118.post-72915082367642420892020-10-30T08:56:00.000-07:002020-10-30T08:56:41.296-07:00How Are You Doing?<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPBkxU2WibB2FB3-OZA0GNEUHvcuLB97wzmJVzr4YbKyYYlOIPmdR0x4sh25M0rfadjYESGB2heuZF6Ma7-P4ynZpl4TE3wY-M4d_B6wsIVXDGvzamG6LvJ_pk6txSHwn2qVuzgtL8JmQ/s2048/IMG_8100.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1365" data-original-width="2048" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPBkxU2WibB2FB3-OZA0GNEUHvcuLB97wzmJVzr4YbKyYYlOIPmdR0x4sh25M0rfadjYESGB2heuZF6Ma7-P4ynZpl4TE3wY-M4d_B6wsIVXDGvzamG6LvJ_pk6txSHwn2qVuzgtL8JmQ/s320/IMG_8100.jpeg" width="320" /></a></div><br /> <p></p><p><span style="font-family: Calibri, sans-serif;">How are you doing?</span><span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;">We are getting along well.</span><span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;">We are not seeing our grandkids as much as we’d like or traveling or doing other things we enjoy.</span><span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;"> </span><span style="font-family: Calibri, sans-serif;">But we are doing all right.</span></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">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.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">We urge you to vote, if you have not done so already. And get your friends and relatives to vote, too. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">If you are still undecided, or know someone who is undecided, take a look at the excellent column by Nicholas Kristof (link is below).<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">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.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">We hope to tune back in next week to celebrate the end of this long nightmare.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Link to Nicholas Kristof’s column:<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="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" style="color: #954f72;">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</a></span><o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p>Photo: Fall colors. Frick Park, Pittsburgh</o:p></p>Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com1tag:blogger.com,1999:blog-6263958504548366118.post-46484004407099551782020-09-19T12:39:00.001-07:002020-09-19T12:39:10.948-07:00The Vote is in!<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiB3M3KYzJE5ZvDsjJ8qbQI5cqqGH4lrD8OwPLd222osHLP7mBdMVrH2EzHGkwSK-DycIrlHau70Yah0WqHwPsJXtgbLDgV7JSA4mG3RBjDalquMQazUb_MsaTAwgDJTkzpKZlAPHI6vLQ/s236/2a82ee9d5c8d90cd77102b081faa6184.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="236" data-original-width="236" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiB3M3KYzJE5ZvDsjJ8qbQI5cqqGH4lrD8OwPLd222osHLP7mBdMVrH2EzHGkwSK-DycIrlHau70Yah0WqHwPsJXtgbLDgV7JSA4mG3RBjDalquMQazUb_MsaTAwgDJTkzpKZlAPHI6vLQ/s0/2a82ee9d5c8d90cd77102b081faa6184.jpg" /></a></div><span> <span> <span> <span> <span> <span> <span> <span> <span> <span> <span> <span> <span> <span> <span> <span> <span> </span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span><div><span style="font-family: arial;">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.</span><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;"><o:p></o:p></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><o:p><span style="font-family: arial;"> </span></o:p></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;">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.”<o:p></o:p></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><o:p><span style="font-family: arial;"> </span></o:p></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;">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.<o:p></o:p></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><o:p><span style="font-family: arial;"> </span></o:p></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;">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.<o:p></o:p></span></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><o:p><span style="font-family: arial;"> </span></o:p></p><p class="MsoNormal" style="margin: 0in 0in 0.0001pt;"><span style="font-family: arial;">FYI. The Seinfeld episode, “The Dinner Party,” is Season 5, Episode 13, and is available on Prime Video.</span><span style="font-family: Calibri;"><o:p></o:p></span></p><br /><span style="font-family: Calibri;"> </span> <p></p></div>Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com1tag:blogger.com,1999:blog-6263958504548366118.post-3711789422173958462020-09-05T13:33:00.000-07:002020-09-05T13:33:00.224-07:00What’s in a Name? Could COVID-19 Be too Mild a Name to Gain Compliance with Preventive Approaches?<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQZ8irxwnWITmL4t5edeSQ_g8Qkkg0Vep5-k0urcmAEGv3_R3knvVNUZmn1gjb3OsXaLalCTGT7hvixmU0GechrsO9gZ1LB5xJJO_q7wetrT_U8mbBuOFyQ3QpN8uJPzMcQ9Uraz1nowQ/s920/e9d7424a090378b02424d96307005968.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="673" data-original-width="920" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQZ8irxwnWITmL4t5edeSQ_g8Qkkg0Vep5-k0urcmAEGv3_R3knvVNUZmn1gjb3OsXaLalCTGT7hvixmU0GechrsO9gZ1LB5xJJO_q7wetrT_U8mbBuOFyQ3QpN8uJPzMcQ9Uraz1nowQ/s320/e9d7424a090378b02424d96307005968.jpg" width="320" /></a></div><br /><p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">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?<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">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?<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">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 14<sup>th</sup> 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. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">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 14<sup>th</sup> 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. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">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.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">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.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">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.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"> <o:p></o:p></p><p><span style="font-family: Calibri, sans-serif;"> </span> </p>Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com0tag:blogger.com,1999:blog-6263958504548366118.post-30625003597494374412020-09-02T07:51:00.007-07:002020-09-02T07:57:41.621-07:00In the Midst of the Covid19 Crisis, Ageism Raises Its Ugly Head<p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><br /></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><br /></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><br /></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZsdouD1sMyObHu9BkiBGiwpDWJv2Qs9WG6n7RLDU_gv6HyI21dsLuy9tniMqOcgoE0eR3DlwDVHjfqvNI_ynAc314yZhutTP2Fk0V-Aj-sXSOq82z63FV4Fam33NEiMuFDVvOVE-6h48/s2048/IMG_7883.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1365" data-original-width="2048" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZsdouD1sMyObHu9BkiBGiwpDWJv2Qs9WG6n7RLDU_gv6HyI21dsLuy9tniMqOcgoE0eR3DlwDVHjfqvNI_ynAc314yZhutTP2Fk0V-Aj-sXSOq82z63FV4Fam33NEiMuFDVvOVE-6h48/w400-h266/IMG_7883.jpeg" width="400" /></a></div><br /><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><br /></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><br /></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">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% <span style="background-color: white;">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.<o:p></o:p></span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;">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.</span><o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">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 <i>The Gerontologist</i>. 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.<o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">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. <o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">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). <o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;"><o:p> </o:p></span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><span style="background-color: white;">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. <o:p></o:p></span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">Photo: We found the graffiti message on this old viaduct to be intriguing. Is it a comment on our times?<o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">Source of Statistics for the Nordic countries: Statista: <span class="MsoHyperlink" style="color: blue; text-decoration: underline;"><a href="https://www.statista.com/statistics/1113834/cumulative-coronavirus-deaths-in-the-nordics/" style="color: #954f72;">https://www.statista.com/statistics/1113834/cumulative-coronavirus-deaths-in-the-nordics/</a></span><o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">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<o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><br /><u><span style="color: #030303;"><a href="https://www.boomlive.in/world/donald-trump-endorses-false-claim-that-cdc-cut-covid-19-death-toll-9580" style="color: #954f72;"><span style="color: #030303;">https://www.boomlive.in/world/donald-trump-endorses-false-claim-that-cdc-cut-covid-19-death-toll-9580</span></a></span></u><o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p>Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com1tag:blogger.com,1999:blog-6263958504548366118.post-65823599411857724092020-08-23T11:31:00.005-07:002020-08-23T11:33:04.519-07:00A New Diagnostic Tool for Alzheimer’s Disease: What Does It Tell Us?<p><br /></p><p><br /></p><p style="text-align: center;"><img border="0" data-original-height="2048" data-original-width="1365" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQ7hyphenhyphenxX20CJTlX18W5JciEgNLi6UF8wlgSs4QCcWHXrSWumCuakkVj7udu2p8fXbJM3HgbPwvsXvKz1bw0KsbN_0QXaoKuti2y1uLQXuziGBTn9eVMr2PuekWUHmQUCb4xQfoNDcGF8PQ/s640/deer.jpeg" /></p><p><span style="font-family: calibri, sans-serif;">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.</span></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">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. <o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">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. <o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">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.<o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">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.<o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><b>What did they find?<o:p></o:p></b></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><b> </b></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">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.<o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><b>What are the implications?<o:p></o:p></b></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><b> </b></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"> 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.<o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"> 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.”<o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><b>Is P-tau217 ready for widespread use for diagnosis?<o:p></o:p></b></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><b> </b></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"> 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. <o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"> 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.<o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><b>Do you want to know your risk for Alzheimer’s?<o:p></o:p></b></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><b> </b></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"> 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. <o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"> 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. <o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"> 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?