Dying With Dementia

Several recent studies about dementia among America’s aged are profoundly disturbing — especially for those of us who aspire to live to a ripe old age.

IMG_1111One study, by the Alzheimer’s Association, concludes that one in three elderly dies with Alzheimer’s disease or some other form of dementia.  The dementia does not necessarily directly cause death,  but does contribute to an earlier demise because the senior forgets to take her medication, or is unable to recognize symptoms that should lead to prompt treatment.  Another study, led by an economist from the RAND Corporation, concludes that 15 percent of Americans over age 71 — about 3.8 million people — have dementia, and that number will increased to 9.1 million by 2040.  The study also found that the direct health care costs for dementia patients, at nursing homes and other care facilities, is $109 billion, and the costs of care also are expected to increase dramatically.

As a society, we must worry about how we are going to pay for such care, but as individuals we worry about becoming one of those statistics.  If you’ve been around someone with dementia, you realize it is an awful way to go.  So many of the afflicted appear to be perpetually frightened, or angry, or both.  They don’t recognize family members, or understand when people are trying to help them.  The disease works terrible, fundamental changes to their personalities and characters, turning the quick-minded former executive into a simpleton or the happy, encouraging aunt into a bitter font of hateful, deeply wounding comments.

So much of life’s joy and richness comes from our interaction with spouses, children, and loved ones; what must it be like to be stripped of those pleasures, left to cope with strangers with only a dim understanding of who you are and why you are there?  It’s a depressing, terrifying prospect.

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The Post-AARP-Card-In-The-Mail Blues

The other day I received another AARP card in the mail.  Immediately my shoulders rounded a bit, I felt an irresistible impulse to hitch my trousers to nipple height, and I developed a keen interest in the weather.

I’ve gotten AARP stuff in the mail before.  On your 50th birthday, you inevitably get an AARP application as a special birthday treat.  At 50, you can laugh it off — but the AARP is persistent.  They keep sending you stuff, and sending you stuff, until they wear you down.  There is a certain grim inevitability to the process.  Once the AARP decides you should be a member, there’s nothing you can do about.  You are caught up, inexorably, in titanic forces beyond your control.

This latest card is heavy cardboard and has the whiff of permanence about it.  Its arrival moved me to verse:

My hair grows grayer

My face is lined

I’m looking older

But I don’t mind.

I ignore the years

Avoid my reflection

As my denial of age

Won’t bear close inspection.

But today my denial

Is impossibly hard

I’ve sadly received

An AARP card.

Saturday “Night” At The Windward Passage

Yesterday various members of the Webner clan — Mom, Kish, Richard, UJ, Cath, Al, and I — had dinner at the Windward Passage restaurant in Upper Arlington.  At least, I think you would call it dinner.  We got there at 4:30 p.m. to beat the rush.  Maybe “linner” is a better word for a meal that we consumed about two hours before we normally have our evening repast.

The bar at the Windward Passage

The Windward Passage, located in a shopping center at the intersection of Henderson and Reed Roads, is one of those throwback places.  It has been around since 1973, and most of its patrons have been frequenting the restaurant for decades.  I would wager that 99 percent of the patrons proudly carry their “Golden Buckeye” cards, and the average age of the drinkers and diners looks to be about 75.  During our visit last night, the emergency squad paid a visit to tend to one of the diners who collapsed, which probably is not that rare an occurrence. I would not be surprised if every Windward waitress had to take CPR training to qualify for the job.

Given their age, it should not come as a surprise that the Windward’s patrons are early birds.  Even arriving at the ungodly hour of 4:30, we barely got a table in the bar.  The place quickly became packed.  Thirsty seniors filled every seat at the bar, guzzling highballs and creating a serious din.  In the meantime, crowds of elderly citizens lurked by the bar and hovered near the tables.  Nothing like a white-haired guy with a walker and his elaborately coiffed wife glaring at you expectantly to spur quick consumption of your meal!  At one point, when the people at the table next to us left, competing groups of hoverers scrambled for the seats — well, perhaps it would be more accurate to say they with as much determination and speed as their artificial hips would allow — and for a few minutes we thought we might have to break up a cane duel between two of the more boisterous seniors.

Last night's Lake Erie perch dinner

Columbus seniors love the Windward because the food is cheap, plentiful, and well-prepared.  I can’t speak to the quality of the menu, generally, because I always get the same entree whenever I go there — fried Lake Erie perch with french fries.  The perch are excellent — lightly battered, moist and flavorful, and not greasy, and the french fries are crisp.  And if you are a senior looking to fill your belly and stretch your budget, you appreciate the fact that the meal comes with broccoli, cottage cheese and a basket of bread.

When we left at around 6 the bar area was jammed and there was a crush of starving seniors hanging out in the Windward’s waiting area — no doubt regularly checking with the maitre d’ to see where they stood on the waiting list and looking in the dining room hoping to stare down a few diners and intimidate them into leaving early.  When Kish and I got home we decided to join AARP.

Rejecting Robot Caregivers

Japan has a problem.  It has a rapidly aging population of senior citizens and not enough younger people to care for them (or for that matter to contribute to the social welfare programs that support them, but that’s another story).

