Could reimbursements be driving diagnoses in elderly patients? Could the powers that be have anything but the best interests of old people at heart?

I have my suspicions.  
 
But hold on, Foth-Regner, hold on! Our President and our Congress have promised not to cut seniors’ Medicare benefits. Apparently they’re going to accommodate all us Baby Boomers without reducing our services, simply by doing a little belt-tightening. And they’re going to use all the leftovers to insure 30 or 47 million uninsured Americans -- somewhere in that range, anyway. 
 
Surely this is a miracle! Somehow, they have managed to overturn the laws of mathematics. According to U.S. Census projections, in Wisconsin alone, between 2010 and 2050: 

--The population of those of working age, 18 to 64, will increase by 28%. 

--The population of seniors 65 and older will increase by 120%. 

No word on what percentage of those in the working-age category will actually BE  working, and therefore paying taxes. But let's not be petty.

So what have we got? Double the seniors, a stagnant workforce, and continued inflation  (the Feds have been printing money as fast as they can – we will be fortunate indeed if we don’t have hyperinflation in a few years). And yet somehow Congress is going to cut $250-500 billion (depending on who’s counting) from Medicare spending over the next decade – AND insure up to 47 million more Americans with the savings! 

And how will they reap these huge savings? By “trimming projected increases in …  payments for medical services.” Really. What medical services? And what happens in a free market when prices fall? Demand goes up … supply goes down. Which means shortages … and longer waits for these “trimmed” medical services. The only solution will be for government to take it all over and provide us with the kind of cheerful, friendly, transparent and competent service we get at the DMV or public schools. 
 
People need to stop listening to what politicians say and start looking at the economics behind their promises. Eventually, the wheels will come off. And now that China et al are becoming increasingly squeamish about lending more money to us, it looks like that day is fast approaching. When we can’t borrow the money from other countries anymore, then what? 

All I can say is that it's probably not a great idea to entrust your health and well-being to any level of government. The numbers just don't add up.

I'm glad my citizenship is in heaven. Hope yours is, too.

(Originally posted 9/21/13)

When I was in my 20s, I was crazy about the poetry of Sara Teasdale, a "lyric poet," which apparently means "romantic" and "hyper-emotional" and perhaps even "self-absorbed" and "narcissistic" -- apt descriptions of my state of mind back then. I was, after all, a completely world-bound young woman, living for the kind of love called "eros" in wonderfully precise ancient Greek.

My favorite Teasdale poems were her most depressing, and I considered the best of them all one entitled "The Long Hill" (1919):  
 
I must have passed the crest a  while ago
     And now I am going down.
Strange to have crossed the crest and not to know--
     But the brambles were  always catching the hem of my gown.

All the morning I thought how proud it would be
     To stand there straight as  a queen--
Wrapped in the wind and the sun, with the world under me.
     But the air was dull, there was little I could have seen.

It was nearly level along the beaten track
     And the brambles caught in  my gown--
But it’s no use now to think of turning back,
     The rest of the way will be only going down.

It's true that we feel young until one day we wake up and realize that this is no longer the case, that our earthly lives are 50%, 60%, 70% or more behind us. But Teasdale was a bit young to have recorded such thoughts; she was only 35 years old when it was published. By the world's standards, she was also a bit too successful to have been so down on her life, having been married in 1914 and having just won, in 1918, a Pulitzer Prize for her poetry.
 
But as they say, you're as old as you feel, and apparently having no eternal hope makes one feel ancient at an age most would consider a prelude to one's prime. I have been unable to find any record of Teasdale having found everlasting life. 

And in point of fact, she was on her way down by the time she published "The Long Hill"; she overdosed on sleeping pills in 1933, dying at the age of 48.

That's one way to avoid the inevitable deterioration of old age, I suppose. 

But there's another, infinitely better way -- and that is to join the apostle Paul in saying, "Therefore we do not lose heart. Even though our outward man is perishing, yet the inward man is being renewed day by day. For our light affliction,  which is but for a moment, is working for us a far more exceeding and eternal weight of glory, while we do not look at the things which are seen, but at the things which are not seen. For the things which are seen are temporary, but the things which are not seen are eternal." (2 Corinthians 4:16-18)

The fact is, it's possible for us to know with absolute certainty, whether we're 30 or 70 or 110, that the best is yet to come. It's a free gift. And it's available to anyone willing to bow the heart to our Creator. 

(Original posted 12/14/13)

I have been searching, off and on, for some official insight into how faith impacts dementia – specifically, whether being a born-again Christian makes the plunge into deep forgetfulness an experience as peace-filled and perhaps even joyous as it does any other experience in life. 

I believe that it does indeed. But my evidence is totally anecdotal, based on what I’ve seen as a nursing home volunteer over the last 13+ years. 

So I’ve conducted lengthy searches here and there, now and then, on the internet. And to my amazement, have found virtually nothing on the subject. 

We live in a nation where 10% of those over 65 will develop the form of dementia known as Alzheimer’s; if we live to 85, our chances of developing it are apparently 50/50. We also live in a nation where roughly 76% self-identify as Christian, according to the U.S. Census Bureau.  

Wouldn’t you think some clinician somewhere in these United States would be interested enough to investigate how our faith impacts something as devastating as slipping into dementia? 

I looked again recently, starting out with www.scholar.google.com, where I do a lot of searching of medical-journal articles for my daily work. I found almost nothing there, medically speaking, which seems impossible; I must go back and try again using different search terms. 

