Home › 2025

Yearly Archives: 2025

The Last Word

Posted on by

By Elly Griffiths – Mariner Books, 2025

Our story kicks off in a quiet British town, where Edwin, an 80-something amateur sleuth, teams up with Natalka, his younger, sharp-eyed partner, who is eager for a proper case after a series of low-level investigations. When a local newspaper writer with a knack for spotting oddities in the obituary column turns up dead, and the authorities shrug it off as natural causes, Edwin and Natalka can’t shake the feeling that something darker is going on. Then Melody, a novelist, dies under suspicious circumstances. Their sleuthing soon leads them to a writers’ retreat where egos, secrets and ambitions swirl—and, of course, another death follows.

Edwin isn’t treated as comic relief because of his age—he’s observant, thoughtful and occasionally underestimated. Natalka brings her own intergenerational struggles, as she deals with the realities of living with her aging mother. Together with Benedict, an ex-monk turned café owner, this unlikely detective crew feels like a group of old friends.

The charm of The Last Word lies in its ability to balance coziness with real-world, timely issues. There’s tea (it’s England after all) and quirky suspects, but there are also themes of aging, grief, cultural displacement and the question of how we’ll be remembered when our own “last word” is written.

Why Brittle Bones Aren’t Just a Woman’s Problem

20 percent of men over 50 have bone fractures because of osteoporosis
Posted on by

Women are more likely to develop osteoporosis than men are, but that doesn’t mean men are in the clear. As journalist Pamela Span explains in this article, it does mean that they’re seldom screened for the disease or treated for it in time to make a difference. KFF Health News posted Span’s piece on October 14, 2025; it also ran in the New York Times. Funding from the Silver Century Foundation helps KFF Health News produce articles (like this one) on longevity and related health and social issues. 

Ronald Klein was biking around his neighborhood in North Wales, PA, in 2006 and tried to jump a curb. “But I was going too slow—I didn’t have enough momentum,” he recalled.

As the bike toppled, he thrust out his left arm to break the fall. It didn’t seem like a serious accident, yet “I couldn’t get up,” he said.

At the emergency room, X-rays showed that he had fractured both his hip, which required surgical repair, and his shoulder. Klein, a dentist, went back to work in three weeks, using a cane. After about six months and plenty of physical therapy, he felt fine.

But he wondered about the damage the fall had caused. “A 52-year-old is not supposed to break a hip and a shoulder,” he said. At a follow-up visit with his orthopedist, “I said, ‘Maybe I should have a bone density scan.’”

As Klein suspected, the test showed he had developed osteoporosis, a progressive condition, increasing sharply with age, that thins and weakens bones and can lead to serious fractures. Klein immediately began a drug regimen and, now 70, remains on one.

Osteoporosis occurs so much more commonly in women, for whom medical guidelines recommend universal screening after age 65,  that a man who was not a health care professional might not have thought about getting a scan. The orthopedist didn’t raise the prospect.

But about one in five men over age 50 will suffer an osteoporotic fracture in their remaining years, and among older adults, about a quarter of hip fractures occur in men. 

When they do, “men have worse outcomes,” said Cathleen Colón-Emeric, MD, a geriatrician at the Durham VA Health Care System and Duke University and the lead author of a recent study of osteoporosis treatment in male veterans.

“Men don’t do as well in recovery as women,” she said, with higher rates of death (25 to 30 percent within a year), disability and institutionalization. “A 50-year-old man is more likely to die from the complications of a major osteoporotic fracture than from prostate cancer,” she said.

(What’s “major”? Fractures of the wrist, hip, femur, humerus, pelvis or vertebra.)

Should some (or all) older men be screened for osteoporosis, as women are? 

In her study of 3,000 veterans ages 65 to 85, conducted at Veterans Affairs health centers in North Carolina and Virginia, only 2 percent of those assigned to the control group had undergone bone-density screening.

“Shockingly low,” said Douglas Bauer, MD, a clinical epidemiologist and osteoporosis researcher at the University of California-San Francisco, who published an accompanying commentary in JAMA Internal Medicine. “Abysmal. And that’s at the VA, where it’s paid for by the government.”

But establishing a bone health service—overseen by a nurse who entered orders, sent frequent appointment reminders and explained results—led to dramatic changes in the intervention group, who had at least one risk factor for the condition.

Forty-nine percent of them said yes to a scan. Half of those tested had osteoporosis or a forerunner condition, osteopenia. Where appropriate, most of them began medications to preserve or rebuild their bones.

“We were pleasantly surprised that so many agreed to be screened and were willing to initiate treatment,” Colón-Emeric said.

After 18 months, bone density had increased modestly for those in the intervention group, who were more likely to stick to their drug regimens than osteoporosis patients of either sex in real-world conditions.

The study didn’t continue long enough to determine whether bone density increased further or fractures declined, but the researchers plan a secondary analysis to track that.

The results revive a longtime question: given how life-altering, even deadly, such fractures can be, and the availability of effective drugs to slow or reverse bone loss, should older men be screened for osteoporosis, as women are? If so, which men and when?

Men would like to believe they’re indestructible, so a fracture doesn’t have the implication that it should. 

—Eric Orwoll, MD

Such issues mattered less when lifespans were shorter, Bauer explained. Men have bigger and thicker bones and tend to develop osteoporosis five to 10 years later than women do. “Until recently, those men died of heart disease and smoking” before osteoporosis could harm them, he said.

“Now, men routinely live into their 70s and 80s, so they have fractures,” he added. By then, they have also accumulated other chronic conditions that impair their ability to recover.

With osteoporosis testing and treatment, “a man could see a clear-cut improvement in mortality and, more importantly, his quality of life,” Bauer said.

Both patients and many doctors still tend to regard osteoporosis as a women’s disease, however. “There’s a bit of a Superman idea,” said Eric Orwoll, MD, an endocrinologist and osteoporosis researcher at Oregon Health & Science University.

“Men would like to believe they’re indestructible, so a fracture doesn’t have the implication that it should,” he added.

One patient, for example, for years resisted entreaties from his wife, a nurse, to “see someone” about his visibly rounded upper back.

Bob Grossman, 74, a retired public school teacher in Portland, blamed poor posture instead and told himself to straighten up. “I thought, ‘It can’t be osteoporosis—I’m a guy,’” he said. But it was.

Another obstacle to screening: “Clinical practice guidelines are all over the place,” Colón-Emeric said.

Professional associations like the Endocrine Society and the American Society for Bone and Mineral Research recommend that men 50 and older who have a risk factor, and all men over 70, should seek screening. 

As osteoporosis develops, it typically produces no symptoms, so without screening, men don’t know their bones have deteriorated until one breaks. 

But the American College of Physicians and the U.S. Preventive Services Task Force have deemed the evidence for screening of men “insufficient.” Clinical trials have found that osteoporosis drugs increase bone density in men, as in women, but most male studies have been too small or lacked enough follow-up to show whether fractures also declined.

The task force’s position means that Medicare and many private insurers generally won’t cover screening for men who haven’t had a fracture, though they will cover care for men diagnosed with osteoporosis.

“Things have been stalled for decades,” Orwoll said.

So it may fall to older men themselves to ask their doctors about a DXA (pronounced DECKS-ah) scan, widely available at $100 to $300 out-of-pocket. Otherwise, because osteoporosis is typically asymptomatic, men (and women, who are also undertested and undertreated) don’t know their bones have deteriorated until one breaks.

“If you had a fracture after age 50, you should have a bone scan—that’s one of the key indicators,” Orwoll advised.

Other risk factors: falls, a family history of hip fractures, and a fairly long list of other health conditions including rheumatoid arthritis, hyperthyroidism and Parkinson’s disease. Smoking and excessive alcohol use increase the odds of osteoporosis as well.

“A number of medications also do a number on your bone density,” Colón-Emeric added, notably steroids and prostate cancer drugs.

When a scan reveals osteoporosis, depending on its severity, doctors may prescribe oral medications like Fosamax or Actonel, intravenous formulations like Reclast, daily self-injections of Forteo or Tymlos, or twice-annual injections of Prolia.

Lifestyle changes like exercising, taking calcium and vitamin D supplements, stopping smoking, and drinking only moderately will help but aren’t sufficient to stop or reverse bone loss, Colón-Emeric said.

Although guidelines don’t universally recommend it, at least not yet, she would like to see all men age 70 and up be screened, because the odds of disability after hip fractures are so high—two-thirds of older people will not regain their prior mobility, she noted—and the medications that treat it are effective and often inexpensive.

But informing patients and health care professionals that osteoporosis threatens men too has progressed “at a snail’s pace,” Orwoll said.

Klein remembers attending a seminar to instruct patients like him in using the drug Forteo. “I was the only male there,” he said.

 

Think the Boomers Ruined Everything? Think Again

Posted on by

In anxious times we look for scapegoats, so boomer-bashing is on the rise. Wondering how to push back? Here’s a quiz:

  1. Cheer up, they’re dying off!
  2. The boomers invented [the internet/water bed/etc.]. What does your [entitled/tech-addicted/etc.] generation have to show for itself?
  3. It’s about class, not age.

It’s easier to point fingers than to address what’s actually going on. So blame the actual culprits, the rich: the politicians, lobbyists, technocrats and corporate leaders who’ve shaped a system that benefits other wealthy people at the expense of the common good. Since the financial crisis of 2008, almost 100 percent of the country’s economic growth has gone to the families of the 1 percent, and they’re doing just fine. As for the underlying forces, blame predatory capitalism, unfettered by shifting political power. It’s not about age. It’s about class.  

Both the 1 percent and the 99 percent are made up of all ages. Americans born into the postwar economic boom were indeed demographically fortunate. The benefits, however, were not evenly distributed. As leading economists have long pointed out, growing wealth disparity within different age cohorts (not between them) underlies the shrinking prospects of ordinary Americans. It’s about class, not age.  

For a clear explanation of what happened to the more egalitarian social contract that followed World War II, and who benefited from its destruction, read “No, the Boomers Did Not take It All” in The American Prospect by journalist Robert Kuttner. Hint: “It wasn’t ‘boomers’….It was Ronald Reagan and the presidents who followed.” Including the Democrats. It’s not about political party or “gerontocracy.” It’s about class and power.

Media coverage is not neutral. Kuttner’s article is subtitled, “Why is the New York Times validating the generational myth, as opposed to taking a hard look at power and class?” Because the status quo serves the New York Times Company’s neoliberal agenda quite nicely; why upset the apple cart? That agenda prioritizes protecting private property over providing social services—services that disproportionately benefit the young and the old. Old people make better targets than kids, and much New York Times coverage is ageist. (Age advocate Stella Fosse lays out the paper’s sorry record on age bias here.) 

Most mainstream media outlets are for-profit companies with sharp eyes on the bottom line. Editors know that generational labels attract readers and that conflict = clickbait. 

Of course, media outlets have options and could choose not to advance the misleading narrative that the old profit at the expense of the young—especially in these divided times. Check out journalist Sheila Callaham’s analysis in Forbes of how the Wall Street Journal and the New York Times covered the same story: older Americans not selling their homes. Guess which one steered clear of the “boomers caused the housing crisis” trope?

Look beyond date-of-birth. Yes, people born in the aftermath of WWII were lucky. That doesn’t make them the enemy. The housing shortage isn’t a selfish-old-person problem, it’s a housing-market problem. It’s a result of policy failures compounded by economic barriers and demographic shifts, and it affects Americans across the age spectrum. Only the wealthy are protected. It’s about class, not age.  

