History > 2006 > USA > The elderly

Kent Burtis, right, a technician for Verizon in Bayville, N.J.,

gets lunch for his father, Ivan Burtis, each workday,

but an aide does the morning shift.

"It's kept me from slitting my throat," Kent Burtis said of that benefit.

Ozier Muhammad/The New York Times

 As Parents Age, Baby Boomers and Business Struggle to Cope        NYT

25.3.2006

http://www.nytimes.com/2006/03/25/national/25care.html

As Minds Age, What’s Next?

Brain Calisthenics

December 27, 2006
The New York Times
By PAM BELLUCK

PROVIDENCE, R.I. — Is there hope for your hippocampus, a new lease for your temporal lobe?

Science is not sure yet, but across the country, brain health programs are springing up, offering the possibility of a cognitive fountain of youth.

From “brain gyms” on the Internet to “brain-healthy” foods and activities at assisted living centers, the programs are aimed at baby boomers anxious about entering their golden years and at their parents trying to stave off memory loss or dementia.

“This is going to be one of the hottest topics in the next five years — it’s going to be huge,” said Nancy Ceridwyn, co-director of special projects for the American Society on Aging. “The challenge we have is it’s going to be a lot like the anti-aging industry: how much science is there behind this?”

Dozens of studies are under way. Organizations like AARP are offering tips on brain health. And the Alzheimer’s Association conducts hundreds of Maintain Your Brain workshops, many at corporations like Apple Computer and Lockheed Martin.

At least two health insurers are pushing brain health. MetLife is giving prospective clients a 61-page book it commissioned called “Love Your Brain.” Humana will provide, free or deeply discounted, $495 worth of brain fitness software to some four million older customers, and offers “brain fitness camps” with the software at computer stores and community colleges.

There are Web sites like HappyNeuron.com, which offers subscribers cranial calisthenics, and MyBrainTrainer.com, marketed to anyone who “ever wished you could be a little quicker, a little sharper mentally.”

And Nintendo’s Brain Age, a video game intended for baby boomers and their elders, features simple math, syllable-counting, word memory activities and the quick reading aloud of passages from the likes of Poe and Dickens, which “gives your prefrontal cortex a workout,” the instructions say.

“I just felt that, Hey, this is something I ought to do,” said Roy Gustafson, 85, who tried it at a Nintendo promotion at his Redmond, Wash., retirement community. He quickly got top scores (his “brain age” was low 20’s), and decided to quit while ahead. But almost daily, he plays the Sudoku games in the handheld device, saying, “It keeps me alert.”

Whether the hopes for brain health programs are realistic is still largely unknown, scientists say.

Certainly most brain-healthy recommendations are not considered bad for people. They do not have the potential risks of drugs or herbal supplements. And things like physical exercise and Omega-3 fatty acids help the body, even if they do not end up bettering the mind.

“All of the things are good for you to do in general,” Dr. Elizabeth Edgerly, a clinical psychologist with the Alzheimer’s Association, said. “Do I have concerns? Yes. We’re very cautious. Is it going to mean you can remember where you left your car keys? We can’t say that.”

Still, the appeal of the programs is strong.

Epoch Senior Living in Providence is among the many assisted living facilities with “brain fitness centers.” Surrounded by posters of Einstein, Rodin’s “Thinker,” and “Brain Facts” (“one billion glial cells in the human brain”), residents spend an hour a day for eight weeks doing computer exercises involving recalling story details and distinguishing similar-sounding syllables.

David Horvitz, 92, an Epoch resident, said, “It did improve my concentration, particularly when I read. Before, my mind would wander and I’d have to reread passages several times. It also seems to me that I’m remembering names a little bit better.”

Emeritus Assisted Living, a chain, started a brain health program for residents, their families, staff members and people in the community. So far, centers in Florida, Massachusetts and South Carolina offer “brain-healthy” foods like salmon and walnuts, activities like spelling bees and reminiscing games, prizes to staff members for recalling brain health trivia, and a “brain health self-assessment” questionnaire asking, among other things, if people play challenging board games, walk 10,000 steps a day, or eat flax seed three times a week.

The brain program at the Isle at Emerald Court in Tewksbury, Mass., an Emeritus facility, includes a five-day-a-week regimen of leg lifts and stretches on the burgundy jacquard lobby chairs, influenced Ray Decker to choose the center for his mother, Joan, 75, who is in the early stage of Alzheimer’s.

“Those types of things may stimulate her brain and, despite her debilitating disease, she actually may come back a little,” said Mr. Decker, 57, who plans to adopt brain-healthy activities. “I think that this will keep my mother healthy for some time to come, actually extend her life in a mental and physical manner.”

While there is encouraging animal research, experts say human studies have generally relied on observations of people with healthier brains, but have not tested whether a particular behavior improves brain health. Perhaps people with healthier brains are more likely to do brain-stimulating activities, not the reverse.

“Right now,” said Dr. Marilyn Albert, director of cognitive neuroscience at Johns Hopkins University, “we can’t say to somebody, ‘We know that if you walk a mile every day for the next six months, your memory’s going to be better.’ We don’t know that if you do certain kinds of puzzles it’s going to have a benefit.”

In addition, few scientists believe brain health activities prevent dementia, only that they might delay it.

The strongest evidence suggests that cardiovascular exercise also probably helps the brain, by improving blood circulation, experts say.

“What’s good for your heart’s probably good for your head,” said Dr. Lynda Anderson, chief of health care and aging studies at the federal Centers for Disease Control and Prevention, which last year received the first Congressional appropriation to study brain health.

Similarly, Dr. Albert said that heart-healthy foods were probably brain-healthy foods.

As for brain-training exercises, studies show improvement from them, though not necessarily in real-life activities, said Dr. David A. Loewenstein, professor of psychiatry and behavioral sciences at the University of Miami medical school.

In a National Institute on Aging study, people given at least 10 hours of training in memory, reasoning or processing speed showed improvement, which held five years later. People reported slightly less difficulty in everyday skills, like handling medication and making telephone calls, but most of those results were not significant, researchers reported.

Dr. Loewenstein, meanwhile, found that people with early Alzheimer’s who were trained in real-life tasks like face-name recognition and balancing checkbooks improved significantly in those skills. People given computer memory and concentration games and crossword puzzles did not do as well on real-life tasks, although many thought they were improving, he said.

“Just because you’re able to recall a story better after six weeks may not mean that it’s had any demonstrable effect on everyday life,” Dr. Loewenstein said.

Posit Science, a San Francisco company that makes the brain fitness software used by Epoch and Humana, said its own studies, some published, showed that its software improved memory and mental focus.

“We’ve seen more than 10 years of improvement,” said Jeff Zimman, the company’s chief executive. “In processing speed, people who were on average 80 years old were performing like 30-year-olds in speed at those tasks.”

Posit, one of several making such software, hopes to adapt it for people with early Alzheimer’s, AIDS-related dementia and schizophrenia. Mr. Zimman envisions other uses: corporations hoping to improve brains of older employees; sports enthusiasts and hobbyists honing, say, bird-watching skills.

Emeritus Assisted Living has partnered with Dr. Paul Nussbaum, a neuropsychologist advocating social, mental, spiritual, nutritional and physical ways to promote brain health, to make its 180 homes “brain health centers for the community,” said Chris Guay, a divisional director of operations. The Isle at Emerald Court hands out brain-shaped stress balls and plans to fly a brain flag out front. One administrator tried stimulating her brain by writing with her opposite hand (with barely legible results). The maintenance director wears a pedometer and gives them to visitors. An Emeritus center in Florida is lobbying grocery stores for brain-healthy food displays.

