Judith Martin: How to maintain a social network as you age

Except for the cigarettes, healthy social interactions

— Photo by Tup Wanders

See New England Centenarian Study

From Kaiser Health News

“It’ s never too late to develop meaningful relationships.’’

— Robert Waldinger, M.D., a clinical professor of psychiatry at Harvard Medical School and director of the Harvard Study of Adult Development.

For years, Carole Leskin, 78, enjoyed a close camaraderie with five women in Moorestown, N.J., a group that took classes together, gathered for lunch several times a week, celebrated holidays with one another, and socialized frequently at their local synagogue.

Leskin was different from the other women — unmarried, living alone, several years younger — but they welcomed her warmly, and she basked in the feeling of belonging. Although she met people easily, Leskin had always been something of a loner and her intense involvement with this group was something new.

Then, just before the COVID-19 pandemic struck, it was over. Within two years, Marlene died of cancer. Lena had a fatal heart attack. Elaine succumbed to injuries after a car accident. Margie died of sepsis after an infection. Ruth passed away after an illness.

Leskin was on her own again, without anyone to commiserate or share her worries with as pandemic restrictions went into effect and waves of fear swept through her community. “The loss, the isolation; it was horrible,” she told me.

What can older adults who have lost their closest friends and family members do as they contemplate the future without them? If, as research has found, good relationships are essential to health and well-being in later life, what happens when connections forged over the years end?

It would be foolish to suggest these relationships can easily be replaced: They can’t. There’s no substitute for people who’ve known you a long time, who understand you deeply, who’ve been there for you reliably in times of need, and who give you a sense of being anchored in the world.

Still, opportunities to create bonds with other people exist, and “it’s never too late to develop meaningful relationships,” said Robert Waldinger, a clinical professor of psychiatry at Harvard Medical School and director of the Harvard Study of Adult Development.

That study, now in its 85th year, has shown that people with strong connections to family, friends and their communities are “happier, physically healthier, and live longer than people who are less well connected,” according to The Good Life: Lessons From the World’s Longest Scientific Study of Happiness, a new book describing its findings, co-written by Waldinger and Marc Schulz, the Harvard study’s associate director.

Waldinger’s message of hope involves recognizing that relationships aren’t only about emotional closeness, though that’s important. They’re also a source of social support, practical help, valuable information and ongoing engagement with the world around us. And all these benefits remain possible, even when cherished family and friends pass on.

Say you’ve joined a gym and you enjoy the back-and-forth chatter among people you’ve met there. “That can be nourishing and stimulating,” Waldinger said. Or, say, a woman from your neighborhood has volunteered to give you rides to the doctor. “Maybe you don’t know each other well or confide in each other, but that person is providing practical help you really need,” he said.

Even casual contacts — the person you chat with in the coffee shop or a cashier you see regularly at the local supermarket — “can give us a significant hit of well-being,” Waldinger said. Sometimes, the friend of a friend is the person who points you to an important resource in your community you wouldn’t otherwise know about.

Carole Leskin lost a group of close friends just before the pandemic. Though she’s made several new friends online at a travel site, she misses the warmth of being with other people.

After losing her group of friends, Leskin suffered several health setbacks — a mild stroke, heart failure and, recently, a nonmalignant brain tumor — that left her unable to leave the house most of the time. About 4.2 million people 70 and older are similarly “homebound” — a figure that has risen dramatically in recent years, according to a study released in December 2021.

Determined to escape what she called “solitary confinement,” Leskin devoted time to writing a blog about aging and reaching out to readers who got in touch with her. She joined a virtual travel site, Heygo, and began taking tours around the world. On that site, she found a community of people with common interests, including five (two in Australia, one in Ecuador, one in Amsterdam, and one in New York City) who’ve become treasured friends.

“Between [Facebook] Messenger and email, we write like old-fashioned pen pals, talking about the places we’ve visited,” she told me. “It has been lifesaving.”

Still, Leskin can’t call on these long-distance virtual friends to come over if she needs help, to share a meal, or to provide the warmth of a physical presence. “I miss that terribly,” she said.

Research confirms that virtual connections yield mixed results. On one hand, older adults who routinely connect with other people via cellphones and computers are less likely to be socially isolated than those who don’t, several studies suggest. Shifting activities for older adults such as exercise classes, social hours, and writing groups online has helped many people remain engaged while staying safe during the pandemic, noted Kasley Killam, executive director of Social Health Labs, an organization focused on reducing loneliness and fostering social connections.

But when face-to-face contact with other people diminishes significantly — or disappears altogether, as was true for millions of older adults in the past three years — seniors are more likely to be lonely and depressed, other studies have found.