Far more resources have always flowed from old to young. That’s as it should be. Already underway, the Great Wealth Transfer is moving an unprecedented $124 trillion from older to younger Americans. However, as with the postwar economic boom, the benefits are not equally distributed. Although high- and ultrahigh-net-worth households make up only 2 percent of American households, they’ll receive over half that money and will pass it on to their already-super-rich children.

Don’t let age divide us. In 2023, the Pew Research Center stopped using generational labels to avoid contributing to generational conflict and suggested that others follow suit. The more energy we waste on generational finger-pointing, the less likely we are to join forces to demand a society that works for all ages. Blaming America’s ills on old people—or on immigrants or feminists or trans folks, for that matter—divides us and distracts us from what’s actually going on. The only winners in this blame game are the ultra-wealthy. Once again, it’s about class, not age.

The story we need to tell isn’t about boomers vs. millennials. It’s about the rich and powerful vs. the rest of us.

A Flower Traveled in My Blood

The Incredible True Story of the Grandmothers Who Fought to Find a Stolen Generation of Children
Posted on by

By Haley Cohen Gilliand – Simon and Schuster, 2025

In 1976, a military junta took control of Argentina and launched a brutal campaign against anyone it viewed as a threat—journalists, artists, students and their family members. Tens of thousands were kidnapped, tortured or killed. One of the regime’s most disturbing crimes was abducting pregnant women, who gave birth in captivity before being “disappeared.” Their infants were secretly given to families aligned with the dictatorship.

For the women whose daughters vanished, the loss was doubled—their children were gone and their grandchildren had been stolen. Refusing to stay silent, a group of determined grandmothers formed the Abuelas (grandmothers) de Plaza de Mayo. These women became tireless investigators. Their commitment to learning the truth led them to American geneticist Mary-Claire King, who helped develop DNA tests that could confirm biological relationships—groundbreaking science that helped the Abuelas locate dozens of stolen children. (While investigating DNA science for the Abuelas, King discovered familial connections to BRCA gene breast cancer.)

Their efforts have helped identify hundreds of missing grandchildren and brought global attention to the fight for truth and justice. Their story is not just about loss—it is about extraordinary persistence, love and the power of ordinary people to confront injustice.

 

Still Marching, After All These Years

Posted on by

Amid America’s turmoil and woe, I like to think of my mother and father.

I am 84. My mother died in 2010 and my father in 1974. Though they are long gone, I hear what they might say and know what they would do now, as if they were close by. They would be reassuring me and keeping up my spirits. They would be carrying signs at the rallies with all of us.

At demonstrations against the Trump administration, I see many people with gray and white hair. My cousin Annie says, “Our demographic is over-represented at these protests, and I couldn’t be prouder. Still marching after all these years.”

At the demonstrations, I see people as old as I am everywhere. At a “No Kings” demo in Waltham, they carried signs saying, “Save Social Security,” “If a Parade, then Medicaid” and every other kind of message. One 80-year-old friend carried a cowbell and a sign reading “Basta con el miedo!” (“Enough with the fear!”). Another sign read, “I am 90, with Parkinson’s, and I am pissed.” A woman in a wheelchair held a sign saying, “I am 83, my first protest!” A man a little younger than I, wearing an Army cap from the Vietnam era, told me, “I didn’t know then that people could object and protest. Now I know, and I do.”

Many of us have had a lot of practice: Vietnam, Afghanistan, Iraq. We protested every bad government action.

I learned nonviolent civil disobedience from my parents, growing up in Brooklyn. They were activists even before Vietnam. During the civil rights movement in 1964, driving through St. Augustine, FL, they attended a demonstration. When protesters refused to leave a sit-in attempting to integrate the Ponce de Leon Motor Lodge restaurant, some were arrested and jailed. My parents were not arrested, but they were present, in solidarity, as lifelong believers in human rights, in including Black Americans in the American Dream. What we now call DEI was already a good goal.

And me? Young as I was, my good-girl head was down, finishing my master’s thesis on Proust in graduate school far away. I was merely an educated girl, not political yet, not focused on the common good as they were.

Both of them had been radicals in the 1930s, when Jewish leftists and others hoped that a popular front could remake US labor relations, control capitalist greed and bring America closer to equality for women and people of color. Paul Robeson was one of their idols, along with Eleanor Roosevelt.

Later, they opposed the Vietnam War, just as my husband and I did. In 1968, running against feckless Hubert Humphrey, treacherous Richard Nixon promised to end the war and then prolonged it until more than 50,000 men my age died, as well as countless Vietnamese and Cambodians. In 1972, my father worked to elect Elizabeth Holtzman, also of Brooklyn, to Congress. So she was in the House of Representatives in time to vote to impeach the corrupt Nixon in the summer of 1974.

My father, with ALS sapping his body, had followed the investigation and trial avidly from the green couch in the living room. But he missed out on the ending. By August, he was in a coma; he died two days short of Nixon’s ignominious exit.

The night Nixon left, making his awkward, hypocritical peace signs, my mother and I were dining in the dim kitchen with my cousin Sherry, grieving and rejoicing. In that painful, complex mood, we poured some wine and drank to him: “Marty should have been here to see this day.” “Daddy should have been here.”

I know my parents would be out with me on the streets now. They were there, in a sense—at a #HandsOff rally on April 5 in Newton, at an April 19 event to celebrate the 250th anniversary of the beginning of the American Revolution in Waltham, and then at the “No Kings” rally.

The signs were clever and scathing at all these events; drivers going by were honking in approval, shouting, applauding. My laconic father’s sign would have said, very big, in block letters, “NO!” Once when my mother was in her 90s and had lost many memories, I asked her, “What is wisdom?” She answered unhesitatingly: “The greatest part of wisdom is kindness.” Her sign, which I saw an older woman hold at the Waltham rally, would have read “Make America kind again.”

“Nothing is stranger than the position of the dead among the living,” Virginia Woolf wrote in her first, unpublished novel, Melymbrosia. I find it marvelous that my parents can still stand by my side.

The rest of our family is in the streets too: our son and his children in New York City. That solidarity is so welcome to us—just as it must have been to my parents when we opposed the Vietnam War early on, when they felt alone and scorned, when so few Americans had yet come to their senses.

Intergenerational solidarity is precious. That preciousness includes not only the next generations but the oldest too. To all of us lucky enough to have older people in our lives, they comfort us by their presence. Repositories of family lore and legend, they dole out secrets and, for better or worse, guide us by their experiences. And sometimes by the energy of their activism, right now!

I see my parents’ faces vividly. I summon them and their will to do good, which survives them in this national emergency. Their memory is a blessing in the here and now and the strife to come.

Life without Birthdays

Posted on by

Can you imagine not knowing exactly how old you are (and not caring)? Never having celebrated a birthday? 

That’s pretty much unthinkable in our age-regimented society, but that was my husband’s situation. He was born in the 1920s in India, not in a hospital but at home, as pretty much everybody was then. Birth certificates weren’t required. His family—and probably the whole community—didn’t celebrate birthdays.

Mike had no idea exactly when he was born, which didn’t matter until 1952, when he won a scholarship that would pay for grad school in the United States. To get a US visa, he needed a record of his date of birth. 

The only one he could find was on his registration for elementary school, and he knew that was probably inaccurate. An older cousin had taken him to school to register. Asked for Mike’s birth date, the cousin had no idea, so he guessed. 

Once the admission form was accepted for the visa, that became Mike’s legal date of birth. Years later, long after he’d become a US citizen, he was talking to family members about events that happened around the time he was born and realized that he was two years younger than he’d thought he was. 

It was way too late to change the date legally, so for the rest of his life he had one age on all his legal papers and one age he told his doctors. He celebrated birthdays but was a lot more relaxed about them—and about time passing—than most Americans are. 

When the United States was young, it too was relaxed about ages. In colonial times, many Americans didn’t know exactly when they were born. It didn’t matter until they came up against a law that required them to prove they were old enough—or too old—to do something: sign a contract, vote, marry, serve in the military or leave the military because they’d aged out.

From the early 1800s, children’s birthdays were celebrated, but that usually ended once they reached 21. Beyond that, the idea that a birthday was a special occasion didn’t become common until birthday cards were invented late in that century. Birth certificates weren’t required in the United States until 1919. 

Today, beginning in infancy, we’re too often judged by what’s expected from someone our age. Parents become anxious if a baby doesn’t start sleeping, smiling, talking or walking when the average baby does. As soon as we start school, we’re regimented into grades according to our ages, rather than by what we’re capable of. 

We spend our teens wishing we were older, because there are so many things we want to do that we’re told we’re too young to do. Closing in on 40, we start wishing we were younger. We’re afraid of aging—we expect the worst of our later years. And we keep comparing ourselves to others roughly the same age. 

My late 20s were terrifying because at the time, the average woman married at 20. As I neared 30, I was afraid I was becoming that pitiable person, an old maid. It was a huge relief when I finally married at 28. 

Two years later, I was in the hospital, in labor with my first child, when one nurse informed another, talking across my prostrate body, that I was “an elderly primipara”—old to be having a first child. Tell that to today’s mothers! It wasn’t reassuring.

During middle age, I was reasonably happy with whatever age I was except on birthdays. After 50, I tried to hide my age. I was a freelance writer, afraid ageism would cost me an assignment. 

But my 70s and 80s were productive and enjoyable. Now that I’m 90, I’m proud of my age, happy to reveal it to anyone who wants to know. I think a lot of 90-year-olds feel that way. We’re survivors, and we’ve had so much life experience—just ask us, we’d love to tell you.

Our culture is too locked in on aging and too negative about it. My husband was lucky, growing up in a time and place where age mattered less, and birthdays, not at all. 

Books to Give or Keep, 2025

Posted on by

Silver Century regularly recommends books—fiction, nonfiction and memoirs—that reflect our mission by portraying aging in a positive light or offering insights from thought leaders in the field of aging. Here are some of our favorites for holiday giving or to read in the winter months ahead.

The Correspondent

By Virginia Evans – Crown, 2025

Sybil Van Antwerp, a sharp, witty woman in her 70s, begins each morning with a letter—quiet, thoughtful missives to her brother, her best friend, even her favorite authors. But the letters that matter most never leave her desk. A former lawyer, mother, wife and now grandmother, Sybil is endlessly curious and unafraid to speak her mind, especially on the page. When an unexpected letter from her past arrives, she’s pulled back into a chapter she’d hoped was closed, forcing her to confront old wounds with the same honesty and intelligence that shape her days. This beautifully crafted novel explores forgiveness in its most authentic form—slow, reflective and chosen—with Sybil’s unforgettable voice at its heart.

Lula Dean’s Little Library of Banned Books

By Kirsten Miller – William Morrow, 2024

In the charming town of Troy, GA, midlife widow Lula Dean is on a mission to protect her local library from what she sees as inappropriate content. Believing she’s doing a good deed, she sets up a free library in her yard filled with books she considers more suitable, even though she hasn’t read them herself. However, her well-meaning efforts spark unexpected reactions. Someone cleverly adds banned books to her free library, disguising them first by replacing their covers with the covers of more mundane books. This leads to wonderful discoveries for many residents, who uncover hidden talents and forge new connections through their reading journeys. Ultimately, Lula experiences her own transformation, making this story both timely and delightfully relatable.