Mr. Guay said he hoped the program would attract “more people to fill our buildings” and “help us retain employees.”

Some experts say even if there is little cognitive benefit, there may be psychic benefit to mental exercises.

“I feel my brain is better,” said Dorothy Pereshluha, 84, a resident at Isle at Emerald Court, who had trouble finding her room and remembering names when she moved in.

Alice Babulicz, 75, a resident at Wartburg Assisted Living in Mount Vernon, N.Y., which uses brain fitness software, said she paid more attention in church and was so energized that “now I can walk four or five blocks.”

And Marcia Mittleman, 88, who took Epoch’s course twice, with graduation and a medal, said that psychologically, it “filled a void.”

Asked if her cognitive function improved, she replied, “Did it make me smarter? No.”

Suddenly, she scanned the room. “Did anyone see my walker?”

    As Minds Age, What’s Next? Brain Calisthenics, NYT, 27.12.2006, http://www.nytimes.com/2006/12/27/health/27brain.html

Geriatrics Lags

in Age of High-Tech Medicine

October 18, 2006
The New York Times
By JANE GROSS

Margaret Mary Foley, 97, just wasn’t herself. Overnight, she stopped eating, went from mildly confused to disoriented, and was unable to urinate. When her panicked family rushed her to the emergency room, doctors did invasive tests, difficult for a woman her age, and then suggested surgery.

But when Mrs. Foley saw a geriatrician at Mount Sinai Medical Center, surgery proved unnecessary. The geriatrician, Dr. Rosanne M. Leipzig, suspected a silent infection — something the other doctors had missed because Mrs. Foley had no fever, as old people rarely do.

Indeed, within days, antibiotics had done the trick. For the Foley family, it was a welcome result. They had reason to count themselves fortunate to have found a doctor who specialized in treating the elderly.

Even as the population ages and more people like Mrs. Foley need them, geriatricians are in short supply. It is a specialty of little interest to medical students because geriatricians are paid relatively poorly and are not considered superstars in an era of high-tech medicine. In fact, the credo of geriatric medicine is “less is more.”

In 2005, there was one geriatrician for every 5,000 Americans 65 and older, a ratio that experts say is sure to worsen. Of 145 medical schools in the United States, only 9 have departments of geriatrics. Few schools require geriatric courses. And teaching hospitals graduate internists with as little as six hours of geriatric training.

The mismatch between supply and demand is “a troubling issue for us,” said Dr. Leo M. Cooney, a professor at Yale University School of Medicine. In a good year, Dr. Cooney said, one of 45 internal medicine residents decides to be a geriatrician.

The rest, he said, choose “super specialties” like cardiology or oncology. This, despite the fact that geriatricians reported the highest job satisfaction of any specialty in a 2002 survey in the journal Archives of Internal Medicine.

Interest is also low at the University of Oklahoma College of Medicine, which has a rare requirement that medical students do a four-week rotation in geriatrics. Eighty percent said it was time well spent, but less than 10 percent considered it as a career, said Dr. Marie A. Bernard, chairwoman of the geriatrics department. “They want to do laser-guided this and endoscopic that,” Dr. Bernard said.

Caring for frail older people is about managing, not curing, a collection of overlapping chronic conditions, like osteoporosis, diabetes and dementia. It is about balancing the risks and benefits of multiple medications, which often cause more problems than they solve. And it is about trying nonmedical solutions, like timed trips to the bathroom to improve bladder control.

But these are common-sense remedies in a health care system that rewards the heroics of specialists, in both compensation and prestige. The best-paid doctors are those who do the most procedures; radiologists and orthopedic surgeons top the list with average annual incomes of $400,000. Geriatricians, who do a residency in internal or family medicine and then a fellowship in geriatrics, are near the bottom, at $150,000 a year.

While fellow residents followed the money, Dr. Amit Shah, who had the luxury of no medical school debt, chose a geriatrics fellowship at Johns Hopkins University, despite being dissuaded by many people.

The most memorable discouragement came during his residency, from a pulmonologist, Dr. Shah said.

“When I passed him in the hall, he would shake his head and mutter, ‘Waste of a mind,’ ” he said. “My retort was always that the geriatric population is often the most complicated, not only medically but also socially and psychologically, and that was exactly the specialization you should want your top students going into.”

Reimbursement drives doctors’ compensation. Gastroenterology, for instance, became more lucrative — and popular — once Medicare, which sets the standard for most other health insurance, began paying for screening colonoscopies. Geriatricians joke that they are waiting for the invention of a geriscope, so that they too can bill for procedures.

Meanwhile, much of what they do — communicating with family members, discouraging unnecessary tests — is time consuming but not reimbursed.

Another disincentive is the lowly status of geriatrics at most of America’s medical schools, which expect more ambitious choices from top residents like Dr. Shah. In Britain, where every medical school has a geriatrics department, it is the third most popular specialty. Reimbursement there goes up with the age of each patient, a formula that improves compensation.

Historically, the explanation for not requiring geriatric training in this country has been that a majority of hospital patients are old, and thus doctors-in-training absorb what they need to know by osmosis. Nonsense, said Dr. Robert N. Butler, president of the International Longevity Center in New York and the first chairman of geriatrics at Mount Sinai. “All patients have hearts,” Dr. Butler said, “but that doesn’t make all doctors cardiologists.”

One proposed solution to the shortage is for geriatricians to limit their practice to the frailest of the elderly, generally those past 85, along with a subset in the 65-to-85 age bracket who have complicated needs. According to a 2002 study at Johns Hopkins University, 20 percent of those 65 and older have at least five chronic conditions.

Another solution, gaining a foothold among the nation’s top academic geriatricians, is to focus on teaching the core principles of their specialty to everyone, be they surgeons or discharge planners, because it is unrealistic to assume there will be enough geriatricians to go around.

“If we got to the point where everybody in the health care system was an expert in caring for older people, we wouldn’t need geriatricians,” said Dr. Cooney of Yale. “Or we wouldn’t need them as frontline providers. We’d be like consultants, making sure everyone else was as skilled as possible.”

Specialists, internists and emergency room doctors without sufficient training in geriatrics can pinpoint their own inadequacies. In recent surveys by The Journal of the American Medical Association, many said they were unprepared to deal with end-of-life decisions, communication with family caretakers, depression and other issues of aging.

That lack of training can lead to misdiagnosis, because it is often tricky to tell the difference between physical, psychological and cognitive conditions in this age group. That was the case for Rita Zaprutskiy, 75, of Houston who went to the emergency room with a painful arthritic knee, had surgery, was given an array of pain medications and then seemed to lose her mind.

Four hospitalizations and six months later, Mrs. Zaprutskiy’s daughter said, the family was urged to put her in a nursing home because of severe dementia. Instead, her daughter, Yelena Schwarz, tried one last psychological evaluation, at a county hospital, and unwittingly wound up in a geriatric unit. There the doctors knew, from the sudden onset of her symptoms, that Mrs. Zaprutskiy did not have dementia, but rather treatable psychiatric conditions, including depression.

One way to sharpen the skills of assorted specialists is to welcome them at continuing education classes for geriatricians. At a popular Mount Sinai seminar called “The Hazards of Hospitalization,” a nongeriatrician asked Dr. Helen M. Fernandez how she would deal with a 90-year-old woman in the emergency room with dizziness.

After hearing the woman’s history, Dr. Fernandez said she would fight against admission. “You need to be brave enough to march down to the E.R.,” she said, “and tell the attending she’s your patient and you want to peel her off some of her meds before doing a full cardiac work-up.”