“If you’re in the same physical location as a friend or family member, you don’t have to be talking all the time: You can just sit together and feel comfortable. These low-pressure social interactions can mean a lot to older adults and that can’t be replicated in a virtual environment,” said Ashwin Kotwal, an assistant professor of medicine in the division of geriatrics at the University of California-San Francisco who has studied the effects of engaging with people virtually.

Meanwhile, millions of seniors — disproportionately those who are low-income, represent racial and ethnic minorities, or are older than 80 — can’t afford computers or broadband access or aren’t comfortable using anything but the phone to reach out to others.

Liz Blunt, 76, of Arlington, Texas, is among them. She hasn’t recovered from her husband’s death in September 2021 from non-Hodgkin lymphoma, a blood cancer. Several years earlier, Blunt’s closest friend, Janet, died suddenly on a cruise to Southeast Asia, and two other close friends, Vicky and Susan, moved to other parts of the country.

“I have no one,” said Blunt, who doesn’t have a cellphone and admitted to being “technologically unsavvy.”

When we first spoke in mid-March, Blunt had seen only one person she knows fairly well in the past 4½ months. Because she has several serious health issues, she has been extremely cautious about catching covid and hardly goes out. “I’m not sure where to turn to make friends,” she said. “I’m not going to go somewhere and take my mask off.”

But Blunt hadn’t given up altogether. In 2016, she’d started a local group for “elder orphans” (people without spouses or children to depend on). Though it sputtered out during the pandemic, Blunt thought she might reconnect with some of those people, and she sent out an email inviting them to lunch.

On March 25, eight women met outside at a restaurant and talked for 2½ hours. “They want to get together again,” Blunt told me when I called again, with a note of eagerness in her voice. “Looking in the mirror, I can see the relief in my face. There are people who care about me and are concerned about me. We’re all in the same situation of being alone at this stage of life — and we can help each other.”

Judith Martin is a Kaiser Health News reporter.

#elderly

Mass. medical schools join to fight racism in health care

Headquarters, in Waltham, of the Massachusetts Medical Society (MMS), the oldest continuously operating state medical association in the United States. Incorporated on Nov. 1, 1781, by an act of the Massachusetts General Court, the MMS is a non-profit organization with more than 25,000 physicians and medical students as members. Its New England Journal of Medicine is among the most prestigious and influential such publications in the world.

From The New England Council (newenglandcouncil.com)

BOSTON

“The University of Massachusetts Medical School, in Worcester, and the Massachusetts Medical Society are joining other medical schools in the state to combat racism in the health-care industry and medicine. The schools released a set of principles targeting racism in medical schools and other health-care organizations.

The schools, including the Boston-based Harvard Medical School, Boston University Medical School and Tufts University Medical School, also in Boston, outlined their long-term goals in a set of four principles. The first principle relates to the need to acknowledge and learn, including from a historical standpoint, as racism in medical practice has had a longstanding presence. The second point calls on institutional leaders to visibly commit to dismantling racism, and the third call for confronting practices and policies devaluing staff and patients of color. The last of the four principles emphasizes a culture of empathy and recognition of the intersectionality of oppression.

“‘It is mission critical for the Medical Society, the DPH (Massachusetts Department of Public Health) and our state’s medical schools to lead in supporting the next generation of physicians and their patients,’ said the Medical Society’s president, Dr. Carole Allen. ‘This document outlines important steps to address systemic racism as it manifests in health care.”’

In Greater Boston, the intersection of the pandemic and immigration

Cambridge Hospital, part of the Cambridge Health Alliance

From The New England Journal of Higher Education, a service of The New England Board of Higher Education (nebhe.org)

CAMBRIDGE, Mass.

A year into the global pandemic, we are grappling with the scale of its impact and the conditions that created, permitted and exacerbated it. For those of us in the mental health field, tentative strides toward telepsychiatry pivoted to a sudden semi-permanent virtual health-care delivery system. Questions of efficacy, equity and risk management have been raised, particularly for underserved and immigrant populations. The structures of our work and its pillars (physical proximity, co-regulation, confidentiality, in-person crisis assessment) have shifted, leading to other unexpected proximities and perhaps intimacies—seeing into patients’ homes, seeing how they interact with their children, speaking with patients with their abusive partners in the room, listening to the conversation, and patients seeing into our lives.

As the pandemic crisis morphs, it is unclear if we are at the point to do meaningful reflective work, but for now, I offer some thoughts through the lens of my work at Cambridge Health Alliance (CHA), an academic health-care system serving about 140,000 patients in the Boston Metro North region.

