labyrinthworld

A birth cohort is a group of individuals born within a particular year or a particular period.

NBC Morning news ran a segment this morning on women and drinking. According to them, Dr. Richard Grucza, a researcher at Washington University Medical Center at Missouri, found that compared to women born ten years earlier, women born between 1954 and 1963 are showing a significant increase in alcohol dependence. This increase remains for the next two birth cohorts. Fifty percent of this increase is with Hispanic and white women.

NBC also reported that Westchester County is seeing an increase in women driving while drunk, often with children in tow. A lot of this drinking is taking place in the afternoon. Experts say that mothers are likely to turn to alcohol because of stress, loneliness, and loss of self esteem.

Is the primary purpose of my life to make those already rich, even richer? Health care is a general good just like education, military and police. Is government’s reason for being to ensure or to promote the general good? Do the rights of a small group of individuals to make money off my health triumph my right to this general good? I ask these questions as I reflect on John McCain’s free market approach to health care. 

If we believe that government’s reason for being is to promote the common good, a free market approach to health care can be disastrous. Already our privatized health care system is ranked a low 37 by the World Health Organization. To put this in perspective, when it comes to health care, countries like Costa Rica and Columbia rank higher than the US.

John McCain’s proposed health care plan would shift the responsibility for health care from employers or the government onto individuals.  He plans to do this by shifting the tax benefits that now go to employers onto individuals. Under his plan individuals would receive a $2500 credit, families a $5000 credit. The fear is that change would cause some businesses to drop coverage. The result would be a large number of workers flooding the system as they try to obtain individually based plans.

The problem with individually based plans is that individuals have to qualify. For the young and healthy that might not be a problem. But the elderly and those suffering from chronic health problems might be unable to purchase health care plans. A second problem is that the administrative costs of individual polices are at least triple of those of employer based policies.

McCain also wants to deregulate the insurance industry; a step he believes would promote competition. A possible downside of deregulation is that it could lead to looser standards and higher costs and diminished coverage.  As it stands now each state sets minimum standards under which plans can be sold. McCain’s plan could override state regulations. Companies would be able to sell in every state any policy that was approved in any state.  That means that if an insurer’s policy was approved in a state with looser standards, a state with higher standards could not impose those standards on the insurer. For example if one state require insurers to pay for specific procedures such as mammograms, a state that does not set this standard is the one whose rules ensurers must follow.  Or if one state sets a minimum deductible, a state that sets a higher deductible is the one that prevails.

The soon to be released General Accountability Office’s report will be of interest to anyone who has undergone a transplant, known someone who has undergone one, or expect to undergo one. Organ damage can be caused by a number of things. In addition to accidents, alcohol poisoning, some causes are  hypertension, diabetes, heart disease. It so happens hypertension and diabetes run in my family, and a close relative of mine has undergone two successful kidney transplants.

The GAO found that there are broad failings in the organ transplant system. Organs are becoming increasingly scarce. Almost 100,000 people are on the transplant list, and 6000 die before they receive a transplant. Inadequate programs put patients at increased risk of harm or death. The GAO was prompted to look at this issue after 2005-2006 investigative reports by the Los Angeles Times showed that transplant regulators failed to spot problems and didn’t step in quickly to protect patients.

Among its findings, the Los Angeles Times found that in 2005 St. Vincent Medical Center in Los Angeles improperly arranged for a Saudi national to receive a transplant using an organ intended for a higher priority patient. In 2006 the UCI Medical Center did not have a full time transplant surgeon and “had been turning down a disproportionately high number of organs while patients died.” In 2006 Kaiser Permanente was found to have endangered hundreds of patients by delaying critical surgeries or losing track of patients. The Times also found that about 1 in 5 federally funded programs failed to meet government’s minimum standards for patient survival or performed too few operations to ensure competency.

The GAO new report shows that more than 30 kidney transplant programs have not been inspected by Medicare and Medicaid for a decade, and some have not been inspected in 20 years. Since the Times report the Medicare agency has pledged to step up its oversight. That remains to be seen since as recently as 2007 , according to the GAO Report, “Of the 72 programs identified as having low survival rates in 2005, about 40% still were not meeting basic survival standards by August 2007.“ 

Who among us haven’t had a senior moment? For that brief moment our mind freezes, and try as we might, we can’t remember the name of a person who at one time had been so important to us. A shiver runs through us and we can’t help but wonder if it is the beginning of the end, or even worse, a sign of early onset Alzheimer’s. For me, moments of forgetfulness often occurred during the middle of my lectures while I railed against one or another social injustice.

Far worse are those moments of stress when my mind freezes up. It is then I remember riding in the backseat of a car driven by a relative, my mother next to her. We’ve gotten the word that my mother’s granddaughter is dying for the third time, and we are on our way to the hospital to be with her and the family. The stress causes my mother’s short-term memory to desert her, and she talks about events that occurred in the distant past as if they are happening now. My niece survives only to die again and again until it becomes impossible to resuscitate her. My mother’s memory returns, only to desert her each time her granddaughter dies, until finally she could summon it no more.