In another course, “The 10 Minute Geriatric Assessment,” Dr. Fredrick T. Sherman told students to “get the focus off the stethoscope” and watch their patients move around. Can a woman get out of a chair without pushing off with her hands? That means she can still use the toilet. Can a man put on his socks? If not, he will soon need someone to dress and bathe him.

“We want to know what they can do and what they can’t do,” Dr. Sherman said. “That’s a better predictor of the future than a head-to-toe exam.”

A new form of geriatric training comes from elderly patients recruited as mentors, like Alberta Harris, 85, who lunches with students at the University of Oklahoma College of Medicine, regaling them with stories of her life. Residents learn other lessons when they visit the elderly at home. Many doctors consider family members impositions on their time. Seeing them as day-to-day caretakers makes it clear that in geriatrics, an adult daughter, like Mrs. Zaprutskiy’s, is an essential ally.

Ordinary floor nurses can also bring a geriatric sensibility to a hospital. An institute at the New York University School of Nursing helps small community hospitals identify nurses with an affinity for the elderly and provides them with a training curriculum and guidance on how that nurse can be a resource to others.

To increase the number of specialists, N.Y.U. and other nursing schools are building a cadre of geriatric nurse practitioners. Many work in hospital units reserved for the frailest patients, who can spiral downward quickly from a setback like a skin infection or a broken rib.

Mrs. Zaprutskiy was treated in such a unit, run by Dr. Carmel Bitondo Dyer of the Baylor College of Medicine. On a recent visit, while her daughter and doctor discussed the case, Mrs. Zaprutskiy played Russian and Yiddish folk songs on a piano in the day room, her crooked fingers moving gracefully across the keyboard.

Ms. Schwarz wondered if her mother’s psychiatric condition had been caused by medication. Dr. Dyer said there was no way of knowing for sure. But misdiagnosis and overmedication of the elderly is common.

“We see it all the time — elderly people who go from hospital to hospital with no results,” Dr. Dyer said.

“When patients are diagnosed correctly and care is managed accordingly, we see great improvements,” she continued. “Sometimes we don’t cure them; we just make them feel better. But that’s a good thing.”

Laura Griffin contributed reporting.

    Geriatrics Lags in Age of High-Tech Medicine, NYT, 18.10.2006, http://www.nytimes.com/2006/10/18/health/18aged.html

The New Age

Old but Not Frail:

A Matter of Heart and Head

October 5, 2006
The New York Times
By GINA KOLATA

Mary Wittenberg, the 44-year-old president of New York Road Runners, is a fast, strong and experienced runner. But she races best, she says, when she runs just behind Witold Bialokur. He can run 10 kilometers, or 6.2 miles, in less than 44 minutes and he is so smooth and controlled.

“He’s like a metronome with his pacing,” Ms. Wittenberg says. “I am often struggling to keep up with him and it’s a good day when I do.”

While Mr. Bialokur’s performance would be the envy of most young men, he is not young. Mr. Bialokur is 71.

It is one of the persistent mysteries of aging, researchers say. Why would one person, like Mr. Bialokur, remain so hale and hearty while another, who had seemed just as healthy, start to weaken and slow down, sometimes as early as his 70’s?

That, says Tamara Harris, who is chief of the geriatric epidemiology section at the National Institute on Aging, is a central issue that is only now being systematically addressed. The question is why some age well and others do not, often heading along a path that ends up in a medical condition known as frailty.

Frailty, Dr. Harris explains, involves exhaustion, weakness, weight loss and a loss of muscle mass and strength. It is, she says, a grim prognosis whose causes were little understood.

“It means that some people spend a long time in a period of their life where they have lost function,” Dr. Harris says. “People find that very distressing, and there is a tremendous health care cost.”

Now, though, scientists are surprised to find that, in many cases, a single factor — undetected cardiovascular disease — is often a major reason people become frail. They may not have classic symptoms like a heart attack or chest pains or a stroke. But cardiovascular disease may have partly blocked blood vessels in the brain, the legs, the kidneys or the heart. Those obstructions, in turn, can result in exhaustion or mental confusion or weakness or a slow walking pace.

Investigators say that there is a ray of hope in the finding — if cardiovascular disease is central to many of the symptoms of old age, it should be possible to slow or delay or even prevent many of these changes by treating the medical condition.

A second finding is just as surprising to skeptical scientists because it seemed to many like a wrongheaded cliché — you’re only as old as you think you are. Rigorous studies are now showing that seeing, or hearing, gloomy nostrums about what it is like to be old can make people walk more slowly, hear and remember less well, and even affect their cardiovascular systems. Positive images of aging have the opposite effects. The constant message that old people are expected to be slow and weak and forgetful is not a reason for the full-blown frailty syndrome. But it may help push people along that path.

Still, it is a view that can lead to blaming the victim, and some scientists at first resisted it. Now, though, more and more say they have been won over by an accumulating body of evidence.

“I am changing my initially skeptical view,” says Richard Suzman, who is director of the office of behavioral and social research programs at the National Institute on Aging. “There is growing evidence that these subjective experiences might be more important than we thought.”

The Walking Test

Eleanor Simonsick’s initiation into the unrecognized debilitations of aging came with a research study she helped set up. The question was whether older people who are relatively vigorous are also longer-lived. As an epidemiologist at the National Institute on Aging, she thought it was time to ask that in a rigorous way.

So she and her colleagues recruited 3,075 apparently healthy people in their 70’s who said they could walk a quarter of a mile with no trouble and climb a flight of stairs. Each was asked to walk up and down a corridor 10 times, for a distance of a quarter mile, maintaining their pace and not stopping to rest.

A quarter of them could not do it. And it was not just a matter of age. The average age of those who could do it was 73. So was the average age of those who could not. Dr. Harris explained: “I believe most people can amble. But we were asking them to walk as quickly as they could without stopping. That’s what people couldn’t do.”

Some walked so slowly, with tiny steps and labored cadences, that the researchers told them that they could stop because it was clear that they could never finish. Others Dr. Simonsick added, “just said: ‘I’m done. I’m sitting down.’ ”

“It’s very sad,” she added. “It’s not like we put them on a treadmill and cranked it up. You get the sense that they are simply deconditioned.”

The problem became worse. “In the first two years, a third of the group that could walk the quarter mile said they were beginning to have difficulty,” Dr. Harris said. “We thought, ‘Oh, this is impossible.’ ”

But it was real.

The researchers published their data in the May 3 issue of The Journal of the American Medical Association, finding that being unable to walk a quarter mile within five minutes portended troubles. For each minute beyond five, the risk of dying in the next four years increased by a third, the risk of having a heart attack increased by 20 percent, and the risk of having a disability increased by half.

Those who took more than six minutes for the quarter-mile walk had the same risk of dying or having a heart attack as those who could not walk the distance at all, and the effect was independent of age.

That led to the next question. Could teaching people to walk farther and faster prevent their growing so weak they could hardly walk?

Dr. Jack Guralnik, acting chief of the laboratory of epidemiology, demography and biometry at the National Institute on Aging, hopes it can. A new pilot study that he helped direct found that, with training, people could walk faster, improve their balance and more easily rise from a chair. Now he wants to expand that study to explore whether such training helps people retain their ability to walk and improves their health.

Richard J. Hodes, director of the National Institute on Aging is intrigued.

“It would be an extremely expensive study,” Dr. Hodes said, adding that its costs have not been added up. But, he said, if training could keep just 10 percent to 20 percent more people mobile, “I’m sure billions would be saved.”