Mrs. Quinn’s Rise to Fame

By Olivia Ford – Pamela Dorman Books, 2024

Jenny Quinn, 77, is happily married and childless by choice but feels something’s missing. Hoping to leave a legacy—and shake up her routine—she secretly applies to the hit show Britain Bakes. When she’s accepted, she’s swept into the chaos of competitive baking and reality TV, confronting her all-too-relatable anxieties and stubborn self-doubt. After she confesses her secret application to her sweetly supportive husband, an old buried secret bubbles up. What makes this coming-of-(older)-age tale shine is Jenny herself. She finds new passions, welcomes new people into her life and bakes her way straight into readers’ hearts. And yes—every tempting recipe is included.

The Borrowed Life of Frederick Fife

By Anna Johnston – William Morrow, 2024

Lonely, 82-year-old Frederick Fife gets an unexpected second shot at family when a wild case of mistaken identity lands him in a nursing home as the late—and notably grumpy—Bernard Greer. Suddenly, Fred has a warm bed, warm meals and warm friends…as long as no one discovers his little switcheroo. Denise Simms, a caregiver juggling a shaky marriage and her daughter’s health issues, grows suspicious of Fred’s surprising kindness—so unlike the Bernard she knew. Author Anna Johnston blends humor with heartfelt insight into aging and our need for connection, making this a charming, uplifting read for when you need a boost.

Dinners with Ruth: A Memoir on the Power of Friendships

By Nina Totenberg – Simon & Schuster, 2022

NPR correspondent Nina Totenberg reflects on her nearly 50-year friendship with Supreme Court Justice Ruth Bader Ginsburg, tracing their bond from Totenberg’s early days covering the Court and Ginsburg’s rise as a legal scholar to decades of shared support, laughter and personal challenges. Offering a warm portrait of Ginsburg as witty, driven and deeply caring—right into her 80s—the book also highlights the ups and downs of Totenberg’s own career and the family, friends and colleagues who sustained her. It’s a heartfelt tribute to a lifelong connection and the enduring power of friendship.

The Friend

Posted on by

2025, USA, 119 min. 

Iris (Naomi Watts) is crushed after her beloved mentor, Walter (Bill Murray), unexpectedly dies by suicide. Then a complication in fur arrives: he has bequeathed her his dog, Apollo. The Great Dane is the size of a Buick; Iris is tiny and lives alone. Her cozy, rent-controlled, New York City apartment prohibits animals. Iris, who is in a creative lull, needs to finish a book, and the dog demands all her attention. But the two lost souls miss their best friend, a connection that provides a foundation to build a relationship. The Friend will undoubtedly appeal to dog lovers, but it’s more than an ode to companionship. It’s a heartwarming, forthright drama about accepting loss, dealing with our past, and finding the resolve to move forward. 

An Age-Old Fear Grows More Common: ‘I’m Going to Die Alone’

More than 16 million older adults live alone, many without family nearby
Posted on by

Journalist Judith Graham reports that this is a growing concern among the health care providers who care for older people and the researchers who focus on their issues. Kaiser Health News posted her story on Oct. 16, 2025. It also ran in the Washington Post. 

This summer, at dinner with her best friend, Jacki Barden raised an uncomfortable topic: the possibility that she might die alone.

“I have no children, no husband, no siblings,” Barden remembered saying. “Who’s going to hold my hand while I die?”

Barden, 75, never had children. She’s lived on her own in western Massachusetts since her husband passed away in 2003. “You hit a point in your life when you’re not climbing up anymore, you’re climbing down,” she told me. “You start thinking about what it’s going to be like at the end.”

It’s something that many older adults who live alone—a growing population, more than 16 million strong in 2023— wonder about. Many have family and friends they can turn to. But some have no spouse or children, have relatives who live far away, or are estranged from remaining family members. Others have lost dear friends they once depended on to [help them in] advanced age and illness.

More than 15 million people 55 or older don’t have a spouse or biological children; nearly 2 million have no family members at all.

Still other older adults have become isolated due to sickness, frailty or disability. Between 20 and 25 percent of older adults who do not live in nursing homes aren’t in regular contact with other people. And research shows that isolation becomes even more common as death draws near.

Who will be there for these solo agers as their lives draw to a close? How many of them will die without people they know and care for by their side?

Unfortunately, we have no idea: national surveys don’t capture information about who’s with older adults when they die. But dying alone is a growing concern as more seniors age on their own after widowhood or divorce, or remain single or childless, according to demographers, medical researchers and physicians who care for older people.

Some hospitals have programs that match volunteers with patients who are near the end of life.

“We’ve always seen patients who were essentially by themselves when they transition into end-of-life care,” said Jairon Johnson, MD, the medical director of hospice and palliative care for Presbyterian Healthcare Services, the largest health care system in New Mexico. “But they weren’t as common as they are now.”

Attention to the potentially fraught consequences of dying alone surged during the COVID-19 pandemic, when families were shut out of hospitals and nursing homes as older relatives passed away. But it’s largely fallen off the radar since then.

For many people, including health care practitioners, the prospect provokes a feeling of abandonment. “I can’t imagine what it’s like, on top of a terminal illness, to think I’m dying and I have no one,” said Sarah Cross, MD, an assistant professor of palliative medicine at Emory University School of Medicine.

Cross’ research shows that more people die at home now than in any other setting. While hundreds of hospitals have “No One Dies Alone” programs, which match volunteers with people in their final days, similar services aren’t generally available for people at home.

Alison Butler, 65, is an end-of-life doula who lives and works in the Washington, DC, area. She helps people and those close to them navigate the dying process. She also has lived alone for 20 years. In a lengthy conversation, Butler admitted that being alone at life’s end seems like a form of rejection. She choked back tears as she spoke about possibly feeling her life “doesn’t and didn’t matter deeply” to anyone.

Without reliable people around to assist terminally ill adults, there’s also an elevated risk of self-neglect and deteriorating well-being. Most seniors don’t have enough money to pay for assisted living or help at home if they lose the ability to shop, bathe, dress or move around the house.

Fewer than half of older people who are under the age of 85 turn to hospice services for help. 

Nearly $1 trillion in cuts to Medicaid planned under President Donald Trump’s tax and spending law, previously known as the “One Big Beautiful Bill Act,” probably will compound difficulties accessing adequate care, economists and policy experts predict. Medicare, the government’s health insurance program for seniors, generally doesn’t pay for home-based services; Medicaid is the primary source of this kind of help for people who don’t have financial resources. But states may be forced to eviscerate Medicaid home-based care programs as federal funding diminishes.

“I’m really scared about what’s going to happen,” said Bree Johnston, MD, a geriatrician and the director of palliative care at Skagit Regional Health in northwestern Washington state. She predicted that more terminally ill seniors who live alone will end up dying in hospitals, rather than in their homes, because they’ll lack essential services.

“Hospitals are often not the most humane place to die,” Johnston said.

While hospice care is an alternative paid for by Medicare, it too often falls short for terminally ill older adults who are alone. (Hospice serves people whose life expectancy is six months or less.) For one thing, hospice is underused: fewer than half of older adults under age 85 take advantage of hospice services.

Also, “Many people think, wrongly, that hospice agencies are going to provide person power on the ground and help with all those functional problems that come up for people at the end of life,” said Ashwin Kotwal, MD, an associate professor of medicine in the division of geriatrics at the University of California-San Francisco School of Medicine.

Instead, agencies usually provide only intermittent care and rely heavily on family caregivers to offer needed assistance with activities such as bathing and eating. Some hospices won’t even accept people who don’t have caregivers, Kotwal noted.

That leaves hospitals. If seniors are lucid, staffers can talk to them about their priorities and walk them through medical decisions that lie ahead, said Paul DeSandre, DO, the chief of palliative and supportive care at Grady Health System in Atlanta.

If they’re delirious or unconscious, which is often the case, staffers normally try to identify someone who can discuss what this senior might have wanted at the end of life and possibly serve as a surrogate decision-maker. Most states have laws specifying default surrogates, usually family members, for people who haven’t named decision-makers in advance.

I would not feel comforted by someone being there holding my hand or wiping my brow or watching me suffer. I’m really OK with dying by myself.

—Elva Roy

If all efforts fail, the hospital will go to court to petition for guardianship, and the patient will become a ward of the state, which will assume legal oversight of end-of-life decision-making.

In extreme cases, when no one comes forward, someone who has died alone may be classified as “unclaimed” and buried in a common grave. This too is an increasingly common occurrence, according to The Unclaimed: Abandonment and Hope in the City of Angels, a book about this phenomenon, published last year.

Shoshana Ungerleider, MD, a physician, founded End Well, an organization committed to improving end-of-life experiences. She suggested people make concerted efforts to identify seniors who live alone and are seriously ill early and provide them with expanded support. Stay in touch with them regularly through calls, video or text messages, she said.

And don’t assume all older adults have the same priorities for end-of-life care. They don’t.

Barden, the widow in Massachusetts, for instance, has focused on preparing in advance: all her financial and legal arrangements are in order and funeral arrangements are made.

“I’ve been very blessed in life: we have to look back on what we have to be grateful for and not dwell on the bad part,” she told me. As for imagining her life’s end, she said, “it’s going to be what it is. We have no control over any of that stuff. I guess I’d like someone with me, but I don’t know how it’s going to work out.”

Some people want to die as they’ve lived — on their own. Among them is 80-year-old Elva Roy, founder of Age-Friendly Arlington, TX, who has lived alone for 30 years after two divorces.

When I reached out, she told me she’d thought long and hard about dying alone and is toying with the idea of medically assisted death, perhaps in Switzerland, if she becomes terminally ill. It’s one way to retain a sense of control and independence that’s sustained her as a solo ager.

“You know, I don’t want somebody by my side if I’m emaciated or frail or sickly,” Roy said. “I would not feel comforted by someone being there holding my hand or wiping my brow or watching me suffer. I’m really OK with dying by myself.”

 

Cocoon

Posted on by

1985, United States, 117 min.

Three friends (Wilford Brimley, Don Ameche and Hume Cronyn) break the monotony of life at a Florida retirement village by sneaking onto a nearby abandoned estate and taking a dip in its pool. When a vacationing out-of-towner (Brian Dennehy) rents the space for a month and uses the pool to store boulder-like cocoons, the fellas aren’t dissuaded. They keep swimming and feel revived, even when the new tenant and his “cousins” reveal their otherworldly identities. And that’s when things get complicated. One part fairy tale, one part reflection on responsible aging, the film is distinguished by Brimley and Cronyn’s heartbreaking, all-too-human performances. Their characters grapple with the unanticipated price that comes with a second chance and give the movie an emotional heft to complement the feel-good storyline. Followed by a 1988 sequel.  

 

Many Older People Are Eager for Vaccines

Recent studies are proving them right
Posted on by

Researchers have found that, not only are the main vaccines recommended for older people effective, but a pair of them also reduce the risk of dementia. Journalist Paula Span sums up what you need to know in this piece that appeared in Kaiser Health News on June 23, 2025. It also ran in the New York Times. Funding from the Silver Century Foundation helps KFF Health News produce articles (like this one) on longevity and related health and social issues. 

Kim Beckham, an insurance agent in Victoria, TX, had seen friends suffer so badly from shingles that she wanted to receive the first approved shingles vaccine as soon as it became available, even if she had to pay for it out of pocket. 