<o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"> 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. <o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"> <o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">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). <o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"> <o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><b> </b></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p>Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com0tag:blogger.com,1999:blog-6263958504548366118.post-64721312812507505492020-08-12T12:38:00.000-07:002020-08-12T12:38:45.956-07:00Celebrating National Chocolate Chip Cookie Day<div class="separator"><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin-left: 1em; margin-right: 1em; margin-top: 0in;"><img border="0" data-original-height="1365" data-original-width="2048" height="342" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirFEX5U_r8K-a9GhqY-3pqJPXpWAh3hTiyUUD65X7qed-2gzLAPJ31qOjkGYV-oaadM9ioJq3UnvKng_yIdB9w084ddvdsUAGC1hkvWCYnxXrA-Rn6KL-PyuIEoOy9v_TImsbQNiLLs14/w512-h342/IMG_7807.jpeg" width="512" /></p></div><p> </p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><br /></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">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. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">Cooking and baking are ways we have connected with our grandkids. They all like to help out, and they all love eating the results. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">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. <o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;">You can find the recipe for chocolate chip cookies on Judy’s blog at <span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="http://jzcooks.blogspot.com/2012/09/" style="color: #954f72;">http://jzcooks.blogspot.com/2012/09/</a></span> The recipe follows the section on baking and cooking measures. Or browse through for other recipes for cookies and brownies.<o:p></o:p></p><p class="MsoNormal" style="font-family: Calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p>Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com0tag:blogger.com,1999:blog-6263958504548366118.post-66157882882407097162020-08-05T17:04:00.001-07:002020-08-05T17:06:51.686-07:00Is the Pandemic an Opportunity for Improving Support to Caregivers<p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><br /></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><br /></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><br /></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-btDcPmlOWV0e2zViWg6KHP7O16ZFMT94wn0sUjFd3P0R83KgToZadh6VN51kIRRPF84XFJ5b3RrAknFGa2zqlGoupcb1_IBNvF0KcIcbIaucOyzkCoPT6aDUXr_rfVsoJACSVo7QY2k/s2048/keep+your+distance.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1536" data-original-width="2048" height="307" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-btDcPmlOWV0e2zViWg6KHP7O16ZFMT94wn0sUjFd3P0R83KgToZadh6VN51kIRRPF84XFJ5b3RrAknFGa2zqlGoupcb1_IBNvF0KcIcbIaucOyzkCoPT6aDUXr_rfVsoJACSVo7QY2k/w410-h307/keep+your+distance.jpg" width="410" /></a></div><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><br /></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><br /></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><br /></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">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. <o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">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. <o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">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. <o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">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. <o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">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.<o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;"><o:p> </o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">You can find Bryce Covert’s article, “Biden’s Quietly Radical Plan,” at this link:<o:p></o:p></p><p class="MsoNormal" style="font-family: calibri, sans-serif; margin: 0in 0in 0.0001pt;">https://www.nytimes.com/2020/08/02/opinion/biden-child-care.html?action=click&module=Opinion&pgtype=Homepage<o:p></o:p></p>Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com0tag:blogger.com,1999:blog-6263958504548366118.post-5835390074470110242020-07-13T12:32:00.000-07:002020-07-13T12:40:01.774-07:00Keeping Sane in an Insane World<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEif5i4KL6-1wMFxymh56B0XQiIa81cQFK2fUdQmdZ-86hekpCVc4g069HgXEOBh5ho5WQrhMrF1tLyyjQQyU1dRhi2Ffa2k6Kla0OYDb09JhxgbPPhcPlQ_GF42a6G70BvV_B6Z6Dlk4_Q/s1600/IMG_0451.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1200" data-original-width="1600" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEif5i4KL6-1wMFxymh56B0XQiIa81cQFK2fUdQmdZ-86hekpCVc4g069HgXEOBh5ho5WQrhMrF1tLyyjQQyU1dRhi2Ffa2k6Kla0OYDb09JhxgbPPhcPlQ_GF42a6G70BvV_B6Z6Dlk4_Q/s320/IMG_0451.jpeg" width="320" /></a></div>
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Southern Oregon Coast</div>
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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:<o:p></o:p></div>
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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.<o:p></o:p></div>
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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. <o:p></o:p></div>
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<span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.nytimes.com/2020/06/30/movies/carl-reiner-stream.html?searchResultPosition=3" style="color: #954f72;">https://www.nytimes.com/2020/06/30/movies/carl-reiner-stream.html?searchResultPosition=3</a></span><o:p></o:p></div>
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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. <o:p></o:p></div>
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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. <o:p></o:p></div>
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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 <i>Casablanca. </i><o:p></o:p></div>
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It didn’t work. Most were caught, or made their way back across the German lines.<o:p></o:p></div>
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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.<o:p></o:p></div>
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<span class="MsoHyperlink" style="color: #0563c1; text-decoration: underline;"><a href="https://www.facebook.com/PennsylvaniaGov/photos/a.444036569279842/1227626537587504/?type=3&theater" style="color: #954f72;">https://www.facebook.com/PennsylvaniaGov/photos/a.444036569279842/1227626537587504/?type=3&theater</a></span><o:p></o:p></div>
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I guess the governor likes a good laugh, too.<o:p></o:p></div>
<br />Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com0tag:blogger.com,1999:blog-6263958504548366118.post-79673428522715778182020-05-07T08:02:00.000-07:002020-05-11T07:49:32.423-07:00Small Pleasures<div class="MsoNormal" style="margin: 0in 0in 0.0001pt;">
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Blondies</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Like all of you, we are staying mostly at home these days, and have found that simple, unexpected things sometimes brighten up the day.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Like receiving face masks in the mail</b>. 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.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">You can order through this site: <a href="https://davidalanmasks.com/" style="color: #954f72;">https://davidalanmasks.com</a><o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Like baking</b>. 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. <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">You can find Judy’s blondie recipe at: <a href="https://jzcooks.blogspot.com/2012/08/blondies.html" style="color: #954f72;">https://jzcooks.blogspot.com/2012/08/blondies.html</a><o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Like contributing to the Pittsburgh Food Bank. </b>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.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Like discovering Schitt’s Creek</b>. 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. <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Like having baseball to watch. </b>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<i> Naked Gun</i>. Games are broadcast live early in the morning, but rebroadcast in the afternoon. Here’s more information about the KBO.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"> <a href="https://www.nytimes.com/2020/05/05/sports/baseball/coronavirus-baseball-korea-opening.html?referringSource=articleShare" style="color: #954f72;">https://www.nytimes.com/2020/05/05/sports/baseball/coronavirus-baseball-korea-opening.html?referringSource=articleShare</a><o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><b>Like having time to read. </b>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. <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">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, <i>The Day of Battle</i>. 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. <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">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.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">There is a quote I love in <i>An Army at Dawn</i>. 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? <o:p></o:p></span></div>
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<b>Postscript.<o:p></o:p></b></div>
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I have now completed <i>The Day of Battle. </i>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. <o:p></o:p></div>
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<span style="font-family: Calibri, sans-serif; font-size: 12pt;">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</span></div>
Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com0tag:blogger.com,1999:blog-6263958504548366118.post-78096145519247796382020-04-26T13:20:00.001-07:002020-04-26T13:20:14.442-07:00What Does a Starfleet Captain Do in Retirement?<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: Arial, Helvetica, sans-serif;">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.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">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.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">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. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">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.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">And if you are really serious about Star Trek, and who isn’t, I just read that Tribbles are available on e-Bay.<o:p></o:p></span></div>