Staving Off Frailty

Dorothy Bower, 78, used to take walks around the grounds of her assisted living residence in Wilkinsburg, Pa., near Pittsburgh. But no more. In the past six months, Ms. Bower says she has lost her energy. “I make it down the hall and to the dining room,” she says. “I have the feeling that if I worked at it I would get better, but it’s hard to get the motivation to try harder.”

“It is enough of an effort as far as I’m concerned to get to the door of our room,” Mrs. Bower says. “That takes me about five minutes.”

Mrs. Bower’s problem is frailty, doctors say. It is increasingly common as people age, and its symptoms — losing muscle mass and strength, feeling depleted, walking slowly, losing weight and doing less and less in a day — go together, says Dr. Linda Fried, a geriatrician and epidemiologist at Johns Hopkins who defined and characterized the syndrome. “They are all connected and form a vicious cycle,” she says.

Gerontologists say the full frailty syndrome is uncommon until people reach their 80’s, but its likelihood increases rapidly from then on.

For example, the Cardiovascular Health Study, a national study of more than 5,000 participants 65 and older, found that 9.5 percent of those 75 to 79 were frail. Among those 80 to 84, about 16 percent were frail, and nearly a quarter of those 85 to 89 had the frailty syndrome.

“I would say all 100-year-old people are frail,” said Dr. Anne Newman, a professor of epidemiology and medicine at the University of Pittsburgh. “Most 90-year-olds are frail. And some 80-year-olds are frail.”

Dr. Newman and her colleagues wondered what could be causing frailty in some but not others. They thought of undetected cardiovascular disease. The idea was that blood flow to the heart or muscle or brain could be impeded even if a person had had no overt signs of cardiovascular disease.

It was a new way to think about cardiovascular disease and a new way to think about aging, Dr. Newman said. “With frailty,” she said, “the slowing of gait, the loss of muscle strength, we had chalked up to being totally nonpreventable.”

When Dr. Newman and her colleagues examined participants in the Cardiovascular Health Study they saw evidence that their hunch seemed right. Participants with obvious disease who had congestive heart failure or a heart attack or stroke, for example — were likely to be frail. But those with no symptoms but partly blocked blood vessels seen on scans and other tests were nearly three times as likely to be frail as healthier people. And they became disabled — unable to care for themselves — about five years earlier than people without cardiovascular disease at the start of the study.

The researchers emphasize that cardiovascular disease is unlikely to be the sole cause of frailty. Severe arthritis or osteoporosis, for example, could make people slow down and set the cycle in motion. Strokes, heart attacks, cancer or any number of illnesses could bring on the frailty syndrome. But in explaining frailty among seemingly healthy people, the findings on cardiovascular disease made sense.

“With a lot of people, slow walking is due to poor blood flow in the legs,” Dr. Newman says. “Then their muscles atrophy.” And reduced blood flow to the brain, she says, can make people feel sluggish and depleted and unable to move quickly.

Cardiovascular disease may be why Mrs. Bower became frail. For 60 years, she says, she has had diabetes, a disease that damages blood vessels. So even though she has not had a heart attack or a stroke, blood flow to her muscles, heart and brain may be impeded, researchers say.

If they are right about frailty, Dr. Newman and others say, then the condition may be prevented or delayed by not smoking and keeping cholesterol and blood pressure levels low and by staying active.

But, the researchers add, their finding may be good news for today’s middle-age people who had the advantage of drugs to control their blood pressure and cholesterol levels before serious damage to blood vessels set in. And many are more active than their parents were when they were middle age.

Dr. Newman, for one, is optimistic.

“I think there will be less frailty and I think it will be delayed,” she says.

Overcoming Stereotypes

At 79, Dr. Robert Butler, still works 60 hours a week. He is president and chief executive of the International Longevity Center, a research and education foundation in New York and a professor of geriatrics at the Mount Sinai School of Medicine. He says he expects nothing less of himself, attributing his vigor in part to his luck in having excellent health and in part to something more subtle. He never bought into the pervasive stereotypes of old age.

Dr. Butler noticed the problem when he was a medical student. He recalls the private names doctors had for the elderly like crock and old biddy. In the decades since, he says, attitudes among doctors and the general public have not really changed. And, he adds, the stereotypes have an effect. “My experience with older people is that they certainly do get cowed by this,” he said.

But how much, and to what extent people get cowed surprised even researchers. It is hard to avoid seeing or hearing demeaning depictions of the elderly. There are greeting cards that make old people the butt of jokes. There are phrases like “senior moment” to describe a memory lapse. Then there are the ways older people are treated. For example, researchers find that people use “elderspeak,” speaking louder and using simpler words and sentences when talking to old people.

Still, when Becca Levy, a psychologist at Yale University, began her work on stereotypes’ effects on the elderly, she was not sure that she would find anything of note. She had examined the area with a study finding that older people in two cultures with a positive view of aging, China and the deaf Americans, fared better on memory tests than older people in the general American population.

Such studies are tricky, though, because there can be hundreds of differences between cultural groups, and something else could be responsible for the memory differences. So Dr. Levy and her colleagues decided try a method that was used to study the effects of stereotypes about race and gender. The idea is to flash provocative words too quickly for people to be aware they read them.

In her first study, Dr. Levy tested the memories of 90 healthy older people. Then she flashed positive words about aging like “guidance,” “wise,” “alert,” “sage” and “learned” and tested them again. Their memories were better and they even walked faster.

Next, she flashed negative words like “dementia,” “decline,” “senile,” “confused” and “decrepit.” This time, her subjects’ memories were worse, and their walking paces slowed.

Thomas Hess, a psychology professor at North Carolina State University, came to a similar conclusion about the effects of stereotypes of aging.

In his studies, older people did significantly worse on memory tests if they were first told something that would bring to mind aging stereotypes. It could be as simple as saying the study was on how aging affects learning and memory. They did better on memory tests if Dr. Hess first told them something positive, like saying that there was not much of a decline in memory with age.

But, Dr. Levy wondered, were there long-term effects of believing the stereotypes of aging? She found a study that could provide answers, the Ohio Longitudinal Study of Aging and Retirement. The two-decade-long study included 1,157 people, nearly every resident of Oxford, Ohio, who was 50 or older and was not suffering from dementia. And it had questions about beliefs about aging.

It turned out that people who had more positive views about aging were healthier over time. They lived an average of 7.6 years longer than those of a similar age who did not hold such views, and even had less hearing loss when their hearing was tested three years after the study began. The result persisted when the investigators took in account the participants’ health at the start of the study, as well as their age, gender, and socioeconomic status.

Some like Dr. Suzman were swayed, but Dr. Hodes urges caution. As provocative as the data may be, he notes, the studies cannot tell for sure what is cause and what is effect. It may be that people who had negative attitudes about aging somehow knew that they were not really well.

Dr. Hodes confesses that in this case indirect studies may be the best that can be done. To obtain direct evidence would require randomly assigning some participants to keep hearing negative comments about themselves as they age and others to hear positive things. “How ethical would that be?” he asks.

If it is true that perceptions of aging affect memory, behavior and health — and many researchers are betting that they do — that may bode well for today’s middle-age people, Dr. Levy says. They may not be quite so willing to declare themselves old when they reach their 60’s and beyond and they may be less likely to believe the stereotypes of old age.

Still, Dr. Levy and others say, it can be difficult to resist the pervasive stereotypes of aging. Many people may accept them without realizing it.

“Then they become a self-fulfilling prophecy,” Dr. Levy said.

But not for people like Dr. Butler or Mr. Bialokur, who managed to escape that trap. Others, too, say they have thrived simply by ignoring the stereotypes.