I am cautiously optimistic. A the new report shows that moments of forgetfulness in older adults may signal a broad attention span. As people grow older their focus of attention widens which may make it difficult to latch onto one idea. Broad attention span may be an advantage in that older adults have more data that they can use to become better problem solvers.    

This week was nursing home week. In connection with this event, the senate held a hearing on enforcement of federal quality of care standards for nursing homes. The hearing was broadcast by Cspan. Click here to watch the testimony if you missed it.  You’ll find it under “Recent Programs.” As I wrote earlier, the Government Acccounability Office (GAO) found that nursing home inspectors are derelict in their duty of identifying and enforcing violations.

Also, the Senate Special Aging Cmte. held a hearing on breakthroughs and challenges in treating Alzheimer’s. If you didn’t get a chance to watch it, videotaped testimony by Fmr. Supreme Court Justice Sandra Day O’Connor about caring for a spouse with Alzheimer’s can be accessed on Cspan’s website.  Along with her testimony is  testimony from a patient, health care specialists and other caregivers.   I read a wonderful article awhile back about O’Connor’s ability to value her Alzheimer’s husband great fortune to be able to find love a second time. Although they have been married since 1952, he no longer recognizes O’Connor and has fallen in love with a patient who lives at the same Alzheimer’s facility. It is a touching story. I believe I wrote something about it, but can’t remember if I posted it.

Latest reports show that nursing home inspectors routinely minimize or ignore potential life threatening problems.  Added to the problem is the fact that nationwide, one-fifth of nursing homes were cited for serious deficiencies last year. Nursing homes are required to be inspected yearly. Inspection is done by a state employee. federal officials validate the reports by accompanying inspectors or through a follow-up survey.

More than 1.5 million people live in nursing homes. The federal government in the form of Medicare and Medicaid cover more than two-thirds of their residents. As a condition for participating in Medicare or Medicaid programs, nursing homes must meet stringent federal standards.

The chief counsel to the inspector general of the Department of Health and Human Services, Lewis Morris, said he often had problems identifying owners of nursing homes that provide substandard care. Some of the problems found were residents that were dehydrated or malnourished, maggot infestations in wounds, dead flesh, and broken bones that have gone unmended.

Adults are not able to hear some sounds that children can.  This fact gained a lot of attention a couple of years ago when it became known that there were ringtones that children could hear that adults couldn’t hear. For older Americans it is worse. An AARP survey revealed that nearly half of the 76 million babyboomers have experienced some sort of hearing loss.  Dr. Steven D. Rauch, a professor of otolaryngology at Harvard, in a New York Times article stated that by age 65 about a third of people have significant hearing loss. By age 75, its about half. He states that if it sounds like people around you are mumbling, you need a hearing test.

Although she does not explicitly use the word mumbling, it sounds like that’s what the writer on the sethedaughter’s blog is experiencing. Perhaps its time for her to get a hearing test.

Caring for someone afflicted by Alzheimer’s can be overwhelming. To get relief some caregivers turn to adult day care. As the sole caregiver for my mother, that’s what I did. As my mother’s disease progressed, I found that she needed 24 hour care. It was overwhelming since her deterioration was accompanied for a long period by what I perceived to be unreasonable anger and constant demands to say nothing of the emotional pain she and I both experienced as the result of her gradual and profound loss. The changes were also accompanied by emotional abandonment as friends and loved ones slipped away. 

Adult day care provided a way for her to connect with individuals that could offer her friendship. It provided her the opportunity to be the person that existed in her mind. In my mother’s case that person was someone who was young and alluring with childlike appeal. It provided me with a window of time that I could use to pursue my own dreams.

The care was free, offered by the local government. Along with the care came free transportation. Transportation was not always reliable - the drivers sometimes were late in picking up my mother, and on one or two occasions simply forgot about her. Still it was a tremendous help.  This type of care is available in most communities. Although some places charge, there are others that are free.  The best place to find out what’s available in your community is to check with your local government, with the local agency on aging, or with AARP. 
 

One of the unfortunate side effects of sports is the wear and tear on the joints.  This seems to be more true for girl athletes than boys.  For some this could mean hip or knee replacement surgery by the time they are 30. (see Michael Sokolove’s article on injuries suffered by girl athletes). An alternative to hip replacement is hip resurfacing, a less invasive procedure.  Since it’s necessary to have strong bones for this type of procedure, this is more of an option for the young (under 50). Alternately, the average age for hip replacement is 68. See AARP bulletin.

While not young, and not old, and certainly no athlete, I have begun suffering from first hip pain, and lately knee pain.  The injury came from over use, and even though the pain is no where near what it was when I first injured my hip, it resurfaces when I put too much stress on it.  Of course I am in denial and am determined to banish all trace of injury through sheer will power.  Like many baby boomers, I refuse to go gently into the good night.