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“Older People” And Covid

It has to be one of the misguided articles in the New York Times. Covid’s Risk to Older Adults by David Leonhardt.

The article quotes Janet Baseman, an epidemiologist at the University of Washington and presumably an expert:

“I think the risk is not super high for relatively healthy and boosted people in their 70s,” Janet Baseman, an epidemiologist at the University of Washington, told me. “I think it’s moderate at most.”

So what more do we need to know? This response echoes other comments from doctors about Covid-19. which I reported in this article. But if we stopped there, we’d have no story to fill the Times column-inches.

Baseman goes on to say “that if she were in her 70s, her primary worry would be getting moderately ill, needing standard medical care and not being able to get it at an overwhelmed hospital.”

Wait….being moderately ill isn’t the same as having moderate risk. Moderately ill patients are defined as needing hospital care but not “organ support..”

It’s not clear what’s meant by “moderate risk.” The only definition I could find refers to long-term health conditions that aren’t immediately life-threatening but could cause problems later, such as pre-diabetes, obesity, and hypertension.

Regardless, we’ve got some muddy thinking here.

Even worse, the article lumps all 75-year-old women together. The author seems to have listened to “Grandma Got Run Over By A Reindeer” a few too many times. Many 75-year-old women have comorbidities. Many live in some form of assisted living or even nursing homes. Without controlling for those factors, the numbers are meaningless…and of no particular relevance to any 75-year-old reading this article. You have “older” people like Willie Murphy, the body-builder who attacked a burglar in her home. You have people like the late Olga Kotelko, who died at 93 a few weeks after competing in track and field events. You have thousands of men and women competing in senior games…and even more who are healthy and trying to stay that way, despite the best efforts of their doctors.

The 75-year-old women I know are less concerned of dying from Covid than of living long enough to end up in nursing homes, where 25-40% of the residents are abused. Every time an article gets published about the horrors of these homes, hundreds of readers write comments to express their wish for easier access to assisted dying.

They’re frustrated with doctors who treat them like children, catastrophize minor problems or dismissively ask, “What do you expect, at your age?” They’re tired of doctors who lack understanding of the physiology of people over 50 and who impose meaningless tests, such as EKG’s with an 80% false positive rate that were never intended for screening healthy people.

At a certain point in life people stop fearing death. They’re more concerned with how they will die and how to avoid. the tortures conceived by the medical industrial complex. After all, spies in World War II got cyanide pills they could use to avoid torture; nobody suggested they see a psychiatrist first. They knew torture when they saw it, and so do older people today.

Articles like this portray older people as uniformly weak and unhealthy. They make it difficult (if not impossible) for anyone over 6o to be taken seriously. I shudder to think how many well-meaning adult children will insist that their healthy parents take precautions that will do little to affect their health and well-being, but do more to take away meaning and happiness from the time they have left.

The Joy Of Being A Woman In Her 70s — who are we kidding?

Re The New York Times, Jan 12, 2019 – The Joy Of Being A Woman In Her 70s – by Mary Pipher:

Mary Pipher writes, “In America, ageism is a bigger problem for women than aging… we are denigrated by mother-in-law jokes…” Mother-in-law jokes are mild. What about those grandma and geezer jokes?

There’s no place for a woman who wants to keep working, who’s up to date with tech and social media, who’s lucky enough to be going to zumba class instead of medical appointments. She’s still treated as “cute” and subjected to patronizing, insensitive remarks on a daily basis. Potential employers look at her face — not her fitness levels — and the stereotypes surrounding age. They point to movies that reinforce stereotypes, such as The Intern.

No other disadvantaged group is expected to tolerate this degree of disrespect and discrimination, and still come out smiling and praised for being resilient “in spite of…” this treatment. We should be fighting for our rights instead of celebrating our vibrancy (which is, as some readers noted, limited to healthy, financially comfortable women).

The Times regularly runs articles about African-American women who experience prejudice in work and in life. Those articles do not run with the subtitle, “Happiness is a choice.”