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Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com0tag:blogger.com,1999:blog-6263958504548366118.post-72663654398723722632020-04-17T11:06:00.000-07:002020-04-17T11:06:04.845-07:00Covid-19 Deaths in Nursing Homes: Why It Is Important to Consider Causes and Solutions<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: Arial, Helvetica, sans-serif;">This headline in yesterday’s Washington Post caught our eyes: “Covid-19 is ravaging nursing homes.<span> </span>We’re getting what we paid for” (see link below).<span> </span>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. <span> </span>Half of the deaths in Pennsylvania have been among nursing home residents and staff.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">We should not be surprised.<span> </span>Nursing home residents constitute the most vulnerable group in society.<span> </span>But it’s not just that residents are old and frail.<span> </span>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.<span> </span>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. <span> </span>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.<span> </span><o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Nursing homes are not the only problem area.<span> </span>The Covid-19 crisis has revealed many weaknesses in our health and public health infrastructure.<span> </span>Federal and state governments have spent the last few decades cutting back public services and investments in health, education and most everything else.<span> </span>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.<span> </span>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.<span> </span>And then there is testing and tracking of the virus.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">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.<span> </span>Instead, we have a rickety system of funding. <span> </span>People who can pay privately for care can often, but not always, receive good care.<span> </span>But the typical nursing home that depends primarily on Medicaid will, despite good intentions, struggle to provide a high quality program.<span> </span><o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Here is a modest list of what we need, or at least where to start.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Arial, Helvetica, sans-serif;"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]-->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.<span> </span>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.<span> </span>That way, the tax burden does not fall on young workers, who tend to have lower earnings.<span> </span>And by 40, most of us have realized we may need to help aging parents, and indeed, that we may need help for ourselves.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Arial, Helvetica, sans-serif;"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]-->Long term care programs, and indeed, all of health care, should be run either by government or by non-profit organizations.<span> </span>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.<span> </span>We have seen that happen over and over.<span> </span>Some of the worst clusters of Covid-19 have been in for-profit nursing homes.<span> </span>They didn’t pay for adequate staffing or for taking the steps to protect residents and staff.<span> </span>When owners of these programs have been identified by the press, they often hide or refuse to comment.<span> </span><o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The perversions caused by using a business model that prioritizes profits over care affects all of health care.<span> </span>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.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Arial, Helvetica, sans-serif;"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">3.<span style="font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]-->We need stronger programs for helping older people remain at home.<span> </span>Almost no one wants to end their life in a nursing home.<span> </span>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.<span> </span>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.<span> </span><span> </span><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Arial, Helvetica, sans-serif;"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">4.<span style="font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]-->The people who work in aging services need better training.<span> </span>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.<span> </span>Everyone from administrators to nurses to the aides that deliver the care needs specific training in aging and long-term care.<span> </span>All too often, the training people receive involves how to meet various state and federal requirements and not how to provide optimal care.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">In the US, a certified nursing assistant receives 75 hours of training.<span> </span>By contrast, in Sweden where nursing home care as well as community services are generally quite good, care assistants (vardbitr<span>ä</span>de) receive one year of training, and nursing assistants (<span>undersköterska) complete three years training.<span> </span>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.<span> </span>As a result, they can live on their salary.<span> </span>Workers can also gain the training needed to move up, from care assistant to nursing assistant to nurse.<i> </i><span> </span>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.<span> </span>That would be quite a nice step forward.</span><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Arial, Helvetica, sans-serif;"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">5.<span style="font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-caps: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]-->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.<span> </span>They pay attention to the details of everyday care, and make sure that all staff share the same values around good care.<span> </span>We need to find more people like that, reward them, and make sure their voices are heard.<span> </span><o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">There are likely to be shakeups in how we do things in this country, once the immediate crisis diminishes.<span> </span>We need to make sure that long term care gets included in the discussion.<span> </span><o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Reference:<span> </span><o:p></o:p></span></div>
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<a href="https://www.washingtonpost.com/opinions/2020/04/16/covid-19-is-ravaging-nursing-homes-were-getting-what-we-paid/"><span style="font-family: Arial, Helvetica, sans-serif;">https://www.washingtonpost.com/opinions/2020/04/16/covid-19-is-ravaging-nursing-homes-were-getting-what-we-paid/</span></a><o:p></o:p></div>
Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com1tag:blogger.com,1999:blog-6263958504548366118.post-68154545067446276782020-04-11T16:39:00.001-07:002020-04-11T16:39:08.693-07:00Missing Baseball <div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: Arial, Helvetica, sans-serif;">Sitting mostly at home these days, I found myself wishing that there was baseball. Baseball is the perfect sport for when you have lots of time on your hands. The slow pace doesn’t matter. I remember a time when I was in graduate school and had a bad case of the flu that kept me in bed for more than a week. I looked forward each day to the radio broadcasts of the White Sox games. Win or lose, it brightened the day.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">In the absence of real games, I decided to watch my favorite baseball movie, <i>Bang the Drum Slowly</i>. It doesn’t make most lists of favorite baseball movies, but I find it captures more of the essence of the game than films like Field of Dreams that romanticize the game. The movie was released in 1973, but it was based on a book written by Mark Harris in the 1950s and has the feel of an era before baseball became big business. The movie stars a young Robert de Niro who gives a terrific performance as a back-up catcher who has a terminal disease. The team’s star pitcher (Michael Moriarty) tries to help him hide the illness and stay on the team. Despite the serious theme, the movie is often quite funny. The pep talks given by the manager (Vincent Gardenia) are hilarious, as is much of the banter among the players. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">In the end, the movie quenched my thirst for baseball, at least temporarily. It felt like baseball. The players faced real dilemmas that teams encounter during a pennant race. With, of course, one major difference, a teammate who was dying. The players responded with an awkwardness you would expect from young men and but also with sensitivity. Maybe it’s a movie for our times. Or at least to enjoy baseball for a couple of hours.<o:p></o:p></span></div>
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Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com0tag:blogger.com,1999:blog-6263958504548366118.post-66029782308788163912020-04-04T16:10:00.000-07:002020-04-04T16:10:02.081-07:00HIGH RISK!<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: "arial" , "helvetica" , sans-serif;">In Marrakech airport </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">During our stay in Morocco, one of the emails we received from the US Embassy asked us to </span><span style="font-family: Arial, Helvetica, sans-serif;">register with the embassy so they could contact us. They also asked us to indicate if we were at </span><span style="font-family: Arial, Helvetica, sans-serif;">high risk for COVID-19. After looking at each other for a minute, we realized we are at high risk </span><span style="font-family: Arial, Helvetica, sans-serif;">by our age. Although the embassy did little to help in the end, it did change how we think about </span><span style="font-family: Arial, Helvetica, sans-serif;">ourselves.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Since coming home, our “high risk” designation has been reinforced. Every communication in </span><span style="font-family: Arial, Helvetica, sans-serif;">the media emphasizes that we should take extra precautions. Food stores are creating “senior </span><span style="font-family: Arial, Helvetica, sans-serif;">hours” where we can shop when there are fewer people in the store. One of our friends, </span><span style="font-family: Arial, Helvetica, sans-serif;">however, warned us that lines form outside before the stores open, but we have not</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Being considered high risk comes as a shock. We are used to thinking of ourselves as healthy. </span><span style="font-family: Arial, Helvetica, sans-serif;">After all, we lead active lives. We exercise daily and travel to exotic places like Morocco. Yet </span><span style="font-family: Arial, Helvetica, sans-serif;">there it is—high risk. The label conveys in a very tangible way the consequences of our age. </span><span style="font-family: Arial, Helvetica, sans-serif;">But we are adapting. Gyms are closed so we take 3 walks a day around our community. Lots of </span><span style="font-family: Arial, Helvetica, sans-serif;">our neighbors, young and old, are out, too, and we all say hello but keep the appropriate social </span><span style="font-family: Arial, Helvetica, sans-serif;">distance. We restrict our trips to stores to a minimum. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">\We discovered an unexpected treasure </span><span style="font-family: Arial, Helvetica, sans-serif;">the other day, discovering that we could buy tissues and 4 rolls of toilet paper at our local </span><span style="font-family: Arial, Helvetica, sans-serif;">pharmacy. Who knew that buying toilet paper could be exciting? </span><span style="font-family: Arial, Helvetica, sans-serif;">We have decided it is important to help our neighborhood restaurants during the crisis by </span><span style="font-family: Arial, Helvetica, sans-serif;">ordering take out on a regular basis. On Monday, it was soup dumplings and pot stickers from </span><span style="font-family: Arial, Helvetica, sans-serif;">Everyday Noodles. Then, it was croissants and sandwiches from La Gourmandine Bakery. Next, </span><span style="font-family: Arial, Helvetica, sans-serif;">some excellent Thai food from Silk Elephant. This really seems “win-win.”</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The hardest thing about being high risk is not visiting our two grandchildren who live here. Our </span><span style="font-family: Arial, Helvetica, sans-serif;">daughter-in-law is a pediatrician who works in a hospital and could be exposed to the virus. As </span><span style="font-family: Arial, Helvetica, sans-serif;">“high risk” people, we need to avoid any place we might pick up the virus. So far, we are doing </span><span style="font-family: Arial, Helvetica, sans-serif;">Face Time, and hoping for a quick resolution, though we suspect COVID-19 will be around for a </span><span style="font-family: Arial, Helvetica, sans-serif;">while.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">We would feel better about the situation if the government had an organized approach to the</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">crisis. Our governor has taken positive steps but the federal government has dropped the ball </span><span style="font-family: Arial, Helvetica, sans-serif;">on marshalling resources needed for medical care and protecting people from the virus.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">There are people who see the whole picture and know what we need to do, such as Anthony </span><span style="font-family: Arial, Helvetica, sans-serif;">Fauci and Ezekial Emanual, who wrote a terrific column the other day (see the link below).