CHA is a unique system: a teaching hospital of Harvard Medical School, which operates the Cambridge Public Health Department and articulates as “core to the mission,” health equity and social justice to underserved, medically indigent populations with a special focus on underserved people in our communities. Within the hospital’s Department of Psychiatry, four linguistic minority mental-health teams serve Haitian, Latinx, Portuguese-speaking (including Portugal, Cape Verde and Brazil) and Asian patients.

While we endeavour to gather data on this across CHA, anecdotal evidence from the minority linguistic teams supports the existing research suggesting that immigrant and communities of color are bearing a disappropriate impact of COVID-19 in multiple intersecting and devastating ways: higher burden of disease and mortality rates, poorer care and access to care, overrepresentation in poorly reimbursed and “front-facing” vulnerable jobs such as cleaning services in hospitals and assisted care facilities, personal care attendants and home health aides, and overrepresentation in industries that have been hardest hit by the pandemic such as food service, thereby facing catastrophic loss of income.

These patients also face crowded multigenerational living conditions and unregulated and crowded work conditions. These “collapsing effects” are further exacerbated by reports from our patients that they are also being targeted by hateful rhetoric such as “the China virus” and larger anti-immigrant sentiment stoked by the Trump administration and the accompanying narrative of “economic anxiety” that has masked the racialized targeting of immigrants at their workplaces and beyond.

Telehealth. As we provide services, we have also observed that, despite privacy concerns, access to and use of our care has expanded due to the flexibility of telehealth. Patients tell us that they no longer have to take the day off from work to come to a therapy appointment and have found care more accessible and understanding of the demands of their material lives.

Some immigrant patients report that since they use phone and video applications to stay in touch with family members, using these tools for psychiatric care feels normative and familiar. For deeply traumatized individuals, despite the loss of face-to-face contact, the fact that they do not have to encounter the stresses inherent in being in contact with others out in the world has made it more possible for them to consistently engage in care with reduced fear as relates to their anxiety and/or PTSD. These are interesting observations as we try to tailor care and understand “what works for whom.”

Immigrant service providers. Another theme in the dynamics of care during the pandemic is found in the experiences of immigrant service providers whose work has been stretched in previously unrecognizable ways—and remains often invisible.

Prior to the pandemic, for example, CHA had established the Volunteer Health Advisors program, which trains respected community health workers, often individuals who were healthcare providers in their home country, who have a close understanding of the community they serve. They participate in community events such as health fairs to facilitate health education and access to services and can serve as a trusted link to health and social services and underserved communities.

What we have seen during the pandemic is even greater strain on immigrant and refugee services providers who are often the front line of contact. We have provided various “care for the caregiver” workshops that address secondary or vicarious trauma to such groups such as medical interpreters often in the position of giving grave or devastating news to families about COVID-19-related deaths as well as school liaisons and school personnel, working with children who may have lost multiple family members to the virus, often the primary breadwinners, leaving them in economic peril.

While such supportive efforts are not negligible, a public system like ours is vulnerable to operating within crisis-driven discourse and decision making. With the pandemic exacerbating inequities, organizational scholars have noted in various contexts that a state of crisis can become institutionalized. This can foreclose efforts at equity that includes both patient care as well as care for those providing it. The challenge going forward will involve keeping these issues at the forefront of decisions regarding catalyzing technology and the resulting demands on our workforce.

Diya Kallivayalil , Ph.D., is the director of training at the Victims of Violence Program at the Cambridge Health Alliance and a faculty member in the Department of Psychiatry at Harvard Medical School.

Latest wrap-up of region's COVID-19 response

The front entrance of MGH, in Boston

Here is the most recent wrap-up the region’s COVID-19 developments from The New England Council (newenglandcouncil.com):

• “Harvard Medical School Researchers Publish COVID-19 Rehabilitation Study – Researchers at Harvard Medical School have published a study detailing rehabilitation plans crafted for patients in Boston and New York-based hospitals. The team has treated over 100 patients and points to continued studies to address persistent COVID-19 symptoms. Read more here.

• “Mass General Releases Guidance on Weaning Patients Off Ventilators – Clinicians at Massachusetts General Hospital have released an article with an accompanying video to demonstrate effective ways to wean patients with serious COVID-19 infections off of ventilators. The materials offer step-by-step instructions and were published in The New England Journal of Medicine. Read more here.