I did find lots of plain ol’ web listings purporting to address this issue – more than 5.7 million of them, with a simple search for combinations of words such as Alzheimer's, faith and truth. 

There was a nicely written article headlined, “Yes, Faith Does Change the Alzheimer’s Journey.” It was written by a woman whose mother had Alzheimer’s. But she really didn’t address how it impacted her mother. She just said that she was on a personal pilgrimage of some sort, and then realized that this wasn’t about her, but about her mother, who was after all the one with the disease. So no insights there.

There was another article outlining the search for “dementia and a resurrection theology.” I think it was promoting the use of religious ritual to help the senile find themselves again. According to this article, such “very familiar practices” as communion “witness to the spiritual meaning of a person’s life.” Whatever that means. Is it ritual that gives our lives “spiritual meaning,” or reflects the “spiritual meaning” of our lives? A strange teaching.

The Alzheimer’s Association has posted dozens of links to pages entitled “Walking in Faith,” or some variation thereof. But they don’t seem to have anything to do with Christian faith; I’m not sure what the point is, except that the Association seems to be reaching out to churches for support.

I did find one intriguing report. Published in 2010, its abstract describes a very small study of just 64 Alzheimer’s patients, with two tests conducted 12 months apart. The researchers' conclusion:“Higher levels of religiosity in Alzheimer's dementia seem to correlate with a slower cognitive and behavioral decline, with a corresponding significant reduction of the caregiver's burden.” 

Very interesting and worth noting. But still, eventually we all end up at the same place. What I want to know is if peace and joy prevail for Christians, even through the challenges suffered by those with Alzheimer’s. 

Have any of you come across this sort of research, dear readers? 

(originally posted 10/29/13)

Conventional wisdom says that nursing homes are always bad, and staying at home is always good. But is this really the case?

The recent death of my friend R. has me reconsidering this. At 88, she was still living alone in the home that she and her late husband had built 40 years ago. She loved the house, with good reason: It was indeed beautiful, and spotlessly maintained (I think R. may have been a bit OC about cleanliness and order).  What’s more, living there enabled her to keep the cat she had rescued from the wild 13 years earlier, and loved to pieces.

But R. was so frail, and prone to the UTIs that can lead to confusion. In the end, a relative found her knocked into delirium by a massive stroke or sepsis or both, three whole days after the last person had spoken with her by phone. How long she had been in this state, no one could say.  She died a week later, in the hospital, never regaining her faculties and in fact lapsing into a coma just a day into her hospitalization.

I wonder: Would R. have been better off in a nursing home, surrounded by people her own age and thriving under the watchful eye of a solid-gold nursing staff?

Another elderly friend died about the same time, under slightly different circumstances.  Long-widowed, J. had lived alone in an apartment until a couple years ago. But she was becoming increasingly forgetful, so one of her sons took her in to his home. It was great at first; he took excellent care of her, and no doubt continued to do so right up to the end. But he works full time and then some, so at first she was alone most of her waking hours. Later, deciding that she might be unsafe alone, he hired an aide to sit with her while he earned his living. But it was apparently too little, too late: She soon tumbled into full-blown dementia, occupying it in horror and misery for about a year before she died.

Would J.  have been better off in a nursing home? Might she have blossomed in such an environment, enjoying the company of people her own age and engaged in a steady stream of activities tailored specifically to her evolving abilities?

I guess only God knows for sure. But I tend to think that both R. and J. would have been happier in a facility designed to meet their needs for medical care, companionship and intellectual stimulation.

When it comes time for you to figure out a way to take care of your elderly parents or grandparents, don’t automatically assume that home with you is the best place for them. Those who routinely denounce nursing homes are not necessarily doing the elderly any favors; there are situations in which leaving day-to-day care to the professionals in a fine nursing home may well be the best solution for your loved ones.

Lately I’ve been noticing a refreshing phenomenon at the nursing home where I hang out: an uncanny level of mutual compassion among the residents.

Maybe it’s always been there, and I’ve just missed it. Maybe I just happen to know some ultra-kind folks at the moment. Or maybe my own tired bones are making me more aware of how these people treat each other, and how sympathetically they respond when a neighbor suffers yet another physical setback – even when that setback disturbs their own fragile peace or comfort. 

Here’s just one example: an elderly woman who was crying out in her sleep almost every night, often disrupting her roommate’s rest. The roommate was offered a bed in another room, but she decided to stay put; the sleep-talker couldn’t help it, she pointed out, and after all, she could always catch up on her own sleep during the day.

When I heard this, I couldn’t help but recall a dear friend who experienced such middle-of-the-night terrors some years ago. His neighbors complained bitterly about the racket. They didn’t care who it was or why he was crying out; they just wanted him to stop.

Today, there’s more compassion in evidence everywhere I look. And it’s a beautiful thing to see when, for instance, one old woman asks the same question repeatedly, and the folks nearby answer again and again, without even a trace of impatience in their voices. Or when, in a hymn sing, a severely disabled man struggles to help turn pages for the even worse-off fellow in the adjacent gerry chair. Or when a very with-it old gal goes out of her way to sing the praises of a tablemate’s sunny disposition, even though everyone knows that this tablemate is the victim of cognition-sapping dementia.

I suppose there’s an awful lot of “there but for the grace of God go I” thinking at work in this place – proving, once again, that there’s a ton of wisdom and love to be found in the halls of your local nursing home. If you haven’t already done so, I hope you’ll discover it for yourself just as soon as possible.