</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">We received a terrific video from our friend, Elia. The video was made by Dr. David Price, a</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">pulmonary specialist at Weill Cornell Medical Center in New York City. Dr. Weill, who has been </span><span style="font-family: Arial, Helvetica, sans-serif;">providing care to the COVID-19 patients in his hospital, discusses how the virus is transmitted </span><span style="font-family: Arial, Helvetica, sans-serif;">and how the steps he proposes will reduce risk. He also discusses what to do if you begin </span><span style="font-family: Arial, Helvetica, sans-serif;">developing symptoms. We highly recommend the video and have provided a link. It made us </span><span style="font-family: Arial, Helvetica, sans-serif;">feel that maybe we are not at such high risk after all. Of course, in light of new information in the past week, some of what Dr. Price says has to be modified (the part about aerosols). And now we are wearing face masks whenever we go out. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">There was also an excellent editorial in the NY Times by James Baker that lays out the steps that need to be taken to lead us out of this. </span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Link to Dr. Price’s video: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">https://www.youtube.com/watch?v=WxyH1rkuLaw</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Link to the column by Ezekial Emanuel:</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">https://www.nytimes.com/2020/03/23/opinion/contributors/us-coronavirus-</span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">response.html?action=click&amp;module=Opinion&amp;pgtype=Homepage</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">Link to the James Baker editorial: </span><br />
<span style="font-family: Arial, Helvetica, sans-serif;">https://www.nytimes.com/2020/04/03/opinion/defense-protection-act-covid.html?smid=nytcore-ios-share</span></div>
Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com0tag:blogger.com,1999:blog-6263958504548366118.post-33668887225890550622020-03-25T08:36:00.002-07:002020-03-25T08:36:13.826-07:00Morocco!<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: Arial, Helvetica, sans-serif;">We are home from a culinary and cultural tour in Morocco. The food was wonderful and the Moroccan people were friendly and welcoming. But we had some unexpected excitement at the end. To prevent transmission of COVID-19 to the country, Morocco cut off flights to most international locations, including our flight out. For a few days, we felt a bit like Ilsa Lund and Victor Laszlo from the movie Casablanca searching for a way out.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Let’s begin with the many good things that happened. We have found that culinary tours are an excellent way to find out a lot about its culture and history. We found this to be especially true on the two tours we previously had taken with Peggy Markel, to Tuscany and India, and on this trip as well in Morocco.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Peggy operates a company that offers small group culinary and cultural tours in several countries and leads the tours herself. These tours are not like any other we have been on. It’s not like checking off tourist sites from a guidebook. We are instead meeting Peggy’s friends. These are people she has developed friendships with over the years who are doing interesting things as chefs or in growing and producing food, or as artisans working on local crafts. When we meet them, we feel welcomed into their homes and communities and we learn about their cuisine, culture and way of life. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">On this trip, we were based at a small Riyadh outside of Marrakesh called Jnane Tamsna. Peggy has known the couple who own the Riyadh, Gary and Mary Ann Martin, for over 20 years. In addition to running the Riyadh, they are involved in organic and sustainable agriculture. We used produce and herbs from their garden and nearby farm in our cooking classes. We also learned about the couple’s work in helping build local cooperatives that are developing new products to help improve the local economy. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The cooking lessons at Jnane Tamsna were given by their long-time chef, Bahija. We learned how to do Moroccan cooking in tajines and about the different herbs and spices that give the food its special flavor. We also made breads, couscous and kefta. Although Morocco borders on the Sahara desert, the produce grown there is varied, delicious, and fresh. Through Gary and another organic farmer we visited, Domain Sauvage, we learned how they were able to grow crops in that setting, for example, protecting plants from the heat by siting them in the rows between olive trees, and judicious use of scarce water. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">We traveled from Marrakesh for a few days to see a bit of the country. Our first stop was an an inn, the Kasbah du Toubkal, which is located in the Atlas Mountains near the 13,000 foot peak of Mount Toubkal. The inn was developed for trekkers and has been recognized for its sustainable design. It was also accessible only by foot or by mule. We opted for the mules, who were more sure-footed than we would likely be. During our stay, we walked higher up the mountain through walnut groves and terraces used for agriculture to a village perched on the edge of the mountain. There we were invited into a home—Peggy’s friends—for tea and conversation about living in the mountains. And we had a cooking lesson from the Inn’s chef.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">From there we went to the Atlantic coast near the town of Essaouira. We visited the shops in town, including a Berber rug store where we succumbed to the charms of the owner and the beauty of the rugs. Steve also got to emulate Lawrence of Arabia with a camel ride on the beach.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">We came away from the trip with an understanding of the possibilities for organic, small-scale and sustainable agriculture. We also saw how people in Morocco were able to work in cooperatives that helped them develop new products and markets. Like the other trips we took with Peggy, this was no ordinary tour, but a genuine look into the culture and daily life of a country, accompanied by delicious meals made with fresh, local ingredients.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">At the end of the trip we were back at Jnane Tamsna but with no way home. The US Embassy was of little help. Not only had most flights out of Morocco been canceled, the government was saying it would close down all international flights in a few days. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Two heroes, however, rode to our rescue. Stephanie and Alice, who are service representatives with United Airlines, managed to get us out via British Air, which was still flying. They were great. We got home one day late filled with memories of the wonderful experiences we had and armed with new recipes to try out at home. <o:p></o:p></span></div>
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Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com0tag:blogger.com,1999:blog-6263958504548366118.post-21124347771617318592020-02-21T14:06:00.001-08:002020-02-21T14:06:42.156-08:00The Integration of Creativity and Experience<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: "arial" , "helvetica" , sans-serif;">I recently received a remarkable book, <i>These Are Not Your Grandfather’s Medals, </i>by James MaloneBeach. Some of you have probably met or know about Beach. He is married to my long-time friend, Leeny MaloneBeach. Beach is an accomplished metal-smithing artist who has worked for many years on medals. Medals have a long history as objects that are markers of allegiance to a higher authority or, as we know them, as symbols of high achievement. Beach’s medals have been exhibited world-wide, and several pieces can be found in leading museums, including several in the British Museum. The book contains photos and commentary by Beach of medals he has created across his career. The medals draw on classical and contemporary designs and are often humorous and joyous. Some medals also provide ironic commentary on contemporary people and events.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">I mention the book for two reasons. It is delightful to read and to see the wonderful range of images Beach has created. And the book covers the whole of Beach’s artistic career, including the most recent years since his retirement from teaching. The book reminded me of an issue we raised in a previous blog, that retirement can involve a continuation of activities that we did earlier in life. And as Beach’s work shows, creative work can be done at a high level.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">There is a belief that great artists, musicians, and writers do their best work when they are young. After all, how many great symphonies did Mozart compose after age 35? If you said none, you are right. Mozart died when he was 35. That is part of the reason that we believe that younger artists are most likely to be creative. In the past, many creative people died young, like the rest of the population.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Given a long life, however, many creative people remain creative into their old age. Dean Keith Simonton, who is Distinguished Professor Emeritus at UC Davis, cites examples of people who made major contributions in old age, including J. S. Bach, Verdi, DaVinci, Gailieo, Goethe, Kant, Einstein, and Georgia O’Keefe. Dr. Simonton also suggests that the type of creative work differs by age. Works of creative people when they are young tend to take new and different perspectives, to be paradigm-breaking or as Simonton writes “hot from the fire.” By contrast, creative works by older people tend to emphasize integration of perspectives, complexity, and insight into interrelationships of ideas and people. They draw on knowledge and experience.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">I am in no way an artist, but I find something similar in the work I continue to l do with younger colleagues, I find I can draw upon things that I learned in the past that provide a broader perspective or at the least help them avoid some wrong turns in their research. And although I don’t consider myself a creative photographer, I can call upon knowledge from the past to capture images that I enjoy and, importantly, that my grandchildren enjoy. We don’t lose the knowledge acquired over the course of our lives, and that knowledge does not necessarily become obsolete. Having activities that we enjoy and can carry over into retirement or even expand seems like a good way to go.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">For more information, here is the complete reference for Beach’s book:<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">James MaloneBeach (2020). <i>These are not your grandfather’s medals. </i>PolyMarket Press. <a href="http://polymarketpress.net/" style="color: #954f72;">http://polymarketpress.net</a><o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Here is a reference to Simonton’s work: Simonton, D. K. (1990b). Creativity in the later years: Optimistic prospects for achievement. <i>Gerontologist, 30, </i>626-631.</span><span style="font-family: "calibri";"><o:p></o:p></span></div>
Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com0tag:blogger.com,1999:blog-6263958504548366118.post-16995943843870254542020-01-31T16:10:00.001-08:002020-01-31T16:10:40.558-08:00Retirement Is a Process<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCna-F-BDQrtkYRU9QpYf3Z5ll0v75X9dYUOoCEbuMNPFaLZEwhd_YXKSOCFRKqyxD2-zHgJwLztTW_DWAup6887PZ7R3d-95SCDjj72-mw54u6dIQRg0-QLGUEvDP5tTXfY8zTcRP0DA/s1600/CB1438CF-639F-4DC4-8285-D3E92AD113C0_1_105_c.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="724" data-original-width="1086" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCna-F-BDQrtkYRU9QpYf3Z5ll0v75X9dYUOoCEbuMNPFaLZEwhd_YXKSOCFRKqyxD2-zHgJwLztTW_DWAup6887PZ7R3d-95SCDjj72-mw54u6dIQRg0-QLGUEvDP5tTXfY8zTcRP0DA/s320/CB1438CF-639F-4DC4-8285-D3E92AD113C0_1_105_c.jpeg" width="320" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The view from our third floor balcony</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">When Judy and I first retired, it felt like looking over a precipice. There was only a sketch of a plan and we wondered how it would all work out. But a few years down the road and opportunities have come along.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">I have been thinking about retirement as a process this week, because a journal article just came out with me as lead author about a study that came about quite fortuitously. Around the time that we moved to Pittsburgh, I was asked to serve as a consultant at Presbyterian SeniorCare Network. We have written previously about Woodside Place, their outstanding dementia residence. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">In my consultant role, I attended a meeting at one of the rehabilitation units run by Presbyterian SeniorCare. An occupational therapist, Chris Krause, who works for a computer company called iN2L (an acronym for “It’s Never too Late”) demonstrated the use of the computer platform that iN2L developed for engaging persons with dementia in rehabilitation activities. Presbyterian SeniorCare was thinking of purchasing some units for their rehabilitation programs. The presentation, which included video, showed that the iN2L had considerable promise in rehabilitation. Patients could be engaged in therapy activities by using music, video or other stimuli selected from the iN2L’s library. It wasn’t just any music or any video, but it was selected to match the interests of a particular patient. Although the system had been adopted in many rehabilitation programs, there was no research on it. So sitting there and feeling calm because I had no work demands to worry about, I blurted out, “It would be easy to do a study.” I was asked to develop a plan, and Presbyterian SeniorCare obtained a small grant to fund the study.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The idea for the study was to determine if the iN2L was effective in increasing engagement in the rehabilitation process for someone with dementia, and if increased engagement led to better outcomes. If the iN2L could do that, it meant that would be possible to help more persons with dementia regain functioning after an illness or injury. Remaining as independent as possible is very important in dementia. People then are able to remain active doing things they enjoy, and are less likely to become restless, bored or agitated.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">To do the study, we compared patients with dementia at two rehabilitation facilities run by Presbyterian SeniorCare, one that was going to use the iN2L on a trial basis and another facility that was not getting the iN2L. The two facilities had similar policies, staffing and patient populations. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">I had a great team to work with—supervisors and staff at the two rehabilitation units, and two research assistants who gathered the data. But the research was not without its stress. It took months to obtain human subjects approval from Penn State for the research and then from the State Department of Health. And then once the study was finally up and running, I found myself having all the worries I used to have when I was conducting a study. I would wake in the middle of the night worrying if we would get enough subjects to enroll in the study, whether we could get the data we wanted, what was the right way to do the data analysis, and would we find anything at all. It was a small-scale study (96 participants in the end) and it can be hard to show results with a small study.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">So what happened? The iN2L worked. Persons with dementia at the rehabilitation unit that had the iN2L showed increased engagement in therapy and better rehabilitation outcomes than the comparison unit. The iN2L helped restore a bit more independence that usual care. You can link to the full study below, if you are interested. Access will be free in a couple of weeks.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">This study was a path that unexpectedly opened up for me. Some retirement paths will take people in new directions. For this work, however, I got to use well-practiced skills, and apart from some sleepless nights, it was an enjoyable process, especially in light of the good people I worked with and the good outcome. The next path might take me in a different direction. It’s a matter of being open to the possibilities.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">You can find the paper at:<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><a href="https://www.tandfonline.com/doi/full/10.1080/13607863.2020.1711864" style="color: #954f72;">https://www.tandfonline.com/doi/full/10.1080/13607863.2020.1711864</a><o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">It will be available soon through open access (free).<o:p></o:p></span></div>
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Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com0tag:blogger.com,1999:blog-6263958504548366118.post-13334157975440173442019-11-11T15:43:00.002-08:002019-11-11T15:43:34.936-08:00Extraordinary Aging<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: Arial, Helvetica, sans-serif;">John le Carré has a new book, <i>Agent in the Field</i>. It is his 25<sup>th</sup> book in a writing career that began in 1961. What’s notable about the book is that le Carré just turned 88 and <i>Agent in the Field </i>is a terrific book, one of his best. Age can be a limiting factor on creativity, but here is an example of someone who like many of the characters in his books has beaten the odds.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">If you are not familiar with le Carré, which is the pen name for David Cornwall, he is the master of spy novels. He rescued the genre from the James Bond comic book portrayals of spies. His novels are serious and thoughtful. They address enduring human qualities—trust, deception, betrayal, and the search for truth. His best-known novels include <i>The</i> <i>Spy Who Came in from the Cold </i>and <i>Tinker, Taylor, Soldier, Spy</i> and the other Cold War books that feature George Smiley. As the Cold War wound down, le Carré, began writing about other conflicts, among them Russia’s involvement in Chechnya (<i>The Russia House</i>), Israeli-Arab struggles (<i>The Little Drummer Girl</i>), and the corruption of international drug makers (<i>The Constant Gardener</i>). Like the earlier Smiley books, these novels are engaging, tense, and interested in character as much as plot. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">In 2017, Le Carré published <i>A Legacy of Spies. </i>The book<i> </i>was set in the present, but it revisited characters and events from <i>The Spy Who Came in from the Cold </i>and <i>Tinker Taylor. </i>The book seemed to be a summing up, a capstone for a long odyssey. By tying up loose ends from the early books, it seemed almost like a retirement announcement.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Yet here is le Carré with a new book. <i>Agent in the Field</i> has a contemporary feel, not just because it is set in the present, but in the characters and the issues they confront. Events are colored by Brexit, the disintegration of American foreign policy, and the power of outrageously rich people. The book has a compelling plot, and like all le Carré’s books, you experience the dilemmas and anguish of the main characters. The denouement is shocking. I won’t give any clues, but It took my breath away, and perhaps most upsetting, the ending is quite plausible. <o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">How has le Carré persisted over his long life as a writer and commentator on contemporary society through his novels? I really don’t know much about him. Does he eat a healthy diet and exercise, or like some of his characters in the novels drink a whiskey or two every evening? In the end, we don’t know much about what makes for successful aging, but le Carré demonstrates what can sometimes be achieved in a long life.<o:p></o:p></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">A few additional notes: <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->If you haven’t read any of le Carré’s books, I’d suggest starting with the classic <i>Tinker, Taylor, Soldier, Spy. </i>In addition to the book, there is a 2011 movie that was quite good, though it would help to read the book first to be able to keep the characters straight. There is an even better BBC series based on the book with Alec Guinness playing George Smiley. It may still be available on Netflix or some other source. I also just read there is another Guinness series based on the book <i>Smiley’s People.</i> <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt; font-stretch: normal; line-height: normal;"> </span><!--[endif]-->And finally—the old writer of the East-West cold war struggles has some choice words in <i>Agent in the Field</i>, about Putin and Trump.<o:p></o:p></span></div>
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Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com0tag:blogger.com,1999:blog-6263958504548366118.post-56602573771934913782019-11-07T08:34:00.000-08:002019-11-07T08:34:32.987-08:00Karen's Students questions<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Steve saw this restaurant in Sweden recently</span><br />
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<span style="color: black; font-family: "arial";">Our friend Karen Fingerman has again 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. Karen and her teaching assistant selected 7 questions and sent them to us. The students once again raised excellent questions. Here are the questions and our answers. <o:p></o:p></span></div>
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<b><span style="color: black; font-family: "arial";"><o:p> </o:p></span></b><b style="font-size: 11pt; text-align: center; text-indent: -0.25in;"><span style="font-family: "arial";">1.<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;"> </span></span></b><b style="font-size: 11pt; text-align: center; text-indent: -0.25in;"><span style="font-family: "arial";">How does the death of a partner in old age affect the aging process of the surviving spouse? </span></b></div>
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<b><span style="color: black; font-family: "arial";">– answered by Judy</span></b><span style="font-family: "arial";"><o:p></o:p></span></div>
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<span style="font-size: 11pt;">This is one of those answers that must embrace individual differences, as we have seen a wide variety of responses to loss of a partner over the years. Loss of a long-time life partner is always painful, as over time the two people usually have developed a symbiotic sort of relationship. Whether the loss comes suddenly or after a period of decline, the finality of death forces the survivor to live in an altered reality not of their choosing. They must make all of the decisions for themselves, after a life of shared decision-making (usually). </span></div>
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<span style="font-size: 11pt;">As we think of the many people we have seen, there are probably two or three main patterns. One is for the surviving spouse to want to re-couple as quickly as possible. We used to think it was mainly men who did this, responding to the casserole-toting widows and divorcees who seek them out, and wanting to find someone to take care of the details of everyday life. But I have seen quite a few women who also want to remarry quickly, mainly because they cannot fathom not being part of a couple, and they want to resume that "couples" social life. Once they have re-partnered, they imagine that they will return to their previous status quo. Sometimes that is the case, sometimes not, depending on how the relationship works out. For these people, the trajectory of their aging is largely not impacted.</span></div>