• “Health Leads Releases Joint Statement on Ensuring Racial Equity in the Creation and Distribution of a COVID-19 Vaccine – Health Leads has released a statement, in conjunction with a number of other organizations and individuals, emphasizing the importance of supporting underserved communities in recovering from COVID-19. The statement includes strategies for ensuring equity in vaccine distribution. Read more here.’’

Pandemic news — flu kits for elderly, mask study, sleep tips

World War II poster issued by the U.S. government

BOSTON

From The New England Council (newenglandcouncil.com)

Here is the council’s Oct. 28 roundup:

• “United Health Group Ships Flu Kits to Medicare Recipients – UnitedHealth Group is sending medical care packages including Tamiflu and COVID-19 tests to patients considered the most at-risk for the virus. The kits will also include a digital thermometer and instructions for self-administering the COVID-19 test. Read more here.

• “Harvard Medical School Releases Mask Study – Researchers at Harvard Medical School have found additional evidence of the benefits of mask wearing. The researchers found that universal masking in the Massachusetts health-care system led to a flattening, and then decreasing number of cases, even with cases rising in the surrounding population. Read more here.

• “Massachusetts General Unveils Tips for Better Sleep During COVID-19 – Massachusetts General Hospital has released a number of recommendations for better sleep during the COVID-19 pandemic. Citing increased levels of stress and anxiety, Massachusetts General compiled simple recommendations for people to keep well-rested. Read more here.

• “Catholic Medical Center Adds Second Automated Disinfection Robot – Catholic Medical Center has recently acquired a new Tru-Da device, which will help protect patients from hospital-acquired infections during the COVID-19 pandemic. The robot uses UVC light to modify the DNA and RNA of infectious cells, effectively sterilizing hospital rooms. Read more here.

• “BIDMC Finds New Ways to Anticipate the Effects of COVID-19 – Researchers at Beth Israel Deaconess Medical Center have proposed the adoption of complexity science – a field concerned with understanding dynamic, unpredictable systems, such as the human brain, economies or climates – to predict and inform pandemic responses. Read more here.’’

Martha Bebinger: COVID-19 taking an axe to Mass. health-care workers' pay

Via Kaiser Health News

BOSTON

Just three weeks ago, Dr. Kathryn Davis worried about the coronavirus, but not about how it might affect her group of five OB-GYNs who practice at a suburban hospital outside Boston.

“In medicine we think we’re relatively immune from the economy,” Davis said. “People are always going to get sick; people are always going to need doctors.”

Then, two weeks ago, she watched her practice revenue drop 50 percent almost overnight after Massachusetts officials told doctors and hospitals to stop performing elective tests and procedures. For Davis, that meant no more non-urgent gynecological visits and screenings.

Late last week, as Davis and her partners absorbed the stunning turn of events, they devised a stopgap plan. The 35 nurses, medical assistants and secretaries they employ would have two options: move from full-time to part-time status or start collecting unemployment. Doctors in the practice would take a substantial pay cut. Davis said she’s hearing from colleagues who may have to permanently close their offices if the focus on crisis-level care continues for months.

“It’s shocking,” she said. “Everyone has been blindsided.”

Atrius Health, the largest independent physician group in Massachusetts, said patient volume is down 75 percent since mid-March. It is temporarily closing offices, placing many nonclinical employees on furlough and withholding pay for those who remain. The average withholding is 20 percent and the company pledges that pay withheld will be returned. The lowest-paid workers, those earning up to $55,000, are exempt.

Steven Stongwater

“What we’re trying to do is piece together a solution to get through the crisis and keep employed as many people as we can,” said Dr. Steven Strongwater, Atrius Health’s CEO.

Atrius cares for 745,000 patients in clinics that often include primary care, specialists, radiology and a pharmacy under one roof.

Strongwater said physician groups must be included when the federal government distributes $100 billion to hospitals from the $2 trillion stimulus package.

It’s not clear if that money will stop the tide of layoffs and lost pay at hospitals as well as in doctor’s offices. A Harvard Medical School physician group will suspend retirement contributions starting April 1.

Part of Beth Israel Lahey Health.

Beth Israel Lahey Health, the second-largest hospital network in Massachusetts, announced executive pay cuts Monday.

“The suspension of elective procedures and decline in visits to our primary-care practices and urgent care centers have resulted in financial challenges,” wrote CEO Dr. Kevin Tabb in an email to employees. Tabb said he would take a 50% salary cut. Other executives and hospital presidents in the system will forgo 20% of their salaries for the next three months.

“Although executive leadership compensation is being reduced, we will never compromise on doing the things that are essential to protect your safety and the safety of our patients,” Tabb told staff.