Anita Vazzano, who turned 75 on Aug. 9, says she just does not give old age much of a thought. A widow who lives alone, she still works, taking a bus each day from her home in Bensonhurst, Brooklyn, to her office in Manhattan. She knows many people become weak and frail when they grow old, but that is not her, she says. “It has to happen someday, but that day is so far off,” Mrs. Vazzano says.

She knows the stereotypes. She has seen the offensive greeting cards. And she hates them.

“If I was old,” she says, then catches herself and laughs. In her view, she adds, old age, “is not going to happen for a long time.”

    Old but Not Frail: A Matter of Heart and Head, NYT, 5.10.2006, http://www.nytimes.com/2006/10/05/health/05age.html

Forensic Skills

Seek to Uncover

Hidden Patterns of Elder Abuse

September 27, 2006
The New York Times
By JANE GROSS

SANTA ANA, Calif. — The elderly man in the emergency room was covered with bruises, some purple and others fading to yellow. Despite signs of dementia, he told the same story over and over: His wife’s burly home health aide had beaten him. But the health aide and the wife insisted he had fallen. Now it was up to the members of Orange County’s Elder Abuse Forensic Center to decide which story was true.

As the man lay on a gurney, he was interviewed by a team from the center: a geriatrician, a social worker and an investigator from the sheriff’s office. The bruises on the man’s chest, they determined, were the result of being punched. There were bloody outlines of a shoe on the man’s leg. His clear, consistent story, and cognitive tests, persuaded the prosecutor to charge the aide with a felony.

At the center here, public health and law enforcement officials are learning to speak the same language and using the same forensic techniques as those popularized on the three C.S.I. television series to diagnose elder abuse and neglect. For decades, the techniques have been the state-of-the-art approach for investigating child abuse and domestic violence. But elder abuse has lagged far behind, suffering from a lack of financing, research and data.

Now change is in the air, and forensic techniques are just one of many new initiatives nationwide to protect the elderly. Geriatricians at the Baylor College of Medicine in Houston, for example, review county autopsy reports looking for suspicious themes. Bank tellers at Wachovia branches nationwide are learning to detect irregular transactions in the accounts of elderly customers.

Congress is also expected to consider, before the October recess, the Elder Justice Act of 2006, which would create the first nationwide database on elder abuse, replacing inconsistent or unavailable data. The legislation, which has bipartisan support, also assigns a federal official to coordinate projects and technical assistance and helps replicate programs like Orange County’s.

The legislation moved from committee to the full Senate on a unanimous vote within days of a celebrity scandal involving elder abuse accusations against the son of Brooke Astor, 104, the grand dame of New York society. The accusations against Mrs. Astor’s son, Anthony D. Marshall, himself 82, include mismanagement of her fortune for his own enrichment and neglect as a result of cutting back on her care. Mr. Marshall has denied those accusations.

Mrs. Astor’s situation is not exceptional. She is a member of the fastest-growing segment of the American population, those 85 and older. Half in that age group suffer from dementia and are often incapable of informed consent. The fact that the elderly control 70 percent of the nation’s wealth makes them tempting targets for greedy relatives or swindlers.

Those are the circumstances that set the stage for most elder abuse, experts say. The most common form is physical neglect, like untended bedsores, dehydration or the reek of urine. A family member who is providing care, most often an adult child, is usually the guilty party. Greed is generally the motive, whether there is a multimillion-dollar inheritance or a monthly Social Security check at stake.

All this was well known to the assorted professionals in Orange County, but before the forensic center was established, each had to improvise without easy access to others’ expertise. A social worker might need a public guardian to sort out conflicting claims from adult children over who had power of attorney. The social worker might also need advice from a detective about securing evidence, but calls to colleagues often went unreturned for weeks, and there was likely to be no doctor to consult because few were trained to detect elder abuse.

Now, in Orange County, such professionals meet face-to-face at least once a week, with a doctor at the helm, and often speak daily.

“It’s a no-brainer,” said Rebecca Guider, the director of adult services and assistance programs in Orange County. “Almost every case benefits from this approach.”

Some 6,000 cases of elder abuse are reported annually in Orange County. In California, 100,000 reports were filed in 2003, accounting for 20 percent of the 500,000 reports nationwide. But there is widespread agreement among professionals that those numbers may be low. In a 1996 study, only one in 14 cases of physical abuse and neglect were reported and one in 100 of financial exploitation.

In Orange County, Craig M. Cazares, a deputy district attorney, reviews about 120 cases a year that are considered potential crimes, twice the number before the creation of the forensic team. Half of the cases are prosecuted, Mr. Cazares said, with a 90 percent conviction rate including plea deals.

The team approach, he said, can lead to pitched battles because doctors and social workers “don’t understand that not everything they want to be criminal is criminal.”

Nevertheless, Mr. Cazares added, “we can make borderline cases better” because of shared information and, most important, the medical expertise to assess physical injury and mental capacity.

Confidentiality laws prohibit outsiders at team meetings at the Elder Abuse Forensic Center. But in interviews, members discussed three cases, one involving neglect, one abuse and one financial exploitation.

In the neglect case a 60-year-old woman had been providing substandard care to her 96-year-old husband, who has heart disease and dementia and uses a wheelchair. After home visits by a physician, a social worker, a detective, a public guardian, a mental health expert and an array of outside social service agencies, no criminal charges were filed.

When the team took the case, reported by a neighbor, the husband had an open wound on his thigh from a kitchen accident and showed signs of malnourishment. But Dr. Lisa Gibbs said the wife had not intended harm. “So we worked with her, educated her, sent in a lot of social services and she is trying to do a better job,” Dr. Gibbs said.

In the abuse case, involving the elderly man in the emergency room, the home health aide first accepted a plea deal that would send him to jail for a year, but is now vacillating. If found guilty at trial, the aide could be sentenced to up to nine years in state prison.

The financial exploitation case, a classic sweetheart scam, ended when Jennifer Mitchell was sentenced to four years in a state prison and her husband, Anthony, an accessory, was given 12 months in the Orange County jail. Ms. Mitchell, described by investigators as “an attractive young woman,” was convicted of defrauding three elderly men of a total of $300,000 by feigning romantic interest in them. Dr. Laura Mosqueda and Dr. Gibbs established that mental impairment, depression and isolation had made all three men vulnerable.

The couple was charged with multiple counts of financial abuse, which carry heavy prison sentences. But the judge offered a plea deal demanding full restitution.

“This case wasn’t about the sentence,” said Kenneth W. Johns, the deputy public guardian for Orange County. “These men needed their money back so they can be taken care of.”

Some members of the team, including Kenneth Smith, a veteran investigator, say the typical abuser tends to be the “weak link” in a family, without a career or a home. The abuser often has mental health or substance abuse problems.

Mr. Smith said other family members were relieved to delegate the task of caring for an elderly person and turned a blind eye to incompetence and other factors that raised the risk of abuse, like the need for money.

Dr. Mosqueda fiercely objects to that stereotype, which ignores the stress on those taking care of the elderly. A police investigator may never encounter loving and attentive adult children driven to the brink, she said, because the police work at the margins of society, after other interventions have failed.

Dr. Mosqueda said she saw caretakers in her office every day and asked them, directly, if they had ever yelled at or struck the person in their care or even been afraid they might.

“If your mother has Alzheimer’s,” Dr. Mosqueda said, “and she’s belittling you all the time, screaming, asking the same questions over and over, and you have a husband and kids and a job, at some point you’re going to say, ‘If she asks me that same damn question one more time, I’m going to hit her.’ ”

Dr. Mosqueda continued, “ ‘I’m doing the best I can’ isn’t an excuse, but sometimes it’s really true, and it’s our job to know the difference and help families solve it so it doesn’t ever get to the team at the forensic center.”