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<span style="font-size: 11pt;">A second group of people are those who have no desire to ever be in another relationship. They may believe that their partner was their lifelong love, and thus, irreplaceable. Or, if there was an extended period of caregiving, they may not want to take that on again. Some of these individuals go through an extended period of mourning, which validates the importance of their relationship, and comes to define them to the world. Eventually they may seek out same sex activities or resume previous friendships that do not challenge their decision to remain single. This allows them to develop a social support network that is likely beneficial to their mental and physical well-being. Other people, however, isolate themselves in their grief, or they may have under-developed social skills that prevent them from joining in activities with others. These individuals are more vulnerable to premature aging, or to poor self-care that may lead to declines in health.</span></div>
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<span style="font-size: 11pt;">There's a third group we have seen, those who have large extended families, which serve the function of cushioning the isolation that might otherwise occur following the death of a spouse. If there are multiple generations in the family, they may find a helping role, such as caring for grandchildren or preparing holiday meals, that provides meaning and motivation to remain active and engaged in life.</span></div>
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<span style="font-size: 11pt;">In summary, there are multiple possible ways that loss of a spouse can affect individuals, and the mediating factor in how they navigate the aging process is probably social support.</span></div>
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<b style="font-size: 11pt;">2. How does one come to terms with death? What is the correct time to have a discussion about it? </b></div>
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<b><span style="color: black; font-family: "arial";">– answered by Judy</span></b><span style="color: black; font-family: "arial";"><o:p></o:p></span></div>
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<span style="font-size: 11pt;">Having spend thirty years in practice and doing research with aging populations, we have a particular bias about this. Death is a very natural part of life. All living things die. When our four-year-old or seven-year-old grandchild asks about death, we explain it to them in words they can understand. They lost one of their grandparents about two years ago, when they were two and five. They lost a great-grandmother six months before that. They will inevitably lose other people. Because none of our family has hesitated to respond to their questions, they have a basic understanding that will make it much easier as they go through life. At times they are sad about it, but they are also accepting of it. </span></div>
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<span style="font-size: 11pt;">Unfortunately, many people simply do not want to talk about death. My father certainly could not. But my mother, who was his caregiver, was eager to speak up about her wishes at the end. In the past twenty years, Advanced Directives have become part of estate planning, which present people with the opportunity to designate which life-saving procedures they do or do not want in the event of a fatal situation. These decisions should be made by the individual unless they are not competent to do so.</span><span style="font-size: 11pt;"> </span><span style="font-size: 11pt;">Ideally, Advanced Directives are made when the person is perfectly healthy so they can think about them objectively. What is sometimes not done, however, is to explain exactly what those "life-saving" procedures are and what the consequences may be. I actually spent a fair amount of time in my practice explaining those things, particularly to my clients who were in assisted living or skilled nursing. </span></div>
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<span style="font-size: 11pt;">One way to initiate conversations about death and dying, and particularly end of life decisions, is to do so indirectly. For example, when an acquaintance or friend of the family member dies, you can have a conversation about what happened and what they might want to have happen differently for them when the time comes. By the time my mother died at nearly 92, she had seen many, many people die, and it helped her decide what she did and did not want at the end. Every time someone died, we would talk about it, and re-affirm her decisions.</span></div>
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<b style="font-size: 11pt;">3. What should you do when differences of opinions arise in a family for end-of-life care? –answered by Judy</b></div>
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<b><span style="color: black; font-family: "arial";"> </span></b><span style="color: black; font-family: "arial";">This is related to the previous question. The ideal situation is for the person who is dying to have already made those choices. The next best choice is for the dying individual to have indicated who they wanted to make those choices for them. My mother chose to move to be near me because she knew that not only did I know what she wanted, but that I wouldn't be afraid to follow through on her choices in the face of criticism from other family members. As it turned out, by the time she died, the entire family was supportive of her decisions, which made our life simpler. However, there are times when family members come forward with their own ideas that are different from either the dying person or their spouse, and that can cause needless emotional distress for the caregiver.<o:p></o:p></span></div>
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<span style="font-size: 11pt;">When decisions have not been made ahead of time, health care providers will sometimes be helpful in explaining exactly what the options are, but not always. Sometimes they simply don't take the time, and sometimes their explanations are hopelessly medicalized so no one really understands them. Some health care workers are uncomfortable talking about death and dying, too, and it causes them to either hold out false hope or to fail to respond realistically to family's questions. In that case, if there is a social worker or psychologist available with expertise in end of life care, having a disinterested third party can help everyone come to a compromise agreement.</span></div>
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<b><span style="color: black; font-family: "arial";">4. In class, I have learned that stress does seem to age you faster as opposed to being carefree. As a 20 year old worried about her aging parents, how can I convince them to take advantage of vacation days without making them more stressed about missing out on work days? <o:p></o:p></span></b></div>
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<b><span style="color: black; font-family: "arial";">–answered by Steve and Judy</span></b><span style="color: black; font-family: "arial";"><o:p></o:p></span></div>
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<span style="color: black; font-family: "arial";">You ask a good question about the association of stress and aging, and it sounds like you want to have a positive influence on your parents. It sounds like you already know that they do not readily take advice when it comes from their child. That is very common in parent-child relationships. One reason for this resistance is that parents still see themselves in the parenting role, no matter how old their children might be. Their adult children give advice, but their parents don’t necessarily take it. They also may resist changes, because they want to stay in control of their lives. So when a child tells them what to do, they often resist, even if what the child proposes is a reasonable thing to do.<o:p></o:p></span></div>
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<span style="color: black; font-family: "arial";">Instead of suggesting ways your parents might manage the stress in their lives, you might take a more indirect approach. When someone they know takes a vacation, you may show an interest in how those people have lowered their stress by using their vacation days effectively. Similarly, if you find an article (and there are lots of articles about stress and how to lower it), you might send that on to them. Lowering stress is about making conscious choices about how you use your time, and includes things like diet, exercise and self-care, so you can perhaps try to do some of those things yourself, and share your experiences about how it lowers your own stress. When you bring up the subject by talking about what other people do, it is less challenging than giving advice, and less likely to be perceived as a criticism.<o:p></o:p></span></div>
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<b><span style="color: black; font-family: "arial";">5. Both of my mother’s parents had Alzheimer’s before they died. My mother has lived the majority of her adult life with the thought that she will most definitely get Alzheimer’s one day. How can I change my Mother’s mindset regarding her future with Alzheimer’s?<o:p></o:p></span></b></div>
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<b><span style="color: black; font-family: "arial";"> –answered by Steve and Judy</span></b><span style="color: black; font-family: "arial";"><o:p></o:p></span></div>
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<span style="color: black; font-family: "arial";">All the publicity about Alzheimer’s disease and other degenerative brain diseases has been helpful in raising awareness and research funds, but the downside is that this attention also raises people’s fears. For most people the risk of dementia is fairly low, at least until advanced ages (over 85), but that does not stop some people from worrying over each lapse of memory. For someone whose parents both had Alzheimer’s disease, the risk is greater, and worrying about what may happen is understandable.<o:p></o:p></span></div>
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<span style="color: black; font-family: "arial";">When people potentially have genetically-influenced disorders such as Alzheimer’s, the challenge is to live a full life as long as they are able. In a way, we all face that challenge as we grow older, that is, we know something bad will eventually happen, but we don’t know when. As we wrote in the previous example, you will have more success approaching your mother indirectly, rather than giving her advice. There are a lot of articles about possible strategies for lowering risk of dementia. You can pick out articles now and then and show it to your mother. Or you might try one of the strategies yourself, like exercise or diet, which are good generally for health. As we suggested above, your conversation with your mother can be about what other people have done, or your own experience, rather what she should do. <o:p></o:p></span></div>
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<span style="color: black; font-family: "arial";">When we started working in this field, over forty years ago, there was far less information about Alzheimer's disease and dementia. The common view was that if you lived to a very old age, you might become senile, and that was to be expected. As a consequence, not many people worried about it, perhaps because they correctly assumed they might die of something else before that time came. As the dementias became better known, and the possibility of a genetic component became publicized, anxiety about the future began to increase in our client populations. <o:p></o:p></span></div>
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<span style="color: black; font-family: "arial";">Now fear of Alzheimer's is a standard feature of conversations among older people. So while the actual numbers of people who get it have probably not changed, the number of people who are afraid they will has increased exponentially. Trying to get people not to worry about what might not happen can be an exercise in futility, particularly in the face of the constant barrage of news articles about it. We have seen the ravages of dementia up close, and neither of us would want that to happen to us. But, of course, it could. The odds are better that it won't though. So the challenge is to find a way to think about it to ease the anxiety. <o:p></o:p></span></div>