Dallas-based Steward Health Care has told hospital employees in Massachusetts and eight other states where it operates to expect furloughs focused on nonclinical staff. In a statement, Steward Health Care said it prepared for the pandemic but is experiencing a “seismic financial shock.”

“Elective surgeries are the cornerstone of our hospital system’s operating model — and the negative impact due to the cancellations of these procedures cannot be overstated. In addition, patients are understandably cautious and choosing to defer any nonemergency treatments or routine visits until this crisis has passed.”

Dr. Kaarkuzhali Babu Krishnamurthy, an assistant professor of neurology at Harvard Medical School who studies medical ethics, said employers need to think more carefully about the ethics of asking doctors and nurses to live on less when many are working longer hours and putting the health of their families at risk.

“At a time when health-care systems are calling on doctors and nurses to do more, this is not the time to be making it more difficult to do that,” said Krishnamurthy.

There’s talk of redeploying laid-off health care workers to new COVID-19 units opening in shuttered hospitals or to patient overflow sites. Tim Foley, executive vice president for the largest health care union in Massachusetts, 1199SEIU, is promoting the development of a staff registry.

“It is more important, now more than ever, to explore all options to maintain the level of urgent care needed across the state and we look forward to working with all stakeholders to do just that,” Foley said in an email.

This story is part of a partnership that includes WBUR, NPR and Kaiser Health News.

Martha Bebinger is a reporter for WBUR, in Boston.

Martha Bebinger, WBUR: marthab@wbur.org, @mbebinger

Judith Graham: What's in store for aging Boomers in this decade?

From Kaiser Health News

Within 10 years, all of the nation’s 74 million baby boomers will be 65 or older. The most senior among them will be on the cusp of 85. Even sooner, by 2025, the number of seniors (65 million) is expected to surpass that of children age 13 and under (58 million) for the first time, according to Census Bureau projections.

“In the history of the human species, there’s never been a time like [this],” said Dr. Richard Hodes, director of the National Institute on Aging, referring to the changing balance between young people and old.

What lies ahead in the 2020s, as society copes with this unprecedented demographic shift?

I asked a dozen experts to identify important trends. Some responses were aspirational, reflecting what they’d like to see happen. Some were sobering, reflecting a harsh reality: Our nation isn’t prepared for this vast demographic shift and its far-reaching consequences.

Here’s what the experts, in Boston and elsewhere, said:

A crisis of care. Never have so many people lived so long, entering the furthest reaches of old age and becoming at risk of illness, frailty, disability, cognitive decline and the need for personal assistance.

Even if scientific advances prove extraordinary, “we are going to have to deal with the costs, workforce and service delivery arrangements for large numbers of elders living for at least a year or two with serious disabilities,” said Dr. Joanne Lynn, a legislative aide on health and aging policy for Rep. Thomas Suozzi (D-N.Y.).

Experts caution we’re not ready.

“The cost of long-term care [help in the home or care in assisted-living facilities or nursing homes] is unaffordable for most families,” said Jean Accius, senior vice president of thought leadership at AARP. She cited data from the Genworth Cost of Care Study: While the median household income for older adults was just $43,696 in 2019, the annual median cost for a private room in a nursing home was $102,204; $48,612 for assisted living; and $35,880 for 30 hours of home care a week.

Workforce issues are a pressing concern. The need for health aides at home and in medical settings is soaring, even as low wages and poor working conditions discourage workers from applying for or staying in these jobs. By 2026, 7.8 million workers of this kind will be required and hundreds of thousands of jobs may go unfilled.

“Boomers have smaller families and are more likely to enter old age single, so families cannot be expected to pick up the slack,” said Karl Pillemer, a professor of human development at Cornell University. “We have only a few years to plan different ways of providing care for frail older people to avoid disastrous consequences.”

Living better, longer. Could extending “healthspan,” the time during which older adults are healthy and able to function independently, ease some of these pressures?

The World Health Organization calls this “healthy life expectancy” and publishes this information by country. Japan was the world’s leader, with a healthy life expectancy at birth of 74.8 years in 2016, the most recent year for which data is available. In the U.S., healthy life expectancy was 68.5 years out of a total average life expectancy of 78.7 years.

Laura Carstensen, director of Stanford University’s Center on Longevity, sees some cause for optimism. “Americans are beginning to exercise more” and eat more healthful diets, she said. And scientific studies published in recent years have shown that behavior and living environments can alter the trajectory of aging.

“With this recognition, conversations about aging societies and longer lives are shifting to the potential to improve quality of life throughout,” Carstensen said.

Other trends are concerning. Notably, more than one-third of older adults are obese, while 28% are physically inactive, putting them at higher risk of physical impairments and chronic medical conditions.