    Forensic Skills Seek to Uncover Hidden Patterns of Elder Abuse, NYT, 27.9.2006, http://www.nytimes.com/2006/09/27/us/27abuse.html

'Rough time' ahead

for boomers as they age

Posted 9/26/2006 8:41 PM ET
USA Today
By Kathleen Fackelmann

About 15 million people, most of them seniors, rely on home-based caregiver services today — a number that is expected to double by 2050, when baby boomers start to require such care in record numbers.

But a new report says many boomers will be scrambling to find the help they need or be forced to go without care and risk a downward spiral that could put them in a nursing home.

There's already a shortage of caregivers in the USA, and that shortage is projected to get much worse, according to the report, Caregiving in America, which will be released Thursday by the International Longevity Center-USA and the Schmieding Center for Senior Health & Education. Other studies have identified a shortage of caregivers in nursing homes, but this is one of the first to look at the shortfall of paid workers and family members who care for older people at home.

About 20% of adults today, most of them frail seniors, don't get the assistance they need, and that shortfall is expected to get worse as baby boomers begin to develop arthritis and other conditions of old age, says Robert Butler, CEO of the International Longevity Center. Seniors who go without help at home are at risk of falls and other medical emergencies.

"It's likely to be a very rough time for baby boomers," Butler says.

A second study, this one out Wednesday, says about half of the nation's cities and communities have no plan in place to meet the needs of boomers as they age. That study, The Maturing of America: Getting Communities on Track for an Aging Population, says that by 2030, the number of people over 65 will rise to nearly 72 million.

Sandy Markwood, CEO of the National Association of Area Agencies on Aging, which sponsored the report, says cities and towns across the USA must start planning now to provide a range of services that can help keep older people out of a nursing home — such as exercise programs to keep joints healthy and dial-a-ride programs for people who can no longer drive.

Most seniors at home rely on a cadre of friends and family members to help with grocery shopping or other chores, says Larry Wright, director of the Schmieding Center. But boomers face a shrinking pool of available helpers. Wright says boomers had fewer children than previous generations, so there aren't as many adults who can help out. Many American families today also are scattered across the nation, so an older parent might be far from home when a medical emergency hits, he says.

There's a shortage of paid home caregivers now, and there's no indication Americans will be more willing to take these low-wage jobs in the future, Butler says. The Caregiving in America report notes that caregivers' wages are among the lowest in the USA. The report says the median hourly wage for nurse aides was just $10 an hour in 2004, and unskilled home-care workers make even less.

    'Rough time' ahead for boomers as they age, UT, 26.9.2006, http://www.usatoday.com/news/health/2006-09-26-elder-care_x.htm

As Parents Age,

Baby Boomers and Business

Struggle to Cope

March 25, 2006
The New York Times
By JANE GROSS

Nancy Goodman's employer, a telecommunications company in Boston, offers benefits to help employees care for elderly parents. But she found them nearly useless during four years of caring for her mother, who has Parkinson's disease, and her father, who died of kidney failure last year.

"They say they want to do the right thing," Ms. Goodman, 58, said of her employer, which she would not identify for fear of losing her job. "But when it comes down to it, they're not seeing the true picture."

Ms. Goodman's lament is common, as corporate America scrambles to help the soaring number of baby boomers, mostly working women, whose obligation to frail, elderly parents results in absenteeism, workday distractions or stress-related health problems.

Companies are responding, but experts say they often use child care benefits as a model when they do not suit the different and unpredictable needs of the elderly. In addition, at a time of cutbacks in expensive health insurance and pensions, the most commonly offered benefits are those that cost a company little or nothing, like referral services and unpaid leaves.

Ms. Goodman, for instance, tried her company's referral service to supplement inadequate staffing when her parents lived at an assisted living center in Connecticut. It was "like going to the yellow pages," she said, since it did not relieve her of the time-consuming tasks of arranging for and supervising the services from afar. Ms. Goodman was also entitled to a year's leave of absence, a benefit a new mother might appreciate. But if she took a leave now, what happened if her mother lingered?

Employees with ailing parents, more than 20 million nationwide, cite other benefits that would allow them to focus more on their jobs, like geriatric case managers to guide them through the mysteries of Medicaid and Medicare, or backup care for emergencies like a last-minute business trip. Companies that offer this kind of hands-on assistance generally pay for at least part of the service.

But they are rare. According to the Society for Human Resource Management, which represents more than 200,000 human resource and other corporate officials, 39 percent of its members said in 2003 that elder care benefits were "too costly to be feasible." Only 1 percent of their companies subsidized any elder care benefits last year. And only 3 percent offered the emergency backup care — subsidized or otherwise — that experts say saves money by keeping workers at work.

"The perception among companies is that they can't afford elder care benefits," said Frank Scanlan, a spokesman for the society.

It is the largest companies that are the most generous, but even those often subscribe to the mistaken notion that the Mommy Track and the Daughter Track are the same, said Chris Gatti, president of the Work Options Group in Superior, Colo. Work Options, whose clients employ 400,000 people nationwide, provides in-home care for children and the elderly.

"These benefits fall under the same umbrella but are fundamentally different," Mr. Gatti said. "Child care programs are relatively straight-forward and easy to administer compared to elder care, which is a maze with lots of sharp corners and dark secluded places."

An individual supervisor can ease an employee's burden but still leave them vulnerable to management changes. Just 6 percent of employers have written policies about elder care, according to surveys by the Society for Human Resource Management, while 76 percent say they help employees on a case-by-case basis.

For Ms. Goodman, the one godsend since her father died and her mother moved into her Boston apartment has been permission to work at home. But that is likely to change with a new boss. "I'm walking on eggs right now," Ms. Goodman said.

The distinctions between child care and elder care have become apparent as the first of the 77 million baby boomers turn 60 and their parents live past 85, joining the fastest-growing segment of the population.

The most obvious is that children's schedules are predictable — a school holiday next Monday — while elderly parents' needs — a trip to the emergency room — are crisis-driven. Also, children are raised at home; an elderly parent often lives far away.

Guiding the decisions of an elderly parent also requires mastery of arcane legal, financial and medical matters.

"It's a new and very confusing skill set," said Maureen Corcoran, a vice president at Prudential Financial. "You don't just give people a list; you lead them there. Otherwise they spend hours upon hours figuring it out themselves."

For both employees and employers, the costs of elder care are enormous, according to studies by the MetLife Mature Market Institute, which is in the midst of updated analysis to reflect rapidly changing demographics.

The price tag for employers in 1997 ranged from $11.5 billion to $29 billion a year. Most expensive were the replacement of lost workers (at least $4.9 billion a year), workday interruptions ($3.7 billion) and absenteeism ($885 million). The employees lose salary, Social Security and pension benefits as a result of refusing promotions, switching to part-time work or retiring early.

Certain benefits mitigate these costs, and certain companies have learned there is a clear return on investment. At Prudential, for instance, subsidized emergency backup care prevents absenteeism and workday interruptions. Prudential's 21,000 employees, with one phone call to Work Options Group, can get help for parents by the next morning, for a co-payment of $4 an hour.

A $20-an-hour aide, on an eight-hour shift, would otherwise cost a Prudential employee $160, rather than $32. Yet the company says it will save $650,000 during a three-year contract with Work Options, Ms. Corcoran said, because "if our employees needs are taken care of, they can focus on work."

Diane Yankencheck, a Prudential employee in Newark, said the service kept her working during a crisis. Her father has a degenerative neurological disease and round-the-clock care. Her mother manages the household, or did until she broke her wrist. Now an aide from Work Options cooks, cleans and helps her bathe and dress.