Her doctor and several pharmacies turned her down because she was below the recommended age at the time, which was 60. So, in 2016, she celebrated her 60th birthday at her local CVS.

“I was there when they opened,” Beckham recalled. After getting her Zostavax shot, she said, “I felt really relieved.” She has since received the newer, more effective shingles vaccine, as well as a pneumonia shot, an RSV vaccine to guard against respiratory syncytial virus, annual flu shots and all recommended COVID-19 vaccinations.

Some older people are really eager to be vaccinated.

Robin Wolaner, 71, a retired publisher in Sausalito, CA, has been known to badger friends who delay getting recommended shots, sending them relevant medical studies. “I’m sort of hectoring,” she acknowledged.

Deana Hendrickson, 66, who provides daily care for three young grandsons in Los Angeles, sought an additional MMR shot, though she was vaccinated against measles, mumps and rubella as a child, in case her immunity to measles had waned.

For older adults who express more confidence in vaccine safety than younger groups, the past few months have brought welcome research. Studies have found important benefits from a newer vaccine and enhanced versions of older ones, and one vaccine may confer a major bonus that nobody foresaw.

The new studies are coming at a fraught political moment. The nation’s health secretary, Robert F. Kennedy Jr., has long disparaged certain vaccines, calling them unsafe and saying that the government officials who regulate them are compromised and corrupt.

Studies show that enhanced flu vaccines are more effective than standard flu shots. 

On June 9, Kennedy fired a panel of scientific advisers to the Centers for Disease Control and Prevention and later replaced them with some who have been skeptical of vaccines. But so far, Kennedy has not tried to curb access to the shots for older Americans.

The evidence that vaccines are beneficial remains overwhelming.

The phrase “Vaccines are not just for kids anymore” has become a favorite for William Schaffner, MD, an infectious diseases specialist at Vanderbilt University Medical Center.

“The population over 65, which often suffers the worst impact of respiratory viruses and others, now has the benefit of vaccines that can prevent much of that serious illness,” he said.

Take influenza, which annually sends from 140,000 to 710,000 people to hospitals, most of them seniors, and is fatal to 10 percent of hospitalized older adults. 

For about 15 years, the CDC has approved several enhanced flu vaccines for people 65 and older. More effective than the standard formulation, they either contain higher levels of the antigen that builds protection against the virus or incorporate an adjuvant that creates a stronger immune response. Or they’re recombinant vaccines, developed through a different method, with higher antigen levels.

In a meta-analysis in the Journal of the American Geriatrics Society, “all the enhanced vaccine products were superior to the standard dose for preventing hospitalizations,” said Rebecca Morgan, PhD, a health research methodologist at Case Western Reserve University and an author of the study.

Compared with the standard flu shot, the enhanced vaccines reduced the risk of hospitalization from the flu in older adults by at least 11 percent and up to 18 percent. The CDC advises adults 65 and older to receive the enhanced vaccines, as many already do.

The RSV vaccine is 75 percent effective in protecting you from an illness serious enough that you need to see a doctor. 

More good news: vaccines to prevent respiratory syncytial virus in people 60 and older are performing admirably.

RSV is the most common cause of hospitalization for infants, and it also poses significant risks to older people. “Season in and season out,” Schaffner said, “it produces outbreaks of serious respiratory illness that rivals influenza.”

Because the FDA first approved an RSV vaccine in 2023, the 2023-24 season provided “the first opportunity to see it in a real-world context,” said Pauline Terebuh, MD, an epidemiologist at Case Western Reserve School of Medicine and an author of a recent study in the journal JAMA Network Open.

In analyzing electronic health records for almost 800,000 patients, the researchers found the vaccines to be 75 percent effective against acute infection, meaning illness that was serious enough to send a patient to a health care provider.

The vaccines were 75 percent effective in preventing emergency room or urgent care visits, and 75 percent effective against hospitalization, both among those ages 60 to 74 and those older.

Immunocompromised patients, despite having a somewhat lower level of protection from the vaccine, will also benefit from it, Terebuh said. As for adverse effects, the study found a very low risk for Guillain-Barré syndrome, a rare condition that causes muscle weakness and that typically follows an infection, in about 11 cases per 1 million doses of vaccine. That, she said, “shouldn’t dissuade people.”

The CDC now recommends RSV vaccination for people 75 and older, and for those 60 to 74 if they’re at higher risk of severe illness (from, say, heart disease).

As data from the 2024-25 season becomes available, researchers hope to determine whether the vaccine will remain a one-and-done or whether immunity will require repeated vaccination.

Shingles vaccines protect you against shingles and also reduce the risk that you’ll develop dementia. 

People 65 and up express the greatest confidence in vaccine safety of any adult group, a KFF survey found in April. More than 80 percent said they were “very “or “somewhat confident” about MMR, shingles, pneumonia and flu shots.

Although the COVID vaccine drew lower support among all adults, more than two-thirds of older adults expressed confidence in its safety.

Even skeptics might become excited about one possible benefit of the shingles vaccine: this spring, Stanford researchers reported that over seven years, vaccination against shingles reduced the risk of dementia by 20 percent, a finding that made headlines.

Biases often undermine observational studies that compare vaccinated with unvaccinated groups. “People who are healthier and more health-motivated are the ones who get vaccinated,” said Pascal Geldsetzer, PhD, an epidemiologist at the Knight Initiative for Brain Resilience at Stanford and lead author of the study.

“It’s hard to know whether this is cause and effect,” he said, “or whether they’re less likely to develop dementia anyway.”

So the Stanford team took advantage of a “natural experiment” when the first shingles vaccine, Zostavax, was introduced in Wales. Health officials set a strict age cutoff: People who turned 80 on or before Sept. 1, 2013, weren’t eligible for vaccination, but those even slightly younger were eligible.

In the sample of nearly 300,000 adults whose birthdays fell close to either side of that date, almost half of the eligible group received the vaccine, but virtually nobody in the older group did.

“Just as in a randomized trial, these comparison groups should be similar in every way,” Geldsetzer explained. A substantial reduction in dementia diagnoses in the vaccine-eligible group, with a much stronger protective effect in women, therefore constitutes “more powerful and convincing evidence,” he said.

The team also found reduced rates of dementia after shingles vaccines were introduced in Australia and other countries. “We keep seeing this in one dataset after another,” Geldsetzer said.

In the United States, where a more potent vaccine, Shingrix, became available in 2017 and supplanted Zostavax, Oxford investigators found an even stronger effect. 

By matching almost 104,000 older Americans who received a first dose of the new vaccine (full immunization requires two) with a group that had received the earlier formulation, they found delayed onset of dementia in the Shingrix group.

How a shingles vaccine might reduce dementia remains unexplained. Scientists have suggested that viruses themselves may contribute to dementia, so suppressing them could protect the brain. Perhaps the vaccine revs up the immune system in general or affects inflammation.

“I don’t think anybody knows,” said Paul Harrison, MD, a psychiatrist at Oxford and a senior author of the study. But, he added, “I’m now convinced there’s something real here.”

Shingrix, now recommended for adults over 50, is 90 percent effective in preventing shingles and the lingering nerve pain that can result. In 2021, however, only 41 percent of adults 60 and older had received one dose of either shingles vaccine.

A connection to dementia will require further research, and Geldsetzer is trying to raise philanthropic funding for a clinical trial.

And “if you needed another reason to get this vaccine,” Schaffner said, “here it is.”

 

A Silent Killer in My Family

Posted on by

At my annual physical, I brought a list of concerns, feeling uneasy after learning that three of my siblings have high Lp(a), a form of cholesterol that increases the risk of heart and vascular disease. “I think I should get tested too,” I told my doctor. He nodded calmly and said, “Absolutely—and we should talk about what that means for you. Starting with a statin.”

Days later, my results came back: elevated Lp(a), or lipoprotein(a). I’ve never obsessed over cholesterol, blood pressure or diet—my numbers always looked fine—because I thought I was doing enough by eating salmon, walnuts and olive oil regularly. But Lp(a) is different: it’s genetic, unaffected by diet or lifestyle, and fixed at birth. With a 50 percent chance of passing to children or siblings, it quietly runs in families.

What could I do? I couldn’t lower Lp(a) with kale or cardio. But I could take control of other risk factors—keep my LDL low, manage blood pressure and blood sugar and stay active. My doctor mentioned statins, which don’t directly affect Lp(a) but effectively reduce LDL and overall risk. Niacin and estrogen therapy were also referenced, but their side effects and limited benefits make them less viable for me. The hopeful part? Scientists are developing next-gen RNA therapies that could reduce Lp(a) by 80–100 percent in early studies. But they’re not approved yet, and we don’t know if lowering Lp(a) this way will reduce heart attacks or strokes. So for now, lifestyle remains my best tool.

I left that appointment cautiously optimistic, committed to a new strategy: living healthier, taking my statin, checking in with my siblings and watching trial results closely.

If your family has high Lp(a), ask your provider to test you—it’s a one-time, non-fasting blood draw. Don’t panic if your Lp(a) is elevated. Use that as fuel to strengthen your heart-health game while research evolves. Lp(a) may be in your genetic makeup, but that doesn’t mean it determines your fate. 

The Old Gays’ Guide to the Good Life: Lessons Learned About Love and Death, Sex and Sin, and Saving the Best for Last

Posted on by

By Mick Peterson, Jessay Martin, Bill Lyons and Robert Reeves — Harper Wave, 2023

You may recognize them from their dancing videos on TikTok, but you don’t know them like this. Mick, Jessay, Bill and Robert—aka the “Old Gays”—have unique stories and upbringings, but together they went viral in Robert’s Cathedral City, CA, living room. The Old Gays’ Guide to the Good Life is a combination of biographical history and “how-to” life advice based on decades of experience, growing older as gay men in America. The book captures why the world has fallen in love with these men through heartfelt, provocative and laugh-out-loud funny narratives. They pull back the curtain to reveal thoughts about first loves and heartbreaks, managing health conditions, gay marriage and living through the AIDS epidemic. With personality on every page—and even more so in the audiobook, narrated by the authors themselves—readers are reminded that older adulthood can bring unexpected adventure and has the potential to be the best years yet.

 

Home Improvements Can Help People Age Independently 

But Medicare seldom picks up the bill
Posted on by

Journalist Joanne Kenen investigates a program called CAPABLE, which  sends a team of health care providers into the homes of vulnerable older people, along with a  handyman. Their goal is to find ways to improve the senior’s health and also the safety of the home. Kenen also describes the program’s struggles to find funding. KFF Health News posted her story on March 3, 2025; it also ran on the Washington Post. Funding from the Silver Century Foundation helps KFF Health News develop articles (like this one) on longevity and related health and social issues. 

Chikao Tsubaki had been having a terrible time.

In his mid-80s, he had a stroke. Then lymphoma. Then prostate cancer. He was fatigued, isolated, not all that steady on his feet.

Then Tsubaki took part in an innovative care initiative that, over four months, sent an occupational therapist, a nurse and a handyworker to his home to help figure out what he needed to stay safe. In addition to grab bars and rails, the handy worker built a bookshelf so neither Tsubaki nor the books he cherished would topple over when he reached for them.

Reading “is kind of the back door for my cognitive health—my brain exercise,” said Tsubaki, a longtime community college teacher. Now 87, he lives independently and walks a mile and a half almost every day.