Rather than concentrate on treating disease, “our focus should shift to health promotion and prevention, beginning in early life,” said Dr. Sharon Inouye, a professor at Harvard Medical School and a member of the planning committee for the National Academy of Sciences’ Healthy Longevity Global Grand Challenge.

Altering social infrastructure. Recognizing the role that social and physical environments play in healthy aging, experts are calling for significant investments in this area over the next decade.

Their wish list: make transportation more readily available, build more affordable housing, modify homes and apartments to help seniors age in place, and create programs to bring young and old people together.

Helping older adults remain connected to other people is a common theme. “There is a growing understanding of the need to design our environments and social infrastructure in a way that designs out loneliness” and social isolation, said Dr. Linda Fried, dean of Columbia University’s Mailman School of Public Health.

On a positive note, a worldwide movement to create “age-friendly communities” is taking hold in America, with 430 communities and six states joining an effort to identify and better respond to the needs of older adults. A companion effort to create “age-friendly health systems” is likely to gain momentum.

Technology will be increasingly important as well, with aging-in-place likely made easier by virtual assistants like Alexa, video chat platforms like Skype or FaceTime, telemedicine, robotic caregivers and wearable devices that monitor indicators such as falls, according to Deborah Carr, chair of the sociology department at Boston University.

Changing attitudes. Altering negative attitudes about aging — such as a widespread view that this stage of life is all about decline, loss and irrelevance — needs to be a high priority as these efforts proceed, experts say.

“I believe ageism is perhaps the biggest threat to improving quality of life for [older] people in America today,” Harvard’s Inouye said. She called for a national conversation about “how to make the last act of life productive, meaningful and fulfilling.”

Although the “OK Boomer” barbs that gained steam last year testify to persistent intergenerational tension, there are signs of progress. The World Health Organization has launched a global campaign to combat ageism. Last year, San Francisco became one of the first U.S. cities to tackle this issue via a public awareness campaign. And a “reframing aging” toolkit developed by the FrameWorks Institute is in use in communities across the country.

“On the bright side, as the younger Baby Boom cohort finally enters old age during this decade, the sheer numbers of older adults may help to shift public attitudes,” said Robyn Stone, co-director of LeadingAge’s LTSS (long-term services and supports) Center @UMass Boston.

Advancing science. On the scientific front, Dr. Pinchas Cohen, dean of the Leonard Davis School of Gerontology at the University of Southern California, points to a growing recognition that “we can’t just apply one-size-fits-all guidance for healthy aging.”

During the next 10 years, “advances in genetic research and big data analytics will enable more personalized — and effective — prescriptions” for both prevention and medical treatments, he said.

“My prediction is that the biggest impact of this is going to be felt around predicting dementia and Alzheimer’s disease as biomarker tests [that allow the early identification of people at heightened risk] become more available,” Cohen continued.

Although dementia has proved exceptionally difficult to address, “we are now able to identify many more potential targets for treatment than before,” said Hodes, of the National Institute on Aging, and this will result in a “dramatic translation of discovery into a new diversity of promising approaches.”

Another potential development: the search for therapies that might slow aging by targeting underlying molecular, cellular and biological processes — a field known as “geroscience.” Human trials will occur over the next decade, Hodes said, while noting “this is still far-reaching and very speculative.”

Addressing inequality. New therapies spawned by cutting-edge science may be extraordinarily expensive, raising ethical issues. “Will the miracles of bioscience be available to all in the next decade — or only to those with the resources and connections to access special treatment?” asked Paul Irving, chairman of the Milken Institute’s Center for the Future of Aging.

Several experts voiced concern about growing inequality in later life. Its most dramatic manifestation: The rich are living longer, while the poor are dying sooner. And the gap in their life expectancies is widening.

Carr noted that if the current poverty rate of 9% in the older population holds over the next decade, “more than 7 million older persons will live without sufficient income to pay for their food, medications and utilities.” Most vulnerable will be black and Latina women, she noted.

“We now know that health and illness are affected by income, race, education and other social factors” and that inequalities in these areas affect access to care and health outcomes, Pillemer said. “Over the coming decade, we must aggressively address these inequities to ensure a healthier later life for everyone.”

Working longer. How will economically vulnerable seniors survive? Many will see no choice but to try to work “past age 65, not necessarily because they prefer to, but because they need to,” Stone said.

Dr. John Rowe, a professor of health policy and aging at Columbia University, observed that “low savings rates, increasing out-of-pocket health expenditures and continued increases in life expectancy” put 41% of Americans at risk of running out of money in retirement.