Kent Burtis, a Verizon technician in Bayville, N.J., uses similar backup care for his father, who is paralyzed and incontinent. For a while, Mr. Burtis spent hours before work feeding, diapering and dressing him. Now an aide does the morning shift. "It's kept me from slitting my throat," Mr. Burtis said.

Elder care benefits most often seem a luxury at small companies and nonprofits. So even at AARP, dedicated to the needs of older Americans, Deborah Russell, the director of work force issues, was daunted by coordinating long-distance care for her mother and then missing weeks of work to be at her bedside when death neared.

Ms. Russell and her two sisters, grateful for AARP's excellent referral service, still spent "an inordinate amount of time on the telephone" during working hours, distracted and unproductive. As their mother's condition deteriorated, and the siblings rotated weeks in Florida, Ms. Russell used paid vacation time rather than the 12 weeks of unpaid leave guaranteed by the federal Family Medical Leave Act or AARP's more generous 16-week program, also unpaid.

Another benefit assumed to be useful is the flexible spending account, governed by the Internal Revenue Service and widely offered by companies. It permits the use of pretax dollars for dependent care, as long as the dependent meets the I.R.S. definition. Virtually all children do, but most aged parents do not. That means tax breaks for baby sitters but not companions for the elderly.

Experts disagree about whether women will push employers for help with their parents, as they did 30 years ago when child care was their pressing issue.

Ellen Galinsky, 63, president of the Family and Work Institute, led the charge for a day care center at Bank Street College when she was a researcher there in 1969. After "huge resistance," the center opened in 1974. Ms. Galinsky predicts a similar awakening to elder care issues because "demographics are destiny."

"Everyone I know is dealing with this," said Ms. Galinsky, who recently stayed at the bedside of her 98-year-old mother for the last two months of her life. The institute allows unlimited sick leave for such family emergencies. But even with that leeway, Ms. Galinsky said: "I was on another planet. It's like no other experience. I barely have words for how hard it is."

Todd Groves, founder of LTC Financial Partners in Seattle, who advises human resource managers on long term care, is not convinced that women like Ms. Galinsky will have the same galvanizing effect this time around, regardless of their numbers or their passion.

"Back then you still had a paternal business culture," Mr. Groves said. "Now people feel out on their own. They are fearful about their careers and don't feel they can ask for help."

    As Parents Age, Baby Boomers and Business Struggle to Cope, NYT, 25.3.2006, http://www.nytimes.com/2006/03/25/national/25care.html

Census Report Foresees No Crisis

Over Aging Generation's Health

March 10, 2006
The New York Times
By RICK LYMAN

The next few decades will see an explosion in the percentage of Americans over the age of 65, but the economic and social impact of this baby boomer sunset may be gentler than had been feared because of a significant drop in the percentage of older people with disabilities, a new federal study has concluded.

Released yesterday, the United States Census Bureau's 243-page report on the aging population, among the largest and most comprehensive on the subject that the bureau has ever compiled, showed that today's older Americans are markedly different from previous generations. They are more prosperous, better educated and healthier, and those differences will only accelerate as the first boomers hit retirement age in 2011.

"Older Americans, when compared to older Americans even 20 years ago, are showing substantially less disability, and that benefit applies to men and to women," said Richard J. Hodes, director of the National Institute on Aging, on whose behalf the study was conducted. "All of this speaks to an improved quality of life."

What this suggests, Dr. Hodes said, is that while many of these older Americans will eventually become disabled, it will happen later with more of the years beyond 65 free of disability — an increase in what scientists call health expectancy.

And while, as baby boomers age, the growing ranks of the infirm will become a substantial drain on government coffers and devour health care resources, the total impact may not be as devastating as once feared, Dr. Hodes said.

The study showed that the percentage of those over 65 who had a disability that the report described as "a substantial limitation in a major life activity" fell to 19.7 percent in 1999 from 26.2 percent in 1982. There were signs the trend would continue.

Richard Suzman, head of the Behavioral and Social Research Program for the National Institute on Aging, said there was disagreement among those analyzing the results about why this drop occurred. But they assumed, he said, that it was at least partly a result of today's older Americans' being better educated and more prosperous than previous generations.

"People today have a better health expectancy than did their predecessors," Mr. Suzman said. "Education, in particular, is a particularly powerful factor in both life expectancy and health expectancy, though truthfully, we're not quite sure why."

While these results gave the federal researchers optimism, Dr. Hodes cautioned that the growing obesity rate in America may neutralize the positive trend.

The new study, "65+ in the United States: 2005," involved no fresh research but was an effort to draw together all of the relevant information on America's aging population from nearly a dozen federal agencies, said Charles Louis Kincannon, director of the Census Bureau.

"The report tells us that the face of America is changing," he said.

In 1900, Mr. Kincannon said, there were 120,000 Americans over age 85, about 0.1 percent of the population. Today there are more than 4 million, about 1 percent. Indeed, Mr. Kincannon said, it is the nation's fastest-growing age group.

In July 2003, there were 35.9 million Americans over the age of 65, about 12 percent of the population. By 2030, federal officials predict, there will be 72 million older people, about 20 percent of Americans.

And they will be a substantially different class of people than previous generations. In 1959, 35 percent of people over 65 lived in poverty. By 2003, that figure had dropped to 10 percent. The proportion of older Americans with a high school diploma rose to 71.5 percent in 2003 from 17 percent in 1950.

All of these trends are expected to accelerate, and soon. "The future older population is likely to be better educated than the current older population, especially when baby boomers start reaching age 65," the report concluded. "Their increased levels of education may accompany better health, higher incomes and more wealth."

And as younger workers become scarcer, many companies will have to find ways to convince their older workers to stay on the job longer, Mr. Kincannon said.

The report was not all good news.

Divorce is on the rise among older Americans, the study found, leading to concerns that broken families combined with low birth rates among baby boomers may create a situation where fewer people are available or willing to help care for their aging relatives, pushing even more of the burden onto government.

Also, the drop in poverty has not happened across all population groups. "There are subgroups among the old who still have fairly high levels of poverty, including older women, and especially those who live alone," said Victoria A. Velkoff, chief of the aging studies branch at the Census Bureau.

Ms. Velkoff said that while the aging population was more diverse than previous generations, poverty hit blacks and Hispanics, especially women, harder than whites. While 10 percent of older white women lived in poverty in 2003, 21.4 percent of older Hispanic women and 27.4 percent of older black women did.

The coming changes will have a profound effect on the face of American society and the shape of the economy, Mr. Kincannon said.

"Certain products that deal with the problems and needs and opportunities of the older population will become more important," he predicted. "We have a lot more cruise ships now than we did 10 or 15 years ago, and there will be even more in the future. Cars will be designed to be easier to get in and out of."

    Census Report Foresees No Crisis Over Aging Generation's Health, NYT, 10.3.2006, http://www.nytimes.com/2006/03/10/national/10aging.html

Growing Old Together,

in New Kind of Commune

February 27, 2006
The New York Times
By PATRICIA LEIGH BROWN

DAVIS, Calif., Feb. 23 — They are unlikely revolutionaries. Bearing walkers and canes, a veritable Merck Manual of ailments among them, the 12 old friends — average age 80 — looked as though they should have been sitting down to a game of Scrabble, not pioneering a new kind of commune.

Opting for old age on their own terms, they were starting a new chapter in their lives as residents of Glacier Circle, the country's first self-planned housing development for the elderly — a community they had conceived and designed themselves, right down to its purple gutters.

Over the past five years, the residents of Glacier Circle have found and bought land together, hired an architect together, ironed out insurance together, lobbied for a zoning change together and existentially probed togetherness together.