The program that helped Tsubaki remain independent, called Community Aging in Place: Advancing Better Living for Elders, or CAPABLE, has been around for 15 years and is offered in about 65 places across 26 states. It helps people 60 and up, and some younger people with disabilities or limitations, who want to remain at home but have trouble with activities like bathing, dressing or moving around safely. Several published studies have found the program saves money and prevents falls, which the Centers for Disease Control and Prevention says contribute to the deaths of 41,000 older Americans and cost Medicare about $50 billion each year.

Despite evidence and accolades, CAPABLE remains small, serving roughly 4,600 people to date. Insurance seldom covers it (although the typical cost of $3,500 to $4,000 per client is less than many health care interventions). Traditional Medicare and most Medicare Advantage private insurance plans don’t cover it. Only four states use funds from Medicaid, the federal-state program for low-income and disabled people. CAPABLE gets by on a patchwork of grants from places like state agencies for aging and philanthropies.

Research shows that CAPABLE participants live more safely at home and have fewer mobility problems. 

The payment obstacles are an object lesson in how insurers, including Medicare, are built around paying for doctors and hospitals treating people who are injured or sick—not around community services that keep people healthy. Medicare has billing codes for treating a broken hip but not for avoiding one, let alone for something like having a handyperson “tack down loose carpet near stairs.”

And while keeping someone alive longer may be a desirable outcome, it’s not necessarily counted as savings under federal budget rules. A 2017 Centers for Medicare & Medicaid evaluation found that CAPABLE had high satisfaction rates and some savings. But its limited size made it hard to assess the long-term economic impact.

It’s unclear how the Trump administration will approach senior care.

The barriers to broader state or federal financing are frustrating, said Sarah Szanton, who helped create CAPABLE while working as a nurse practitioner doing home visits in west Baltimore. Some patients struggled to reach the door to open it for her. One tossed keys to her out of a second-story window, she recalled.

Seeking a solution, Szanton discovered a program called ABLE, which brought an occupational therapist and a handyworker to the home. Inspired by its success, Szanton developed CAPABLE, which added a nurse to check on medications, pain and mental well-being and do things like help participants communicate with doctors. It began in 2008. 

Szanton since 2021 has been the dean of Johns Hopkins University School of Nursing, which coordinates research on CAPABLE. The model is participatory, with the client and care team “problem-solving and brainstorming together,” said Amanda Goodenow, an occupational therapist who worked in hospitals and traditional home health before joining CAPABLE in Denver, where she also works for the CAPABLE National Center, the nonprofit that runs the program.

Experts who have looked at CAPABLE see possible routes to coverage by Medicare.

CAPABLE doesn’t profess to fix all the gaps in US long term care, and it doesn’t work with all older people. Those with dementia, for example, don’t qualify. But studies show it does help participants live more safely at home with greater mobility. And one study that Szanton co-authored estimated Medicare savings of around $20,000 per person would continue for two years after a CAPABLE intervention.

“To us, it’s so obvious the impact that can be made just in a short amount of time and with a small budget,” said Amy Eschbach, a nurse who has worked with CAPABLE clients in the St. Louis area, where a Medicare Advantage plan covers CAPABLE. That St. Louis program caps spending on home modifications at $1,300 a person.

Both Hill staff and CMS experts who have looked at CAPABLE do see potential routes to broader coverage. One senior Democratic House aide, who asked not to be identified because they were not allowed to speak publicly, said Medicare would have to establish careful parameters. For instance, CMS would have to decide which beneficiaries would be eligible. Everyone in Medicare? Or only those with low incomes? Could Medicare somehow ensure that only necessary home modifications are made—and that unscrupulous contractors don’t try to extract the equivalent of a “copay” or “deductible” from clients?

Szanton said there are safeguards and more could be built in. For instance, it’s the therapists like Goodenow, not the handyworkers, who put in the work orders, to stay on budget.

For Tsubaki, whose books are not only shelved but organized by topic, the benefits have endured.

“I became more independent. I’m able to handle most of my activities. I go shopping, to the library and so forth,” he said. His pace is slow, he acknowledged. But he gets there.

Kenen is the journalist-in-residence and a faculty member at Johns Hopkins University School of Public Health. She is not affiliated with the CAPABLE program.

The Emperor of Gladness

Posted on by

By Ocean Vuong – Penguin Press, 2025

Set in the fictional town of East Gladness, CT, the story follows 19-year-old Hai, a college dropout struggling with suicidal thoughts and opioid addiction. His life takes an unexpected turn when Grazina, an 82-year-old Lithuanian widow with dementia, saves him from a suicide attempt. Hai becomes her caretaker, and their unlikely bond forms the emotional core of the novel. Together, they confront issues such as generational trauma, immigrant experiences and the search for meaning. 

As Grazina’s dementia worsens, Hai remains by her side. In return for shelter, he pilfers frozen meals and prescription medications for her. He also lovingly tries to engage with her by stepping into her imaginary world. When Hai pulls his coworkers from the grocery store into that make-believe world, they create a makeshift family, filled with marginalized individuals who feel isolated without each other. While the novel presents a world of quirky individuals, the human connections and suggestions of redemption for the characters make it an engrossing read.

Just Call Me ‘Whosis’

Posted on by

I love words. I spend my days reading them, writing them and deeply appreciating them when someone else strings them together in a fresh and evocative way.

So why do they so often elude me? Proper and improper names of people and objects get stuck on the tip of my tongue. I know the word I want to use, but my brain won’t let go of it. And why is it almost always nouns that go missing? Why not verbs, adjectives or adverbs? Most nouns are dull by comparison.

Everyone sometimes has tip-of-the-tongue (TOT) moments, but it happens much more often when you’re older. There’s a name for the inability to recall a particular word: lethologica—a term I doubt I’ll be able to remember, because words you don’t use often are the ones most likely to abscond.

According to scientists, dragging words from memory into speech is a process that happens in stages: your brain registers the meaning of what you want to say, picks the right word from your vocabulary, chooses the sound pattern to go with it, and then causes your speech organs (vocal chords, tongue, etc.) to utter it. Things can go wrong at any stage, but with TOT, the problem usually occurs when your brain is retrieving the sound pattern.

What can you do when a word gets stuck? The experts have tips.

Visualize the person, place or object you’re endeavoring to name. Or try to visualize what the written word might look like.

Talk out loud. Say any words that come to you that you think may sound like the one you’ve forgotten.

If you can guess the first letter of the word, try out possibilities. Hitch that letter to various vowels. If it’s “m,” experiment with words that begin with “Ma or “me” or “mi,” and so on.

This never works for me—apparently it does for other people—but the other day, I tried a variation successfully. I was searching for the name of a man I know well that was TOT. Speaking aloud, I said the first male name that occurred to me that began with “a” (Alan), then one that began with “b” (Bob), and so on, listening for something that resonated. When I got to “g” and said “Gerard,” I knew immediately that was the name I was searching for.

Think of related words. For example, if you’re blocked on a neighbor’s name, recall others who live nearby. Or if something like “mango” has escaped you, grease the mental path between brain and tongue by naming other fruits.

Enlist the help of others. This is where living in a retirement community helps. Nobody here is embarrassed about losing a word, because it happens to all of us. When we get together, we often play a version of charades. The individual who has gone blank provides clues, and the rest of us throw out guesses. “It’s a green, oblong, tropical fruit that has a huge pit,” the person who’s lost the word says. Someone fills in the word “mango,” and the conversation rolls on.

Don’t keep trying if none of this works. Release the pressure—distract yourself with other things. It may take a while, but the word you’re hunting will usually pop up.

TOT syndrome can be a symptom of a serious illness, but I’m not worrying about that. Those are unusual cases. Anyway, another of the benefits of living in a retirement community is that, if just about everyone you know has the same problem, the medical profession almost certainly considers it “normal” for your age group.

When you love words as much as I do, it can be maddening when they go missing, but in a pinch, I know I can always resort to one of the three most useful words in the English language: “whosis,” “whatsis” or “whatchamacallit.”

The Health Benefits of Spending Time Outdoors

The evidence is piling up: connecting with nature is good for you
Posted on by

Rajiv Roy is semi-retired from venture capital, but he’s not slowing down. At age 66, he spends about half his time traveling—just in the past six months, he’s been to Colombia, China, India, Japan and Iceland—to capture birds and other wildlife through his camera lens. 

Roy took up wildlife photography about eight years ago, and he’s convinced it’s helping him age more healthfully. When he’s in nature, he’s mentally engaged and physically active. He’s often out by sunrise, scanning the horizon for wildlife, tracking and observing their behavior and moving constantly to position himself for a perfect shot.

“I’ve never had a bad day outdoors,” said Roy. “It gets you away from doomscrolling or stuffing your face mindlessly as you are triggered by political news.” 

A growing body of research confirms Roy’s observation: spending time in nature can help older adults stay physically active, mentally engaged, emotionally balanced, socially connected and even spiritually grounded. 

Compelling evidence is piling up for the health benefits of nature. A 2019 study of nearly 20,000 participants found that those who spent at least 120 minutes per week in nature were significantly more likely to report good health and well-being compared to those with no contact with nature. The positive association was consistent across different age groups and health statuses. 

Similarly, a systematic review of studies through 2017 found that exposure to green space (such as parks or trails) was associated with wide-ranging health benefits, including reduced diastolic blood pressure, heart rate, salivary cortisol, incidence of Type 2 diabetes and stroke, and mortality. Those who live in urban areas with more green spaces are also less likely to have cardiovascular disease, obesity, diabetes, asthma hospitalization or mental distress. 

The benefits are so significant that initiatives like PaRx are cropping up to encourage physicians to write “park prescriptions,” instructing patients to spend more time outdoors. PaRx, offered by the BC Parks Foundation in British Columbia, offers practical resources like quick tips and patient handouts to make prescribing time in nature easy and effective. 

“Health care providers are always looking for simple, practical interventions they can make to improve their patients’ lives,” according to the PaRx website. “The beauty of PaRx is that almost anyone can increase the time they spend in nature, no matter what their physical abilities are or where they live.”

Spiritual Ground

Many cultures have long recognized the value of the natural world to human health. Scandinavians embrace friluftsliv or “open-air living,” which can range from spending days in a remote mountain hut to simply taking a lunchtime run in the forest. In Finland, saunas are a weekly or daily ritual, involving meditative sessions in heated spaces, sometimes alternated with dips in cold water or a quick roll in the snow. 

In Japan, shinrin-yoku, or “forest bathing,” emerged in the 1980s as a kind of ecotherapy promoting mental and physical health. The practice involves spending time mindfully in the forest; other Asian countries, as well as Native American cultures, observe similar practices. 

John Dattilo, PhD, professor emeritus in Penn State University’s recreation, park and tourism management department, was part of a team that surveyed older adult forest bathers in Taiwan. The researchers found that fostering social connections around nature-based activities could improve health and quality of life for older adults.

“Nature seems to provide a platform for connecting with other people and for cultivating a sense of meaning and purpose in life,” he said. 

You hear the river running, the birds singing, and you smell the foliage or the flowers. There’s the sensation of snow or rain on your face. You don’t get that when you’re inside.

—Carol Hatch, MD

When they spend time in nature, Dattilo said, older adults often experience awe and wonder, which promotes a sense of appreciation and gratitude. 

“Gratitude is such an important aspect of healthy aging,” he said. “As we cultivate a sense of gratitude, we tend to be happier and healthier and to age more meaningfully.” 