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<span style="color: black; font-family: "arial";">Anxiety is a generalized worry about what might happen in the future. One way to deal with it is to find aspects of the problem that you do have control over. That includes making decisions about the future, should your mother become incapacitated. Now, while she is fine, is exactly the right time to do it. Who would she want to make decisions for her if she was unable? What kind of living situation would she prefer? Once these decisions have been made, she might be able to let go of worrying about it on a daily basis, knowing that she has done everything she can to plan for the future. The best outcome would be if she decided to postpone worrying about it so that she can enjoy the present time with you.<o:p></o:p></span></div>
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<b><span style="color: black; font-family: "arial";">6. My biggest fear is to live a life full of regrets, only to realize those regrets didn’t matter in the end.What regrets do you wish you let go of as you’ve aged? <o:p></o:p></span></b></div>
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<b><span style="color: black; font-family: "arial";">–answered by Steve</span></b><span style="color: black; font-family: "arial";"><o:p></o:p></span></div>
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<span style="color: black; font-family: "arial";">This is wonderful question that gets at an issue, regret, which is widely discussed in literature, but not in adult development. Regret highlights a major challenge that young adults face, how to know that the decisions you are making will lead you down the right path, or leave you feeling disappointed with your life.<o:p></o:p></span></div>
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<span style="color: black; font-family: "arial";">We have had ups and downs in our lives, and we certainly have some regrets, but on the whole we feel good about what we have done and the choices we made. One reason is we were open to opportunities that arose. For example, we moved across country when our children were still young to take new and better jobs and to live in a better environment. Although we had time-consuming jobs, we found time to do the things we enjoy, such as traveling. Judy says she has heard older clients say they regretted not having taken trips, but no one ever told her they regretted taking trips.<o:p></o:p></span></div>
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<span style="color: black; font-family: "arial";">One thing we have always been able to do is make decisions quickly. Once we get a sense of what we think is the best choice, we move ahead. I probably do a little more mulling on decisions than Judy, but we almost never have gotten stuck. Some choices have not worked out as well as we hoped, but we don’t find ourselves dwelling on regrets. Instead, we are able to enjoy the good things in our lives. <o:p></o:p></span></div>
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<span style="color: black; font-family: "arial";">In the next few years, you are likely to face a lot of decisions that will affect the course of your life. If you tend to get stuck trying to make decisions, there is a strategy that will help. Divide a piece of paper into two columns and write down the pros and cons of the choice you have. Doing pros and cons can help you organize your thoughts, and weigh more carefully whether to proceed or not. You can also see if you need more information before you make your decision. <o:p></o:p></span></div>
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<span style="color: black; font-family: "arial";">You can also use pros and cons if you tend to be impulsive and find yourself regretting hasty decisions? Do you rush into relationships or purchases or other things? You might want to make a rule that you won’t make big decisions without taking some time to think things through. Doing pros and cons will give you time to sort out your thoughts and look at the possible risks and gains. <o:p></o:p></span></div>
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<b><span style="color: black; font-family: "arial";">7. How do you prevent social, emotional, and physical isolation in old age? <o:p></o:p></span></b></div>
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<b><span style="color: black; font-family: "arial";">answered by Steve<o:p></o:p></span></b></div>
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<span style="color: black; font-family: "arial";">This question focused particularly on the isolation that can occur following placement in a nursing home. People who are moved into nursing homes are cut off from family and friends, and are likely to experience feelings of loneliness and isolation. Many nursing homes welcome visitors, but some do not or do not provide places where the resident and friends can comfortably visit. For many people, visiting a friend or relative in a nursing home is upsetting. They do not want to be around people who are old and sick, or have trouble figuring out what to say or do with their friend or relative. And no matter how skilled and caring the staff may be, the social activities they organize in a nursing home will not replace a resident’s long-standing relationships or the comfort of one’s own home.<o:p></o:p></span></div>
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<span style="color: black; font-family: "arial";">Nursing homes can take some practical steps to help foster visits from family and friends. At the time of placement, a staff member can give family members an orientation to the facility, talking about the importance of visiting and helping families think about what they might do or say during the visit. Family may feel guilty for placing a parent or spouse, and being able to talk about that can help them get past feelings of awkwardness about visiting. Staff can also be supportive of visits, making sure the visitors feel welcomed and getting to know the visitors. Better facilities have support groups for family members, often led by a member of the social services staff.<o:p></o:p></span></div>
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<span style="color: black; font-family: "arial";">An unfortunate aspect of most US nursing homes is that residents live in small rooms with one or sometimes multiple roommates. The lack of privacy leads people to withdraw within themselves, and makes visitors uncomfortable. Although it is not likely that facilities will suddenly change to single rooms, they should be able to provide an attractive place for visits, including private areas away from other residents and blaring televisions. Single rooms are the norm in most economically-advanced countries, but that is another discussion.<o:p></o:p></span></div>
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<span style="color: black; font-family: "arial";">Of course, the biggest obstacle to these strategies for reducing isolation is cost. The argument will be that staff are too busy or that space is simply not available or that family simply do not want to visit. But we have been in facilities that provide care in a welcoming, attractive, and homelike setting, and where staff emphasize their interactions with residents and their families. When you find a special facility like that, talk it up or write a letter to your local newspaper or on a social website. <o:p></o:p></span></div>
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Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com1tag:blogger.com,1999:blog-6263958504548366118.post-22212047756951920572019-10-16T13:23:00.000-07:002019-10-16T13:24:24.162-07:00Some Sound Advice for a Healthy Old Age<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: "arial" , "helvetica" , sans-serif;">It’s rare to find a sensible article about healthy aging these days. A recent article in the Washington Post is a rare exception. The article is entitled, “The longevity files: A strong grip? Push-ups? What actually can help you live to a ripe old age.” The author, Christie Aschwanden, sifts through the various claims, and explains why so many of the assertions about diet, exercise or other life style factors are likely to be exaggerated. For example, why do people who do 40 pushups have a lower risk of cardiovascular disease? The answer—people who can do 40 pushups are healthy enough to do them in the first place.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The message of the article, which we strongly agree with, is that there is no magic bullet, no specific exercise or diet or other lifestyle that will help us live longer and healthier. But the article makes a strong case that there are some fundamental approaches that do help. <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">First and foremost is exercise. The benefits of regular moderate exercise are well-established for reducing the risk of illness. Intensive exercise does not add any additional health benefits, but is more likely than moderate activities to lead to injuries. Staying fit also means we can do more of the things we want and have better recoveries from illness or surgeries. <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Likewise, with diet, moderation is the key. The claims of benefits of anti-aging diets and anti-aging foods are exaggerated. The Mediterranean diet has gotten considerable attention for lowering cardiovascular disease, but the article and our own reading of the evidence suggests the effects are modest. Maintaining a good weight (not too high, but also not too low) is also important for health<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Other strategies mentioned in the article for sustaining health were being engaged in activities and </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">with other people, getting enough sleep, and lowering stress. The claims about health benefits of red wine and other alcohol, however, were probably exaggerated. People who had health problems were probably less likely to drink in the first place. <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The barrage of health claims in the media and on the web is likely to continue, along with articles that counter these claims. Stories this past month reported on research that suggested that beef and pork and even cured meats are not actually bad for us. The article has produced a firestorm of response in the public health field. Scientists at Harvard are quoted as saying that the conclusions of the article “harm the credibility of nutrition science and erode public trust in scientific research.” But the real conclusion is that weak research that makes sweeping claims about health benefits of a particular diet or exercise or life style erodes public trust, and really just confuses us all. <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">That’s the conclusion that Aaron Carroll also makes. Carroll, who is a researcher at Indiana University of Medicine, is our favorite writer on health issues. Most writers report on findings that reinforce their beliefs, and most of us pay attention only to the headlines consistent with what we want to believe about healthy living. Carroll is different. He understands research and weighs the evidence carefully. He provides balanced and thoughtful articles on health issues. We have provided a link to his column on the red meat controversy and a couple other articles on the topic.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">For Aaron: Carroll’s article on red meat:<o:p></o:p></span></div>
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<span style="color: #3d85c6; font-family: "arial" , "helvetica" , sans-serif;"><a href="https://www.nytimes.com/2019/10/01/upshot/health-risks-meat-experts.html?smid=nytcore-ios-share" style="color: #954f72;">https://www.nytimes.com/2019/10/01/upshot/health-risks-meat-experts.html?smid=nytcore-ios-share</a><o:p></o:p></span></div>