"Here you get to pick your family instead of being born into it," said Peggy Northup-Dawson, 79, a retired family therapist and mother of six who is legally blind. "We recognized that when you're physically closer to each other, you pay more attention, look in on each other. The idea was to share care."

The four couples, two widows and two who are now living solo live in eight individual town houses, grouped around an inner courtyard. Still under construction is the "common house" with a living room and a large kitchen and dining room for communal dinners; upstairs is a studio apartment they will rent at below market value to a skilled nurse who will provide additional care. It is their own self-styled, potluck utopia.

"It's an acknowledgment that intimacy doesn't happen by chance," said John Jungerman, 84, a retired nuclear physicist and one of several Ph.D.'s in the group, who is perpetually clad in purple socks and sandals.

"At first John said, 'I'm not old enough,' " his wife, Nancy, said of the commune. "I said, 'You're 80 years old. How old do you have to be?' "

There are about a dozen co-operative housing developments for the elderly in development, from Santa Fe, N.M., to St. Petersburg, Fla., a fledgling movement to communally address "the challenge of aging non-institutionally," said Charles Durett, an architect in Nevada City, Calif., who imported the concept he named co-housing — people buying homes in a community they plan and run together — from Denmark in the late 1960's.

Though communal housing for the elderly is new, intergenerational communities have been around since 1991, when the first opened in this politically progressive university town. There are now 82 across the country.

In Abingdon, Va., residents are beginning to move into ElderSpirit, a development founded by a 76-year-old former nun, Dene Peterson. The community of 37, 10 years in the making, includes a "spirit house" for ecumenical prayer and meditation.

"I just thought there had to be a better way for older people to live," said Ms. Peterson, who formed a nonprofit development corporation with three other former Glenmary sisters, a Catholic order, and knit together a variety of private and governmental funds (16 of the 29 units are subsidized affordable housing).

Ms. Peterson says she was haunted and inspired by her work with elderly public housing residents in Chicago in the 1960's.

"The elderly were dying," she recalled, "and they were anonymous."

With millions of baby boomers moving toward retirement, gerontologists and developers are looking to communal housing for the elderly with growing interest, building on a generation's mythology that already includes communes and college dormitories.

In co-operative housing, said Janice Blanchard, a gerontologist and housing consultant in Denver, "the social consciousness of the 1960's can get re-expressed." Baby boomers, she predicted, "are going to want to recreate the peak experience of their lives. Whether a commune or a college dorm, the common denominator was community."

Rich Morrison, 79, a retired psychologist from Sacramento State University and the sole single man at Glacier Circle, only recently gave up his hobby, swimming the major rapids of the Colorado River. "Emotionally, there's no reason why I can't continue to grow until I'm 100, if I'm lucky," he said.

Mr. Morrison is once widowed and twice divorced. Like others in the group who have struggled through every loss, from a child's suicide to the death of a spouse, he speaks about now being able to make "heart choices," hard won.

"I've been lonely," said Lois Grau, 87, whose husband died three years ago. "Little things go wrong that he would have fixed."

Mrs. Grau and her friends have known each other for nearly 40 years, raising children in the same neighborhood. Many residents met through the local Unitarian Universalist Church, and they still begin weekly meetings by pledging to "listen deeply and thoughtfully" to each other. Davis is known for its involved citizenry who dash off to their book groups at 7 p.m. The Glacier Circle 12 even partake of what they call a "dream group," in which they discuss their dreams.

Their talents and resources are by no means typical. They are all accomplished professionals, and the market value of their homes allowed them to purchase land and build their dream at a cost of $3.2 million, or about $400,000 each, plus $350 a month in dues. They expect to collect $850 a month in rental income. Individuals own their own homes but share expenses of common areas.

Stan Dawson, 75, a resident who has a doctorate from the Harvard School of Public Health, retired as chief of air pollution standards for the State of California to navigate the project full time through bureaucratic hurdles.

"It was a wonderful thing my dad played golf every day," he said of his father's retirement. "But I wanted to further my life in old age."

The design-by-democracy may not work for everyone.

The architect, Julie Haney, 49, said tension broke out over the color of gutters and trim on their bungalow-style homes. As Ms. Haney explained, "Ann likes blue, Stan wanted brown, Ann hates brown, everyone liked purple."

Ms. Haney, whose own elderly parents died as the design was nearing completion, said the residents forgot things more often than her younger clients did but made up for it with perspective. "I asked, 'Do you want a 20-year roof or a 40-year roof?" she recalled. "They said, 'If it lasts five years, we'll be happy.' "

To be sure, the challenges are daunting. Sue Saum, 74, for instance, moved in with her husband Jim, 84, a retired professor who, during the course of planning the community, was told he had Alzheimer's disease. Shortly thereafter, Mrs. Saum was operated on for breast cancer, and recently she had back surgery. At some point, she acknowledges, her husband may need care beyond their friends' abilities.

"It's one of those day-at-a-time, figure-it-out-as-you-go things," she said. "But creating a community like this, you learn a lot about the strength of the human spirit."

Twelve friends' buying land at age 80 requires a certain leap of faith. By its nature Glacier Circle will change over time. A homeowners association, consisting of one resident from each unit, has the right of first refusal to buy any home when a vacancy arises, for whatever reason, or what Dr. Jungerman nonchalantly calls a visit from "the great father in the sky."

Glacier Circle is too small to legally mandate age restrictions, but Ray Coppock, 83, a retired editor, thinks that will take care of itself. "They'll take one look at us," he said. "That should reduce the potential buyer situation."

At ElderSpirit in Virginia, which will be fully occupied in late spring, spirituality is the major draw. Ms. Peterson defined spirituality as "people finding meaning in their lives, acknowledging ways to give up the ego and grow the soul."

Six more ElderSpirit communities, in St. Petersburg, Fla., Wichita, Kan., and elsewhere, are in planning stages, with some financing from the Chicago-based Retirement Research Foundation.

Not surprisingly, a streamlined form of community housing may be in the wind, as efforts spring up around the country to speed up the planning process, which normally takes two and a half to three and a half years.

Unlike intergenerational co-operative housing, a niche market of about 5,000 people, communal housing for the elderly has "far more market potential," said Jim Leach, president of the Wonderland Hill Development Company in Denver, which is building Silver Sage, a communal housing development for the elderly scheduled to open in Boulder next year.

Dr. William Thomas, who developed the "Eden Alternative," a widely publicized effort to make nursing homes less institutional, is developing Eldershire in Sherburne, N.Y., south of Syracuse, a hybrid between co-operative housing and a traditional development. The idea is to build first and then attract residents who will run it themselves.

Dr. Thomas compares co-operative housing, and its time-consuming community planning, with "homemade bread — people get together, mix the ingredients, let the dough rise." He's trying to adapt the concept for broader consumption — "100 million people," he says, "buy bread at the store."

Even revolutionaries need to be flexible. At Glacier Circle, where the first tulips of spring are popping up, the group had approved special wall insulation for Mr. Morrison, who has a penchant for playing Mahler's Ninth Symphony at 3 a.m. When the bass and timpani pulse through his subwoofer, his neighbor Dorie Datel, a youthful 80-year-old, just lets it slide. For Ms. Datel, whose husband left her for "the other woman" he met at Elderhostel, this group's wisdom and resolve are embedded in the square footage.

"We've all lived through the Depression and war and the big stuff, so we know that things don't always stay the same," Ms. Datel said. "All of us are interested in living."

    Growing Old Together, in New Kind of Commune, NYT, 27.2.2006,
    http://www.nytimes.com/2006/02/27/national/27commune.html