Many older outdoor enthusiasts report experiencing spiritual connection and meaning outdoors. 

Carol Hatch, MD, 74, a retired pediatric neurologist, finds spiritual nourishment on a hiking trail near her home in Connecticut. Now that they’re retired, she and her husband help maintain the trails as volunteers. Over the decades, she has spent many hours on the trails—sometimes alone, in reflection, and sometimes with friends, talking about what’s going on in their lives. 

“It offers the possibility for introspection or for socialization, depending on how you choose to do it,” she said. “Being on the trail is a symphony of sensory delight. You can feel the sun on your skin and the wind cooling you off. You hear the river running, the birds singing, and you smell the foliage or the flowers. There’s the sensation of snow or rain on your face. You don’t get that when you’re inside.” 

Nature-Deficit Disorder

In 2005, author Richard Louv coined the term “nature-deficit disorder,” identifying “the human costs of alienation from nature,” such as behavioral and physical problems affecting children who never spend time outside. Louv noted that many children born in recent decades were among the first in human history to spend all their time indoors. 

Louv’s research focused on children, but many people who work with older adults observe that those who are confined indoors—whether due to isolation, mobility or health challenges—may suffer similar effects. 

“Small-world syndrome” was the term that Maureen McFadden, senior services manager in Marquette, MI, and her colleagues coined for the negative effects they’ve observed among older adults who never venture outside. 

“They develop a very consistent routine, they become more fearful, and they’re not exposed to new experiences or opportunities to build resilience and confidence,” she said.  

Barriers to Getting Out 

Since retiring about 15 years ago, outdoor activities have kept Don and Kay Wendell on the move. They chalk up about 3,000 miles a year on their bikes and spend time canoeing, skiing, snowshoeing and hiking.  

“It gets your heart rate up,” said Don Wendell, 77. “And I do some of my best thinking when I’m out biking or hiking.”

But having spent his career in recreation—he was director of parks and recreation in Plano, TX, when he retired in 2009—Wendell acknowledges that many older adults don’t get out to enjoy the outdoors. He thinks that many simply don’t know where to go or how to take advantage of outdoor recreation opportunities in their area. 

“I have a saying: ‘It is fun to have fun, but you have to know how,’” he said. 

Other barriers that may keep older adults from venturing out, according to McFadden, include lack of transportation to safe and accessible outdoor spaces; limited physical ability or fear of falling or injury, particularly without guidance or adaptive equipment; social isolation, which can reduce motivation to try new things or venture out alone; and financial constraints, which may make equipment rentals, park entry fees or guided tours inaccessible.

To help overcome those barriers, Marquette’s Senior Center created Silver Sampler, a program to encourage people 50 and older to try a variety of outdoor recreational activities at no cost. Since 2015, Silver Sampler has offered a long list of events, including winter sports like ice skating, cross-country skiing, snow biking and snowshoeing, as well as summer activities like kayaking, stand-up paddleboarding, hiking, rowing, tour biking, trail running, mountain biking, rock climbing and disc golf.   

Participants undergo an interview before joining the program. That serves two purposes, McFadden says: to assess their capabilities and to ensure their safety, but also to gently encourage participants to try new things. For example, McFadden worked with a 76-year-old woman who was hesitant to try kayaking. The woman could swim and was physically up to the challenge, so McFadden reassured her that she would stay near her and teach her paddling techniques. Not only did the woman enjoy kayaking, she came back for another kayaking trip, and with her confidence boosted, joined other Silver Sampler outings. 

Silver Sampler participant Carol Steinhaus says she tried activities through the program she never would have otherwise. 

“I would’ve never been on a fat-tire bike at this age,” she said. “I would not have tried downhill skiing. And I met people I would probably not have met otherwise, and I have really gained a lot from that. I’ve made lots of connections and it’s helped my life in many ways.” 

Overcoming Barriers

Getting outdoors has always been a challenge for Marjorie Turner, 69. In her 30s, brain surgery left her totally paralyzed on one side of her body. She’s able to walk now, using hiking poles, but the experience inspired her to publish a series of regional trail guides for hikers with mobility challenges. She says that getting outdoors may take a little more upfront research for older adults, especially those with mobility challenges. 

“It’s not always easy to gauge the accessibility of a trail before visiting,” she said. Most online sources are written for able-bodied people and often neglect to provide key information about trail surfaces or the availability of parking, benches and bathrooms. A trail rated as “easy” might be level but littered with rocks or roots, posing a fall hazard for an older person with foot drop or neuropathy.  

Turner notes that rail trails—hiking trails built along former railway routes—are often a good bet for older adults. Most are fairly level, paved and handicapped-accessible. Most are located near populated areas, with access to parking and bathrooms. (Find rail trails in your state at the Rails to Trails Conservancy website.) 

Turner advises older people who are venturing out into nature to never hike alone and to bring a cell phone, water and a fanny pack or light backpack. While it may take more planning to find safe, accessible places to enjoy nature, Turner says, it’s worth the effort. 

“As soon as I step outside, my heart is lighter,” she said. 

Transformations 

McFadden says outdoor recreation can transform the lives of older adults. She witnessed that with the Silver Sampler program. One participant, Don Bode, joined shortly after retiring and moving to Marquette. He was overweight, struggled with joint pain, had been physically inactive for many years and didn’t know anyone in the area. 

Bode started kayaking and hiking. He met new people and lost 60 pounds. He discovered asahi, a Finnish fitness practice, and even went to Finland to become a certified instructor. Now he teaches asahi at the Senior Center in Marquette. 

Joining Silver Sampler, Bode said, made him feel part of a community and gave him a sense of purpose. 

“You can wake up every morning and say to yourself, ‘What am I going to do today that’s going to keep me from aging in a poor manner?’” he said. “Or I can do something that the Silver Sampler taught me.’” 

 

Appreciating So Many ‘New’ Things

Posted on by

In 1954, when I was 5 years old, I huddled alone with my mother as Hurricane Carol raged around us. We were in a small, rickety fisherman’s shack on the shore of a large lake in New England. I’ve been going back to that lake almost yearly ever since—more than 70 years.

I grew up there, learning about fish, boats and birds, as well as clams and crayfish. Last week, at the lake, I experienced two things for the first time in my life. Who says you can’t teach an old dog new tricks?

The first discovery was because of technology—a new app on my cell phone, Merlin Bird ID.

I always knew there were lots of birds in the woods by that lake, but I never paid attention to identifying them or counting how many varieties. I knew a robin or a crow or a cardinal when I saw one. Until last week, I never knew what I was missing.

This Merlin app listens to and records the surrounding bird sounds, then identifies them all. My jaw dropped when I saw the list of more than 20 different birds singing away nearby: red-shouldered hawk, red-tailed hawk, short-billed dowitcher, blue-headed vireo, purple finch, red-winged blackbird, bank swallow, rock pigeon, common raven, northern cardinal, American crow, American robin, chimney swift, gray catbird, northern mockingbird, song sparrow, American goldfinch, Carolina wren, red-eyed vireo, tufted titmouse and ruby-throated hummingbird. I’ve gone through my whole life not being aware of and not appreciating the birds in that neighborhood. Thank you, tech, for opening that door for me.

As I become more aware as I age, I’ve been noticing things that I’ve just taken for granted my whole life—like when I’m a passenger in a car, not the driver, and I see things for the first time that I’ve driven past thousands of times.

The second discovery last week was because of my not paying attention. I ran out of gas in our small boat out in the middle of the lake. As I heard the engine start to sputter, I knew exactly what it was, and I was knee-jerk pissed off. I castigated myself. For 70 years, I’ve hopped in and out of small boats with outboard motors, and I’d never run out of gas before. First time for everything! Maybe it was the new gas tank with a new gas gauge that I misread?

And then, pretty quickly, my attitude changed. I chuckled to myself. I saw my beautiful surroundings. I wasn’t in any hurry. I had no meetings to get to, and everything else could just wait. I saw this as a new experience to be appreciated.

And I did appreciate it! And I appreciated the more than a mile that I had to row home. I found myself appreciating the wind blowing in the exact direction that I wanted to go. (I might have felt differently if I’d had to row against the current.) Oh, and I appreciated the two oars as well.

Yes, there is loss and change as we age—and there is opportunity to appreciate so many “new” things.

Sign Me Up!

Posted on by

I have a sticker on my laptop that says, “Brave Enough to be Bad at Something New.” When asked about it, I admit that learning something new is harder for me now that I’m older, but I am committed to trying new activities. To that end, I’ve kept an eye out for offerings from my local recreation department and public library. 

Recently, I’ve been exploring some activities that feel exciting—pickleball and hula-hooping—and that stimulate my memory, processing speed and other cognitive functions that I thought had retired. There’s a spirit-boosting impact in taking on something unfamiliar—and there’s an uncertainty about how my body will perform. I’m not shy about meeting new people, so that’s no deterrent for me. It’s often the social aspect that enhances the fun. 

I learned that people taking the birdwatching class knew so much, they could tell you how old the bird was at a glance before I even focused my binoculars. I tried “forest bathing” with an outdoorsy friend and found it’s not for me, but I enjoyed my time with her. And while I may have failed miserably at both pickleball and hula-hooping, I’m thoroughly enjoying the cornhole league I joined. Let me say I am not good at the game, but I am getting marginally better, and the competitors couldn’t be nicer. We’re all there for a good time.

I know that every little stretch of my mind, even in small daily doses, keeps my brain from stagnating. Although my gray hairs may increase, my mind feels lighter, richer and more curious, proving that both the spirit and the brain thrive when they are continually learning. 

Sophocles’ Play Teaches Us about Honoring Our Dead Who Have Been Wronged

Where Is Their Sacred Grove?
Posted on by

The residents of nursing facilities in the United States died in disproportionate numbers from COVID, when they should have been protected by the Trump administration’s Centers for Medicare and Medicaid, the 50 states’ departments of health, and the owners and operators of their so-called “homes.” In 1,950 facilities where they were protected, they survived.

Instead, as my recent book American Eldercide shows, in the rest of the 15,400 facilities, the residents were locked in, four or more in a room, open to the infection of any one of their companions, left without masks or adequate attendance or, for many crucial months, state inspectors, who could have measured conditions such as understaffing and urged an anxious, preoccupied, devastated nation to pay attention. Many died unnecessarily and prematurely who could have been saved. In the panic of 2020-2021, many were not buried properly.

Since then, there have been no reproaches for the guilty, no memorials for those blameless, COVID dead, no separate commemorations. At this distance of silent years, can those special, 200,000 deaths be made to seem a vast communal loss, worthy of social as well as familial grief? 

“Sweeping up the heart/ the morning after death” (Emily Dickinson’s charge to us) is no simple process when society prefers to forget the hardships of COVID and that marginalized and abandoned group who died. 

In Oedipus at Colonus, the extraordinary play by Sophocles, the Athenian dramatist created suspense about whether the exiled old man will be buried as a polluted and feared outsider or with honorable commemoration. Sophocles wrote the final, and least-well-known play of his Oedipus trilogy shortly before he himself died at the age of 90. The play makes clear that a good end-of-life for Oedipus the King refers not to the end of his exile, not to his old age, nor to the manner of his dying but to what happens to his memory after he dies. 

In the course of the play, Sophocles turns Oedipus from a miserable, self-blinded man, inadvertently guilty of parricide and incest, into a powerful protagonist with a just grievance. Oedipus successfully redescribes his ferocious, lifelong suffering as unjustified. The wrong done him by the gods can be assuaged only by proper recognition of his posthumous standing. 