And if you’re not healthy, you’ll be treated patronizingly by the medical profession. You’ll be subject to abuse in many institutions. You’ll likely be overmedicated and over-treated. Read Christiane Northrup’s book, Goddesses Never Age. Read anything by Gilbert Welch on overdiagnosis.

Would we tell other groups (such as African-Americans) that “happiness is a choice” and dismiss these very real assaults on their personhood? I think not.

Review of Marc Freedman’s new book

Marc Freedman’s latest book should be subtitled Prescription for Aging Well: Become Mentor to Younger People & Work With Children. Rather than break new ground, the book subtly reinforces some of the most common stereotypes of aging. For instance, “older people are more concerned with leaving a legacy than making money;” “older people want to nurture younger people and children.”

For instance Marc says he has three young children and no grandparents close by. “Our silver-haired safety net is located two doors down. Our quirky, engaging eighty-something neighbors …have become quasi-grandparents for our children… “

Freedman notes institutional factors that help older people: social acuity, Medicare and … AARP?! The truth is, many people avoid AARP because of their overly aggressive advertising (I stopped them by sending a public Facebook message) and because it’s not clear how they really help older Americans. In the last election, the two main party candidates differed significantly in their positions on Medicare and Social Security; one clearly would benefit recipients more than the other. Yet AARP remained steadfastly neutral, merely reporting what each side said.

AARP supported the drug “donut hole.” And AARP is, above all, an insurance company, which many people believe is sub-par in both value and customer service. You can just look at the comments under most AARP articles. r

Freedman points to Experience Corps as a model of ways to help both seniors and children. In fact Experience Corps seems to target “vulnerable older adults.” Their web page includes an excerpt from a newspaper article, “Older citizens have time on their hands and skills to share.” Really? Could this be another stereotype.

Freedman praises the movie The Intern as a “great example” of introducing an older person into a Millennial environment. In fact, the notion that older people need to become low-paid (or no-paid) interns seems preposterous. It’s not unusual for companies to hire executives who bring special skills to the table, even if they’re not familiar with all aspects of the organization. DeNiro reinforced many stereotypes — tech-challenged, always wearing a suit and carrying a briefcase. Today’s executives of all ages are likely to show up in business casual or even jeans and sneakers. A Pew Trust survey found that 67% of adults ages 65 and older say they go online, in contrast to just 14% in 2000.

Freedman takes a top-down view of aging, talking to people who create services, products or policy for older people. He talks to architects who offer innovative cross-generation housing. He talks to academics and authors. But the “boots on the ground” older people often don’t want any part of that. They want integrated housing but that means they want to live in an ordinary neighborhood or apartment with people of all ages. They want to work in real jobs for market wages and growth opportunities. These days, five years is a long time in any job, so they have time.

The truth is, some people — age 18 to 80 — just naturally enjoy working with children. Some others in the same age group would rather work in a for-profit environment as a contributor, not an intern. Some people are simply not qualified, by temperament or skill, to work with children. And many younger adults can afford to pay a coach or consultant to mentor them.

The workplace is the single biggest area of ageism (closely followed by the medical profession, which tends to pathologize medicate normal aging processes. See Christiane Northup’s excellent book, Goddesses Never Age.)

Finally, many older people aren’t afraid of dying. They’re more afraid of ending up in a nursing home, where many will be abused. They want to die with dignity. The advice to “accept your mortality” seems to apply to a specific segment of the population.

From John Leland’s Book: Happiness Is A Choice You Make

I wanted to like this book. I ended up with mixed feelings.

Leland’s mother had a DNR.

On p 19, he writes: “Her DNR said to withhold care if she had no reasonable chance of regaining a meaningful life. But this was more like bringing in a hose if the drapes in her room caught fire. Afterward she would return to the life she had in her neat apartment. She had friends and grandchildren she loved; she had matinee concerts at the Philharmonic. People with much less enjoy great lives. It seemed ungrateful to reject that life as not worth living. If she wanted to starve to death she could do it without our help. We approved the tube.”