Ri-Man

Japan had hoped that robots would be the answer.  They envisioned robots that would care for the elderly and staff nursing homes and hospitals.  They have developed robots like Ri-Man, which can lift and carry hobbled senior citizens, and robots to serve as guides in hospitals.  Manufacturers have sunk millions of dollars into efforts to develop such robots.  Now they have concluded that robots are too expensive and impractical — and, even more important, are unwanted by patients and unwelcome, even in robot-friendly Japan.  As one person plaintively said:  “We want humans caring for us, not machines.”

No one should be surprised by this reaction.  It is not just because Ri-Man and the other caregiving robots look like full-scale toys or embarrassing caricatures of the robot from The Day The Earth Stood Still.  Instead, the breathless and triumphal tone of the video introducing Ri-Man, below, demonstrates the disconnect between the views of the entrepreneurs and engineers developing the robots and the seniors who are supposed to be buying them.  Elder care isn’t about technological advances or new frontiers in the science of robotics.  Instead, it is about helping human beings who are failing and who seek companionship and comfort as they decline.  Having to rely only on robots for help would be sterile and depressing. 

The elderly want to know that there is some person who cares enough about them to help them and spend time with them.  Can anyone blame them for concluding that metal and plastic robots are no substitute for a meaningful human connection?

States In The Red, Looking For A Way Out

As even a casual follower of the news knows, many states are struggling with huge budget problems.  Ohio is one of them.  Usually the problems are the result of declining tax revenues, increased government spending and support obligations, and the fact that bills are starting to come due on grossly underfunded state employee pension and retirement plans.

States are taking different approaches to their predicament.  Illinois recently enacted huge increases to its individual and corporate income taxesCalifornia has declared a state of fiscal emergency.  Some states have focused exclusively on cutting spending.  And, it now appears, other states have quietly gone to Congress to explore the possibility of either a federal bailout or changes in the law to allow states to declare bankruptcy.  In these Tea Party days, there doesn’t seem to be much appetite for bailouts — especially for states that seem to have behaved irresponsibly with their budgeting decisions and can’t be trusted to behave responsibly in the future.  So, the “bankruptcy option” evidently is being seriously explored as a way to allow states to avoid their pension obligations.

I’m opposed to a federal bailout of the states.  I’m also opposed to any change in the law to facilitate states wiping out their debts through a bankruptcy-type process.  I think the bankruptcy option would be bad policy for two reasons.  First, I think such an approach is not fair to people who have agreements with the states that would be affected by a bankruptcy process.  State employees who have worked for years on the understanding that they will receive a pension should not be deprived of their pension payments.  For those workers, the pension was part of the deal, they have relied on the pension in their retirement planning, and it would be unfair for states to now renege on the deal.  Second, bankruptcy would affect not only state workers with pensions, but also all people who have contracts with the state, all people who purchases state bonds and debt instruments, and all others who do business with the states.  It would be a drastic step that would, I think, forever affect the state’s credit rating and investor confidence in government securities generally.  States that have been responsible in their budgeting and spending would be tarred, too, and would have to endure higher interest rates on their own borrowing as a result.  Obviously, neither of those results would be welcome.

The solution for states that are in a budget bind should lie in the state, itself, making the tough choices and difficult changes necessary to get their fiscal houses in order.  Cut spending.  Eliminate programs that aren’t essential.  Sell state property and assets.  Negotiate changes  to future pension obligations and eliminate pensions for newly hired employees.  Change laws that require automatic escalations in pension payments.  Explore users fees as additional revenue sources.  But don’t come to Uncle Sam for a bailout, and don’t take a bankruptcy option that could leave retirees high and dry and cripple state credit ratings for decades to come.

Now Comes Scooter Time

Kish and I are in our fifties, and in our daily mail we regularly receive grim reminders of our advancing age, our likely physical and mental infirmity, and our imminent demise.  First it was AARP mailers that came within days of our 50th birthdays, then it was brochures for retirement planning and funeral insurance.  This week, we received information from The SCOOTER Store.

That’s right — it is apparently time for us to consider retreating from the bipedal world and joining the ranks of scooter-bound seniors seen in the classic Seinfeld episode.  The mailing we received urges us to take a “FREE Personal Mobility Assessment” that includes eight questions like “Do you sometimes feel left out by not being able to get together with family and friends?” The cover letter promises to work with Medicare and health insurers and adds:  “What’s really amazing is that you may be able to get a power chair or scooter at little or no cost to you with Medicare and private insurance.”  Even better, if you send in the Personal Mobility Assessment you get a FREE Puzzles and Games booklet!

Does anyone below 50 even receive mail delivered by the U.S. Postal Service anymore?   Most of our daily mail delivery is this kind of ageist claptrap.  Don’t they realize 50-year-olds use email?  And do they really think we 50-year-olds are going to be left trembling with excitement by the offer of a free Puzzles and Games booklet that could jazz up our humdrum existences?  It’s insulting.  What the heck — why not really play to senior stereotypes and offer a free DVD of the first season of Matlock and a Viagra sample if we send in the Personal Mobility Assessment and take that first, tentative step toward scooterdom?