A good burial, rather than a good death, had been on Sophocles’ mind at least since he wrote the Antigone, a play that forcefully argued for the ethics (and human instinct, and religious necessity) of offering a posthumous ritual to a dead brother, even after he had been proscribed as an enemy of the state. The residents in nursing facilities in 2020 were not enemies of the state, yet many died alone, unable to breathe. No one could wish such deaths on their worst enemy. 

Now, in old age, writing a play about a hapless old man who had been afflicted with wretchedness all his later life, Sophocles must have felt the desire for a righteous, state-sponsored, ritual pressing on him even more urgently. 

He made Oedipus mournable. He rewrote the king’s life story to make Apollo declare that Oedipus was worthy of being buried in a special place, a sacred grove.

“There,” said he, “shalt thou round thy weary life, A blessing to the land wherein thou dwell’st, But to [any] land that cast thee forth, a curse.” 

The resting place and the rites promised by the Athenian government will allow him to end his life as a benediction to the state that recognizes his memory as a blessing.  

In the COVID Era, the Colonus is movingly relevant. Like so much in the classic literature of grief, the concept of a good death and the propriety of commemoration have a new resonance now. We need to attune ourselves. President Joe Biden started the healing process for the nation in two grand public ceremonies for all the US dead soon after his inauguration. Both times, he failed to take special notice of the residents of nursing facilities. Perhaps he thought healing divisions required him to ignore the failures of the previous Trump administration, responsible for abandoning them. In any case, no one learned the lessons taught by the nursing facility deaths. 

That omission leaves us little imaginative choice but to think of the residents, most of whom were separated from their loved ones while they were dying, as pained and lonely, passive and bereft. As a result of the Eldercide, they may be judged to have had a miserable end, a “bad death.” It would be purblind and cruel to leave this judgment as the last word on the luckless group who found themselves in nursing facilities when COVID struck. 

Remembering the dead residents appropriately is the next ritual the nation needs to offer the families and friends that grieve for them without closure. What would count as providing those 200,000 people with their own “sacred grove”? 

James LoMastro, a member of the coalition I work with, DignityAllianceMA, which advocates for better conditions for residents of nursing facilities and options for never having to enter one, reminds us of a popular saying, that “We die twice: once when our body dies and once when our name is spoken for the last time.”   

Let there be no such “last time” for these names. American Eldercide suggests that the national government sponsor a locus amoenus, a noble and pleasing monument in the nation’s capital, built out of repentance and grief, in which the names of all the residents who died of COVID would be listed. These would be living names. Every visitor would be able to click on a name and by so doing, see the individual’s photograph, read a tribute and leave with the intention to never again let public health fail so many.  

 The current Congress will never see age justice as an important goal for healing the nation. All of us who care for the old, the sick or people with disabilities, or who wish for a dignified old age for ourselves, may, however, believe that some honorable commemoration will come and will work to bring about that finer day.

Lakeboat

Posted on by

2000, Canada/United States, 98 min. 

This moving, slice-of-life drama, written by David Mamet (based on his play), focuses on a group of irritable, veteran workers that grad student Dale (Tony Mamet) encounters during his summer stint on a steel freighter that slogs across the Great Lakes. The movie is really a series of vignettes capturing the day-to-day lives of these older men. As the months pass, we discover that what happens on the boat—the card games, the musings on women, the tall tales—is the crew’s whole world. Dale has an opportunity to do something different, even worthwhile, which makes him an object of curiosity and perhaps wistful envy. Robert Forster stands out among the loaded cast (which features Peter Falk and Charles Durning) as the lone crew member who can articulate the freedom and future that Dale represents. Directed by actor Joe Mantegna, a longtime David Mamet collaborator. 

 

The Love Elixir of Augusta Stern

Posted on by

By Linda Cohen Loigman – St Martin’s Press, 2024

This charming novel intertwines meticulously researched history with endearing characters, resulting in a heartwarming story of second chances, family bonds, wit and a touch of magic. Spanning past and present, it transports readers to 1920s Brooklyn, where young Augusta works alongside her father in his pharmacy—an unconventional role for a woman at the time. Her great-aunt Esther, an immigrant steeped in old-world herbal remedies, infuses the pharmacy with wisdom and warmth, creating a community hub where healing transcends science. Esther’s potions hint at something beyond mere chemistry—is there magic in them after all? And was a love potion to blame when Irving, the pharmacy’s delivery boy, abruptly left town, severing a blossoming relationship with Augusta and leaving her heartbroken and guarded? 

Decades pass. Augusta has built a fulfilling life through career and friendships, yet love remains elusive. At 80, she reluctantly steps into retirement, uncertain of her future—until a stunning reunion with Irving reignites questions of forgiveness and rekindled possibilities. With rich historical details and its exploration of love’s endurance, this novel offers a nostalgic and inspiring read. 

 

Ministrokes Can Have Major Consequences

If you have a TIA, get to a hospital immediately
Posted on by

The symptoms of a TIA can be so mild that it’s tempting to ignore them. Journalist Paula Span describes the symptoms and reports on the latest research on ministrokes and the consequences of ignoring them. KFF Health News posted her story on May 27, 2025. It also ran in the New York Times. Funding from the Silver Century Foundation helps KFF Health News produce articles (like this one) on longevity and related health and social issues. 

Kristin Kramer woke up early on a Tuesday morning 10 years ago because one of her dogs needed to go out. Then, a couple of odd things happened.

When she tried to call her other dog, “I couldn’t speak,” she said. As she walked downstairs to let them into the yard, “I noticed that my right hand wasn’t working.”

But she went back to bed, “which was totally stupid,” said Kramer, now 54, an office manager in Muncie, IN, “it didn’t register that something major was happening,” especially because, reawakening an hour later, “I was perfectly fine.”

So she “just kind of blew it off” and went to work.

It’s a common response to the neurological symptoms that signal a TIA, a transient ischemic attack or ministroke. At least 240,000 Americans experience one each year, with the incidence increasing sharply with age. 

Because the symptoms disappear quickly, usually within minutes, people don’t seek immediate treatment, putting them at high risk for a bigger stroke.

Kramer felt some arm tingling over the next couple of days and saw her doctor, who found nothing alarming on a CT scan. But then she started “jumbling” her words and finally had a relative drive her to an emergency room.

By then, she could not sign her name. After an MRI, she recalled, “my doctor came in and said, ‘You’ve had a small stroke.’”

Did those early-morning aberrations constitute a TIA? Might a 911 call and an earlier start on anticlotting drugs have prevented her stroke? “We don’t know,” Kramer said. She’s doing well now, but faced with such symptoms again, “I would seek medical attention.”

A TIA can cause a cognitive decline that shows up years afterward. 

Now, a large epidemiological study by researchers at the University of Alabama-Birmingham and the University of Cincinnati, published in JAMA Neurology, points to another reason to take TIAs seriously: over five years, study participants’ performance on cognitive tests after a TIA drops as steeply as it does among victims of a full-on stroke.

“If you have one stroke or one TIA, with no other event over time and no other change in your medical status, the rate of cognitive decline is the same,” said Victor Del Bene, PhD, a neuropsychologist and lead author of the study.

An accompanying editorial by Eric Smith, MD, a neurologist at the University of Calgary, was pointedly headlined, “Transient Ischemic Attack — Not So Transient After All!”

The study showed that even if the symptoms resolve—typically within 15 minutes to an hour—TIAs set people on a different cognitive slope later in life, Smith said in an interview, “a long-lasting change in people’s cognitive ability, possibly leading to dementia.”

The study, analyzing findings from data on more than 30,000 participants, followed three groups of adults age 45 or older with no history of stroke or TIA. “It’s been a hard group to study because you lack the baseline data of how they were functioning prior to the TIA or stroke,” Del Bene said.

With this longitudinal study, however, researchers could separate those who went on to have a TIA from a group who went on to suffer a stroke and also from an asymptomatic control group. The team adjusted their findings for a host of demographic variables and health conditions.

Immediately after a TIA, “we don’t see an abrupt change in cognition,” as measured by cognitive tests administered every other year, Del Bene said. The stroke group showed a steep decline, but the TIA and control group participants “were more or less neck and neck.”

Five years later, the picture was different. People who had experienced TIAs were cognitively better off than those who had suffered strokes. But both groups were experiencing cognitive decline, and at equally steep rates.

After accounting for various possible causes, the researchers concluded that the cognitive drop reflected not demographic factors, chronic illnesses or normal aging, but the TIA itself.

We know a lot more about how to prevent a stroke, as long as people get to a hospital.

—Tracy Madsen, MD 

“It’s not dementia,” Del Bene said of the decline after a TIA. “It may not even be mild cognitive impairment. But it’s an altered trajectory.”

Of course, most older adults do have other illnesses and risk factors, like heart disease, diabetes or smoking. “These things together work synergistically to increase the risk for cognitive decline and dementia over time,” he said.

The findings reinforce long-standing concerns that people experiencing TIAs don’t respond quickly enough to the incident. “These events are serious, acute and dangerous,” said Claiborne Johnston, PhD, MD, a neurologist and chief medical officer of Harbor Health in Austin, TX. 

After a TIA, neurologists put the risk of a subsequent stroke within 90 days at 5 percent to 20 percent, with half that risk occurring in the first 48 hours.

“Feeling back to normal doesn’t mean you can ignore this, or delay and discuss it with your primary care doctor at your next visit,” Johnston said. The symptoms should prompt a 911 call and an emergency room evaluation.

How to recognize a TIA? Tracy Madsen, MD, an epidemiologist and emergency medicine specialist at the University of Vermont, promotes the BE FAST acronym: balance loss, eyesight changes, facial drooping, arm weakness, speech problems. The “T” is for time, as in don’t waste any.

“We know a lot more about how to prevent a stroke, as long as people get to a hospital,” said Madsen, vice chair of an American Heart Association committee that, in 2023, revised recommendations for TIAs. 

The statement called for more comprehensive and aggressive testing and treatment, including imaging, risk assessment, anticlotting and other drugs, and counseling about lifestyle changes that reduce stroke risk.

Unlike other urgent conditions, a TIA may not look dramatic or even be visible; patients themselves have to figure out how to respond.

Karen Howze, 74, a retired lawyer and journalist in Reno, NV, didn’t realize that she’d had several TIAs until after a doctor noticed weakness on her right side and ordered an MRI. Years later, she still notices some effect on “my ability to recall words.”

Perhaps “transient ischemic attack” is too reassuring a label, Johnston and a co-author argued in a 2022 editorial in JAMA. They suggested that giving a TIA a scarier name, like “minor ischemic stroke,” would more likely prompt a 911 call.

The experts interviewed for this column all endorsed the idea of a name that includes the word “stroke.”

Changing medical practice is “frustratingly slow,” Johnston acknowledged. But whatever the nomenclature, keeping BE FAST in mind could lead to more examples like Wanda Mercer, who shared her experience in a previous column. 

In 2018, she donated at the bloodmobile outside her office in Austin, where she was a systems administrator for the University of Texas, then walked two blocks to a restaurant for lunch. “Waiting in line, I remember feeling a little lightheaded,” she said. “I woke up on the floor.”

Reviving, she assured the worried restaurant manager that she had merely fainted after giving blood. But the manager had already called an ambulance—this was smart move No. 1.