Will working longer be a realistic alternative for seniors? Trends point in the opposite direction. On the one hand, the U.S. Bureau of Labor Statistics suggests that by 2026 about 30% of adults ages 65 to 74 and 11% of those 75 and older will be working.

On the other hand, age discrimination makes it difficult for large numbers of older adults to keep or find jobs. According to a 2018 AARP survey, 61% of older workers reported witnessing or experiencing age discrimination.

“We must address ageism and ageist attitudes within the workplace,” said Accius of AARP. “A new understanding of lifelong learning and training, as well as targeted public and private sector investments to help certain groups transition [from old jobs to new ones], will be essential.”

Judith Graham is a Kaiser Health News reporter.

U.S. birth rate (births per 1,000 population). The segment for 1946 to 1964 — the Baby Boomers — is highlighted in red.

Verizon's Boston 5G network concentrated in the Fenway area

Aerial view of West Fenway and Kenmore showing the Back Bay Fens (lower left), Fenway Park (center) and the edge of Kenmore Square (right)

From The New England Council (newenglandcouncil.com)

“As of Nov. 19, customers have been able to access Verizon’s 5G Ultra-Wideband network in various parts of Boston. The telecommunications company made a promise to bring 5G to mobile customers in more cities by the end of 2019.

“Verizon’s 5G network will be concentrated in the Fenway area of Boston, along Brookline Avenue and near Beth Israel Deaconess Medical Center. The service will also be available near Harvard Medical School, Northeastern University, Fenway Park, and Emmanuel College. 5G has a greater bandwidth than 4G, allowing for the transfer of more data in the same amount of time at a lower latency. The network also allows for more devices to be connected at the same time. Verizon began its rollout of 5G in Providence earlier this year.

“We are building our 5G Ultra-Wideband network to support the type of transformative breakthroughs people imagine when they think of next-generation connectivity, and we’re working to build those services with leaders in manufacturing, publishing and entertainment, and in our 5G Labs,” said Kyle Malady, Verizon’s chief technology officer.’’

Judith Graham: The education of a doctor caring for his wife

Dr. Alois Alzheimer's patient Auguste Deter in 1902. Hers was the first described case of what became known as Alzheimer's disease.

From Kaiser Health News

Dr. Arthur Kleinman, a professor of psychiatry and anthropology at Harvard University, calls this “enduring the unendurable” in his recently published book, The Soul of Care: The Moral Education of a Husband and a Doctor.

The book describes Kleinman’s awakening to the realities of caregiving when his beloved wife, Joan, was diagnosed with a rare form of early Alzheimer’s disease that causes blindness as well as cognitive deterioration.

Although Kleinman’s specialty is studying how patients experience illness, he wasn’t prepared for the roller coaster of family caregiving. Each time he adapted to Joan’s changing condition, another setback would occur, setting off new crises and fueling uncertainty and stress.

During 11 years of caregiving until Joan’s death, in 2011, Kleinman learned that no one who goes through this emerges unchanged. He became less self-centered, more compassionate and more aware of how the health-care system fails to support family caregivers ― the backbone of the nation’s long-term care system.

I spoke with Kleinman in mid-November at a caregiving panel. His remarks below are edited for length and clarity.

About his book. “I wrote it for a specific reason. I had spent my whole career as an expert on care. I myself was a psychiatrist who worked with patients with chronic medical disorders, [such as] chronic pain, diabetes, heart disease, cancer. I thought I knew it all. A veil of ignorance was raised from my eyes by my experience as a primary family caregiver.

“What is that veil of ignorance about? It’s about recognizing just how difficult family care is for [people with] dementia and, not just dementia, but many other problems.”

Daily responsibilities. “Let’s say in the fifth year, what was it like? I would get Joan up around 6 a.m. and take her to the bathroom. I have to handle the toilet paper, wash her hands, dress her to work out, take her to the bath and bathe her.

“I would shampoo her hair, dry her, pick out her clothes [for the day]. After that, I would prepare breakfast. As she got increasingly agitated, [that] became difficult because I had to sometimes hold her hands [to] keep her from throwing things or getting up and hurting herself. Because she was blind, she couldn’t see where she was. And then I would help her eat ― usually, at the end, feeding her ― and then take her to a room where we would sit and listen quietly to music.

“Maybe six, seven years into this, I would just sit there and hold her hands. And even that became difficult. So, I would tell her stories of the past … our stories. [Editorial note: This is just the beginning of a day full of similar tasks.]

“I discovered early on that the ritualization of acts of caring ― the dressing, bathing, all these things ― is a way of habit formation that keeps you going.”