This is cruel and heartless. Leland seems to be judging his mother and her quality of life. And starving to death isn’t as easy as it seems. One sip of water and it’s over.

He’s able to be more dispassionate with his interview subject, John Sorensen: “None of us really wants immortality on other people’s terms; it’s no kindness to wish a scaled-down version of it on the people who want it least.”

Some quotes:

p 22: “The elders all knew something you can’t get on the Internet, which is how to be old, and how the world looks from the perspective of someone who has lived in it for awhile and who will soon be leaving it.”

And he quotes Monika Ardelt, associate professor of University of Florida … “Older people still have a lot to offer us, even if only how to die and age gracefully.”

How valuable is that information? Most of the time people aren’t preparing to die. They want ordinary conversation about ordinary tings.

p 29: His interviewee Fred describes happiness as “a view from old age — taking satisfaction in what was available right now, not hitching it to the future.” Sounds more like prison than happiness to me!

On the other hand, more people need to be aware of this (p 33): “At eighty-five and up, only 11 percent live in a nursing home or similar facility, and almost two-thirds say they don’t have trouble caring for themselves…It’s just that the least healthy get the most attention–no one gets a grant to remedy the happiness of old people.”

Bg problem of cohort effect… selective memory of happiness.

This is simply bizarre (p 42): “Imagine that: to be free of the future, meaning the sum of all things that probably won’t happen, minus the one that will, which is one’s death. Even if just for a minute, the feeling is like that of first flight, weightless and free. Most of us live with this future every day, laboring under its weight. To think like an old person is to journey unencumbered.”

Ardelt’s study — pp 43-44 – doesn’t have a citation. He summarizes, “Those who scored higher for wisdom were more content with their lives [in nursing homes] — as content as people their age living independently.” I’d really like to see that research.

Quotes Ardelt, “Older people are more …afraid of the dying process. Wise people are more accepting of the dying process.” p 44

p 77 – “It is a received wisdom in our time that married people live longer.” He cites research showing that it just applies to oemen; but Bella DePaulo found that this research is generally flawed. Marriage isn’t associated with happiness or other positive outcomes.

p 91: “Loss is one of life’s great instillers of wisdom, including the wisdom that finds compensation for the capacities we think we can’t live without. Only people in California want it to be sunny every day.”

That’s absurd. There often are no compensations. Giving up things that hold meaning — independence, intellectual stimulation, choices — isn’t the same as wanting sun every day. The remark about California is condescending and should have been edited out.

He notes that decline “is more a relationship of negotiation, with some variation and wiggle room, than a fixed path.” p 91
Older people, he says, “now have statins to keep their hearts ticking, cataract surgery to keep the lights on, artificial hips and knees to keep them walking, and swanky scooters to keep them mobile when the new knees go south.”

Sorry, it’s not that simple. Statins have horrific side effects. Cataract surgery doesn’t always turn out well. Artificial hips aren’t always available. And “swanky scooters?” Would anyone choose them voluntarily?

Even over one year he noticed a decline among those he interviewed.

p 114: “If you believe you are in control of your life, steering it in a course of your choosing, then old age is an affront, because it is a destination you didn’t choose. But if you think of life instead as an improvisation in response to the stream of events coming at you — that is, a response to the world as it is– then old age is more another chapter in a long-running story.”

That’s a way to say, “Accept the bad stuff and be humble.” It’s the same advice you’d give to a prisoner of war. Escape is honorable.

Simplistic article on suicide in the elderly from Milesetones

Milestones is a tabloid type newspaper published by the Philadelphia Corporation for Aging and distributed free in Philadelphia and downloadable online. It’s the usual party line pep talk stuff.

Their November 2017 issue included an article about suicide. Here’s how I responded.

I was appalled by your article on suicide among the elderly. Milestones reaches a large, diverse audience with a tabloid type newspaper. You have a rare opportunity to share accurate information and raise concerns. Instead, you present a simplistic view of a complex subject, in a way that could actually harm the very people you are targeting for help. (more…)