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<span style="color: #3d85c6; font-family: "arial" , "helvetica" , sans-serif;"><a href="https://www.washingtonpost.com/health/the-longevity-files-a-strong-grip-pushups-what-actually-can-help-you-live-to-a-ripe-old-age/2019/09/27/e2cffb5c-da34-11e9-ac63-3016711543fe_story.html" style="color: #954f72;">https://www.washingtonpost.com/health/the-longevity-files-a-strong-grip-pushups-what-actually-can-help-you-live-to-a-ripe-old-age/2019/09/27/e2cffb5c-da34-11e9-ac63-3016711543fe_story.html</a><o:p></o:p></span></div>
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<span style="color: #3d85c6; font-family: "arial" , "helvetica" , sans-serif;"><a href="https://www.nytimes.com/2019/09/30/health/red-meat-heart-cancer.html?te=1&nl=science-times&emc=edit_sc_20191001?campaign_id=34&instance_id=12746&segment_id=17483&user_id=98f3fcf260219e79a11053d8948e41ec&regi_id=60761850" style="color: #954f72;">https://www.nytimes.com/2019/09/30/health/red-meat-heart-cancer.html?te=1&nl=science-times&emc=edit_sc_20191001?campaign_id=34&instance_id=12746&segment_id=17483&user_id=98f3fcf260219e79a11053d8948e41ec&regi_id=60761850</a><o:p></o:p></span></div>
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<span style="color: #0b5394; font-family: "arial" , "helvetica" , sans-serif;"><o:p style="color: #a64d79;"> </o:p><span style="text-align: center;"><u><span style="color: #a64d79;">https://www.nytimes.com/2019/10/14/upshot/diet-soda-health-myths.html</span></u></span></span></div>
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Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com3tag:blogger.com,1999:blog-6263958504548366118.post-17244781316527821132019-09-18T07:36:00.000-07:002019-09-21T12:18:49.119-07:00Celebrating Our 39th Anniversary in Paris<div class="MsoNormal" style="margin: 0in 0in 0.0001pt;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2VdraZ8tWTSejTB9SRJS-77erIinjd4qtZHYo-5HEWhq5R63VBB2CMDj6Js3TIa8f_1SfIEnzeELkciMjkBjT5nsrOWBcveW52Rp1k6pk5EWmANbxz5OMdXkkKR3q_VwQWJiZINgTIWg/s1600/NUED%25255SHShmRwdhTmzD7tg_thumb_a87e.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="724" data-original-width="1086" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2VdraZ8tWTSejTB9SRJS-77erIinjd4qtZHYo-5HEWhq5R63VBB2CMDj6Js3TIa8f_1SfIEnzeELkciMjkBjT5nsrOWBcveW52Rp1k6pk5EWmANbxz5OMdXkkKR3q_VwQWJiZINgTIWg/s320/NUED%25255SHShmRwdhTmzD7tg_thumb_a87e.jpg" width="320" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Here we are with Notre Dame behind us</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">We have just come back from Europe, where we celebrated our 39<sup>th</sup>wedding anniversary. The trip came about because Steve had been invited to speak at a conference, the International Psychogeriatric Association, which was held in Santiago de Compostela in Spain. Santiago de Compostela turned out to be a lovely town. For over a thousand years, the town has been the destination of a great pilgrimage to visit relics of one of the apostles, St. James. The relics are housed in a magnificent cathedral. Pilgrims from all over Europe walk to Santiago de Compostela to visit the relics.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The conference was quite interesting. Of particular note was the importance several speakers placed on providing high quality medical and social care for persons with dementia. That sounds obvious, yet often the obvious medical problems get overlooked, partly because persons with dementia sometimes can’t report problems and partly because medical personnel are not trained to look for problems. As a result, undiagnosed health problems and untreated pain diminish the person’s quality of life and may compromise further the person’s cognitive ability. Speakers also discussed how social care and the quality of the environment can likewise make a difference for people with dementia.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">Since we were going to be in Europe, we decided to stay longer and celebrate our anniversary in Paris. We have been to Paris many times, but we still enjoy going there. We have seen the major tourist sites, and so we don’t feel pressure to cram in visits to the Louvre or to ride up to the top of the Eiffel Town. Instead, we have a leisurely pace. We may seek out a small museum we have not been to before, or just walk through an interesting neighborhood. Judy keeps a list of restaurants in Paris that she reads about, and we visit new places as well as old favorites. <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">We have found a hotel that we like that is down the block from our favorite bakery, Gontran Cherrier, where we buy breakfast pastries and a half baguette for later in the day. The hotel is in a neighborhood that is off the main tourist route and it looks like a movie set of Paris 75 or 100 years ago. The narrow streets are filled with cafes and shops. In the morning, we see shopkeepers opening up. The fish monger has a prominent location at a street corner, and each morning except Monday starts setting out fish on ice in front of the store. The same routine is going on at other stores. You can get almost anything you might need. Beginning around 4 pm, the cafes begin to fill up with local people, having a drink and sometimes staying for dinner. People are out walking as well, and children can ride on a merry-go-round in the middle of the neighborhood.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">You might ask, why make a big deal on a 39<sup>th</sup>anniversary? Why not wait a year to the 40<sup>th</sup>anniversary and do a big trip then? First, of course, was the opportunity. We were in Europe anyway. But more importantly, what we have learned about aging is to take advantage of opportunities now, because you never know what might happen in the next year. This is not a morbid thought. Rather, we are being practical and know that at some point we won’t be able to make this kind of trip. We have known a lot of older people who say they regret not having traveled to some place special when they still could, but we have never met anyone who said they regretted having made a trip or pursued some other opportunity to do something they always wanted to do. <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">While we were in Paris, we had time to talk about the places we love to visit and things we like to do, and we hit on an idea that is perfect for our 40<sup>th</sup>. Tune in next year to find out what it is.<o:p></o:p></span></div>
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Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com1tag:blogger.com,1999:blog-6263958504548366118.post-3236021016946650072019-09-17T08:31:00.002-07:002019-09-17T08:31:11.041-07:00The Liberation Museum in Paris<div class="MsoNormal" style="margin: 0in 0in 0.0001pt;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHjBWQBKA8VoJGnfGLeGmlPe4VCrxC6FqpzBRb7RTKVq_m6TPk-bawG7n-LsCprAGNeCIGg5DagzcXnz0EWI05DHK_jcjUcwIRc7H4-vpCeNWqKAANceTRJQvZg-IaDs_pMZF4rJ6JPwQ/s1600/IMG_6383.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1067" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHjBWQBKA8VoJGnfGLeGmlPe4VCrxC6FqpzBRb7RTKVq_m6TPk-bawG7n-LsCprAGNeCIGg5DagzcXnz0EWI05DHK_jcjUcwIRc7H4-vpCeNWqKAANceTRJQvZg-IaDs_pMZF4rJ6JPwQ/s320/IMG_6383.jpg" width="213" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The bunker</span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">We grew up in the shadow of World War II. When we first came to Paris many years ago, the scars of the war including the ruins of bombed out buildings, were still present. We've read many books and seen lots of movies about the war. Some of those stories were about the heroic efforts of the French resistance. So we had an idea what it was like during the war in France and in Paris.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">On our recent visit to Paris, we went to the Musee de la Liberation de Paris (The Liberation Museum of Paris), which had recently moved to a new building. The way this museum was designed, we felt that we were stepping back in time as we followed a timeline from World War I onward. The losses in the first World War were devastating to France, which we had seen evidenced in the memorials in every little town listing the fallen in both wars. Whole families were erased in that first war, and the French had little appetite for another war so soon. They slid into denial when Hitler first started his advances, and they</span><span style="font-family: "arial" , "helvetica" , sans-serif;"> thought it would be possible to reach an accommodation that would avoid a war.</span><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span><span style="font-family: "arial" , "helvetica" , sans-serif;">As a result, France was late to rearm and prepare for war. After the Germans occupied France, some people actively supported Nazi ideas and worked with the occupying forces.</span><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span><span style="font-family: "arial" , "helvetica" , sans-serif;">Other people remained passive, hoping just to get by.</span><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span><span style="font-family: "arial" , "helvetica" , sans-serif;">Many others, however, realized how horrible the situation was and became part of the resistance.</span><span style="font-family: "arial" , "helvetica" , sans-serif;"> </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The museum told the story of the war, occupation, and liberation through the lives of two individuals, Jean Moulin and Philippe de Hauteclocque, who used the alias “Leclerc.” By focusing on two minor figures not everyone knows, the museum brought the story down to a personal level. Although they came from very different backgrounds and held different political beliefs, both Moulin and Leclerc made the decision not to go along with the occupation, but to resist. Moulin had been mayor of a Paris suburb when France fell to the Germans in 1940. He quickly became active in the resistance and was captured and killed by German forces in 1943. Leclerc was an officer in the army who fled the country after the occupation, and joined the Free French forces in Africa. In 1944, he led the French troops that liberated Paris. <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The museum also highlighted stories of ordinary people and what they did during that time. </span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">When you read histories or historical novels of that era, it's tempting to imagine that you would do something heroic, out of a sense of commitment and honor. While we were struck by the heroism of these individuals, it was also apparent that their lives were threatened on a daily basis, so in a sense they had nothing to lose to take a risk. They could die anyway, even if they did nothing to oppose the occupation. You’d like to imagine you’d be the one who would be the hero, but if you’re not tested you never know. <o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The museum had photographs, letters, newspapers and even some films clips. One film showed a woman during the fight to liberate Paris. She was young, perhaps 21 or 22 years old, and was fearless. During a firefight, she saw a German soldier go down in the street. She rushed out and wrestled his rifle and other weapons away from him. We don’t know what happened to her or whether she even survived the war. But Judy, especially, was drawn to her because she epitomized the fearlessness that she hoped she might have had in that situation.<o:p></o:p></span></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;">The new museum building has been constructed over a bunker that had served as the hub of resistance activities in the days leading up to the liberation. The Nazis knew there was an air raid shelter there. They didn’t know the resistance had dug out a bunker underneath it and made it a control center for resistance activities across Paris. As we stood In the bunker, it was possible to imagine the activities that took place there, and the incredible tension they lived under as they fought for their lives and the freedom of their country. We came away awed and inspired by the courage they showed in what had to have seemed like a hopeless situation. <o:p></o:p></span></div>
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Judy and Steve Zarithttp://www.blogger.com/profile/11579784162555690931noreply@blogger.com0