Challenging masculinity. “We had a great relationship, but it was asymmetrical. For 36 years, my wife took care of me. I was raised as a classical male in the 1940s. When I showed an interest in cooking, my grandmother said to me, ‘What are you, a sissy?’ I was a tough kid on New York [City] streets. I had the most unpromising beginnings to be a caregiver. And my wife slowly socialized me to a different kind of masculinity, to be able to care.

“[Pay family members for caregiving] and you’ll see more men do it. Go to Australia, for example, where there’s very good compensation for care, and you’re astonished at the number of men who are caring for children, who are caring for elderly, and the like.”

Asking for help. “I have a wide circle of friends and colleagues, and [after the book] many of them said they had never realized what was involved. Part of that was my fault. I had a lot of trouble asking for help. Actually, at one point, I so exhausted myself that my kids, who are great, said, ‘You really need assistance.’ And they stepped in, as did my mother. My mother, who at the time was in her 90s.

“So, I had a great system of care around me, but I [also] needed a home health aide to [help with Joan and] keep myself going. I found an Irish woman … and she was fabulous.”

Maintaining presence. “In spite of that, I found it extraordinarily difficult in terms of other elements of care, one of which is presence. To keep your liveliness, your love, the presence of who you are going while you’re doing all this work of caregiving ― it is extremely difficult and demanding, but it’s crucial.

“When people ask ‘Why do you do [this]?’ the answer of most family caregivers I’ve spoken to is ‘Well, it was there to do. It’s got to be done, [so] you do it.’”

Learning about failure. “I was fortunate in life; I had a golden career. I have a personality that is like a bulldog, and when I start something I finish it. But there’s no finishing care. Every one of us [family caregivers], if we’re honest, you fail at a certain point. The frustrations build, anger mounts, you control your anger so you don’t injure the person you’re caring for. But you’ve got to somehow handle it inside you.”\

The soul of care. “I think what lies at the soul of care is a form of love. You will do everything you can for another because they mean so much to you. [But] it is also problematic, because we all have complex relationships and we’ve got other things going on in our lives.

“We endure, we learn how to endure, how to keep going. We’re marked, we’re injured, we’re wounded. We’re changed … [in] my case, for the better. If you had known me before my 11 years of care, you wouldn’t recognize me today. I was your classical hard-driving Harvard professor … as tough as any other professor at Harvard Medical School.

“I’ve redeemed myself through this experience, in a way.”

A call for change. “How do we strengthen caregiving? How do we do those things that will make it recognized as important as it is? It’s going to take a radical rethinking. Our health-care system [is focused on] entirely the wrong issues. Economics is not the most central aspect of care; it’s caregiving

“Do you know not a single one of the senior neurologists I went to with Joan who wanted to do everything diagnostically made the recommendation ‘You want to think about a home health aide now, even though you don’t need it right now. You have to look into how you’re going to reconfigure your house [for] someone who’s both blind and with dementia. [Or] a social worker is a great navigator of what the health-care system is about. You want to take advantage of that.’

“So, this is where I believe that our whole health care system has got to be rethought, from the bottom up with attention to care at its core.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health-care system. Visit khn.org/columnists to submit your requests or tips.

Judith Graham is a Kaiser Health News journalist.

Will hospital merger mania continue?

Excerpted from Robert Whitcomb's "Digital Diary,'' in GoLocal24.

The collapse of affiliation talks between Care New England,  the Rhode Island hospital chain, and Southcoast Health, in southeastern Massachusetts, as did the collapse of Lifespan and Care New England talks a few years back, raises the question of when we’ll see another hospital chain merger around here, given the inevitable turf battles.

With the drive for economies of scale and for sharing access to the best care and research, will the latest collapse lead to a big Boston-based chain coming in and taking over? Partners HealthCare, whose hospitals include Massachusetts General Hospital and Brigham & Women’s, might eye expansion in these parts because Massachusetts regulators think that it has gotten too big and powerful in Greater Boston. The Brown Medical School would presumably not like a Partners invasion because Partners is joined at the hip with the Harvard Medical School behemoth. Maybe given the size and executive salaries of hospitals these days, affiliating with the Harvard Business School would be appropriate.

Many hospital chains want to merge to strengthen their bargaining power with huge insurance companies. Maybe in 10 years, we’ll have “Medicare for all,’’ which will make much of this moot.

In the meantime, we have something to learn from those independent hospitals, such as South County Hospital,  in southern Rhode Island, that have maintained their independence and high-quality care in the face of the massive disruption that that healthcare sector is now undergoing.