The ER doctors ran tests, saw no problems, gave Mercer intravenous fluids and discharged her. “I began to tell my colleagues, ‘Guess what happened to me at lunch!’” she recalled. But, she said, she had lost her words, “I couldn’t articulate what I wanted to say.”

Smart move No. 2: Co-workers, suspecting a stroke, called the EMTs for the second time. “I was reluctant to go,” Mercer said. “But they were right.” This time, emergency room doctors diagnosed a minor stroke.

Mercer has had no recurrences. She takes a statin and a baby aspirin daily and sees her primary care doctor annually. Otherwise, at 73, she has retired to an active life of travel, pickleball, running, weight lifting and book groups.

“I’m very grateful,” she said, “that I have a happy story to tell.

 

Ageism Also Affects the Young

Posted on by

October is a big month in ageland. October 1 is the United Nation’s International Day of Older Persons. October 9 is Ageism Awareness Day. It’s a time to celebrate all the progress we’ve made, as well as to reflect on what still demands attention. One [thing] is the fact that ageism isolates, because it normalizes and enforces age segregation. Another is the misconception that ageism only affects older people. 

This Ageism Awareness Day, I ask my older readers to remember:

  • how hard it is to be young
  • that ageism affects young people too
  • that we know what it felt like to be 16, but not what it feels like to be 16 now.

I ask that we put down our phones and reach out to the younger people in our lives. To weather the awkwardness and adolescent scorn and hold on tight. This ask is deeply personal. I make it because the shooter in a recent school shooting, an isolated and very online teenager, was a member of my extended family. He shot two kids, then killed himself.

Everything about this is horrible. There’s plenty of blame to go around, not least on a social order that is falling apart. Right now, so much feels weird and bad. The antidote, especially in hard times? Practice togetherness. Isolation is bad for us all, not just teenage boys. At any age, social connection is what makes life rewarding and meaningful. Connecting across generations doesn’t just help end ageism. It could save lives.  

Griefbots

Posted on by

Every day while I take my morning shower, I imagine I’m talking to my husband, Mike, updating him on what’s going on in my life. He died in 2008.

That’s why I was fascinated to learn that AI can create a digital simulation of someone who has died. It’s called a griefbot, and you can talk to it and get answers back, something that never happens in my shower.      

Companies all over the world now offer griefbots (aka deathbots). They’re built by having AI digest someone’s social media posts, texts, voice messages and emails, along with photographs, videos, letters, diaries and so on. These are used to create a likeness of the individual that can carry on a pretty convincing conversation and that harbors many of the memories of the person it’s simulating. 

Some griefbots communicate only in writing: they exchange texts with their users. Some converse online, sounding remarkably like the person they’re imitating. And some are both audible and visible and appear on Zoom or FaceTime or in an interactive video; good ones make eye contact, blink and seem to breathe. Griefbots are also built for virtual reality and as holograms. 

You can get a griefbot of someone else, but you can also commission one of yourself, to leave behind for family and friends when you die. That interested me as well. Like many people my age (I’m 90), I’ve given some thought to how I’d like to be remembered.

In the United States, costs for a griefbot range from $10 for a single session with one to around $15,000 for a full-fledged avatar. 

Some companies intend their bots to help mourners resolve their grief, and sometimes they do. But other firms describe them as a way to keep your loved one with you forever, so you never have to say goodbye. If that’s what you crave, a bot can seem so real that you prefer it to relationships with real people. 

Ethicists say griefbots can harm users. At first, I thought their concerns were overblown but disturbing stories are beginning to emerge. One woman was shocked and upset when she asked her griefbot how he was and where he was. He was miserable, the bot said, and he was in hell. Experts acknowledge that you never really know what today’s generative AI will come up with. 

In another incident, a mother donned a VR helmet to reunite with her small daughter, who had died. When she turned around, her little girl was running toward her, and she reached out, eager to gather up her child. Again and again, her arms closed around thin air. She sobbed uncontrollably. This is heartbreaking to watch, and online viewers were indignant. 

Sociologist Sherry Turkle, PhD, defines grieving as “the very difficult process of accepting a loss.” A griefbot can prevent that if you start to feel that the individual you’re mourning is still with you. 

There are other worries as well. If you stop using a griefbot, will that reignite your grief because it feels as if the person you love has died all over again? What if the AI builds a bot based on the deceased’s worst traits? Can the company that created your griefbot use it for other purposes? In the future, if you don’t want to be digitally resurrected, must you say so in your will?

As I read about griefbots, it didn’t take long to realize I’d never want to make one of myself or my husband. For one thing, I’ve written a memoir. That’s what I’ll be leaving behind for my children and grandchildren, and it’s enough. 

Is the man in my shower my own, limited version of a griefbot? It started out that way. I talked to Mike because I missed him, but I soon discovered it was a useful thing to do. My worries, spoken out loud, always seem less dire than they did when they were lurking, half-formed, in the shadows of my mind. 

Over the years, lulled by warm water, I’ve weighed the pros and cons of difficult decisions out loud and talked through blogs I was writing. Perhaps most important, I’ve formed the habit of regularly taking stock of my life. 

I suppose I could simply talk to myself out loud, instead of imagining Mike is listening, but telling things to someone else gives me some distance on them. Sometimes I do stop to consider how he might have responded, but mostly I don’t bother. 

I have a firm grip on reality—I know Mike’s not really there. He died 17 years ago, and a Mike bot would creep me out.  

If building griefbots becomes highly profitable, internet behemoths may step in: Amazon and Microsoft have already applied for patents. That could mean a future in which griefbots are common and change the way we mourn our dead. In this already death-denying culture, the eventualities ethicists worry about might come true. 

Having imaginary conversations with the ghost of someone is much safer. For anyone it appeals to, I recommend it. 

The Beers Criteria: What Patients Need to Know

These guidelines list drugs that can harm older people 
Posted on by

Before she landed in the hospital, Wilma Jones (not her real name) was living independently and generally managing well, despite some mild cognitive impairment. But one day, when an insurance assessor came to her home, Jones answered in her underwear, in a state of confusion, and fell. 

Hospital staff determined that Jones, in her late 80s, was taking two medications for insomnia: clonazepam (Klonopin), prescribed by her physician, along with Advil PM, an over-the-counter (OTC) medication she had self-prescribed.

“The combination of these medications had a significant effect on her cognition and her ability to maintain safety, causing her to fall multiple times,” said Katie Pescatello, a nurse practitioner and hospitalist who helped care for Jones. “After those medications were removed, she returned to her normal cognitive status.” 

Jones’s ordeal is far from rare. As many as one-third of emergency hospital admissions among people 75 or older may be in part due to medication-related problems. Those with cognitive impairment are especially vulnerable. 

To help address the problem, the Journal of the American Geriatrics Society (AGS) maintains the Beers Criteria, a directory of drugs that are potentially harmful for older adults. In July 2025, the AGS published new recommendations for treating common symptoms affecting older adults that list alternative medications as well as nonpharmacological treatments. 

But many patients and caregivers aren’t aware of the Beers Criteria—or that it includes common OTC medications that many older adults self-prescribe. 

“People assume they’re benign, but over-the-counter medications can be very harmful, depending on your age, your concurrent medications, and your kidney and liver function,” said Dominick Trombetta, PharmD, associate professor at Wilkes University School of Pharmacy in Wilkes-Barre, PA.

The Beers Criteria was developed in 1991 by the late Mark Beers, MD, and colleagues, originally as a guide to prevent improper use of medications in nursing home settings. The list gained popularity and was eventually expanded to include all older adults. The AGS has maintained the Beers Criteria since 2011 with periodic updates, most recently in 2023. 

Until recently, the Beers Criteria only flagged drugs whose potential for harm outweighed their intended benefits. A panel of experts would hammer out specific recommendations to guide physicians in handling common conditions that affect older adults and are often treated with Beers Criteria medications, including allergic rhinitis, pruritus (itching), pain, diabetes, involuntary weight loss, atrial fibrillation (Afib), anxiety, insomnia, delirium, gastroesophageal reflux (GERD) and recurrent urinary tract infections. 

The current publication also recommends alternative medications and nonpharmacological interventions, such as cognitive behavioral therapy for sleeplessness, or exercise, physical therapy and psychological interventions for pain.  

Problematic OTC Medications

Among the most common OTC medications on the list are sedating antihistamines, including Benadryl (diphenhydramine), Unisom (doxylamine) and Bonine/Dramamine (meclizine). These medications are used to treat allergies or to aid with sleep, since they cause drowsiness in many patients. (They are sometimes called “first-generation” antihistamines, distinguishing them from second- and third-generation antihistamines, which are less likely to cause sleepiness and less likely to cause interactions with other medications.)

With these medications, older adults have increased risk of side effects, which may include dry mouth, constipation, overheating (especially during the warm summer months) and short-term confusion, according to Man-Khoi Nguyen, PharmD, director of clinical pharmacy at Archwell Health in Nashville, TN.   

“The risk increases even further with regular use,” he said. “The drugs are also linked with increased risk of falls and dementia.” 

Many older adults aren’t aware of these potential dangers. 

“Patients and caregivers often know about issues like the potential for aspirin to cause stomach bleeding, for example,” said Pescatello. “But not many people are aware that antihistamines, or any medicine with ‘PM’ in the name, pose extra risks for older adults.” 

Another common class of OTC medications included in the Beers Criteria: nonsteroidal anti-inflammatory drugs—or NSAIDs—such as Motrin and Advil (ibuprofen) and Aleve (naproxen.) These may increase blood pressure, increase risk of ulcers or stomach bleeding or may worsen heart failure or kidney disease in patients with these conditions.

“We see older patients, almost on a weekly basis, who’ve taken NSAIDs and who come to the hospital because of either acute stomach bleeding or even acute kidney injury,” said Trombetta.

The Beers Criteria also cautions against prolonged use of proton pump inhibitors such as Prilosec (omeprazole) or Nexium (esomeprazole) for heartburn or acid reflux. When taken for longer than eight weeks, PPIs are associated with an increased risk of bone loss, fractures and a severe type of diarrhea called C. diff.   

Common Problems, Alternative Interventions

The July update lists medication alternatives that are generally considered safer than Beers Criteria drugs. For example, for allergic rhinitis (hay fever or seasonal allergies), instead of first-generation antihistamines, the update recommends nasal sprays (which are absorbed into the bloodstream less than oral medications and have fewer adverse effects). For those taking oral antihistamines, second- or third-generation antihistamines (such as loratadine (Claritin) or cetirizine (Zyrtec)) are preferred. 

The July update also details nonpharmacological interventions for several common symptoms, many of which, it says, “are often safer or equally or more effective than the potentially inappropriate medications they are replacing.”   

Examples include: 

  • Allergic rhinitis: Avoid allergens, when possible; irrigate nasal passages with distilled saline, using a neti pot or similar system. 
  • GERD: Make lifestyle changes, such as smoking cessation, avoiding trigger foods, not eating within two to three hours before bedtime and elevating the head of the bed. 
  • Constipation: Increase fluid and fiber intake, exercise. 
  • Arthritis-related pain: Exercise, physical therapy, education and psychological interventions such as cognitive behavioral therapy. 

Insomnia—the condition that ultimately sent Jones to the hospital—illustrates the need for nonpharmacological interventions and why they are so often challenging to implement.

The American Academy of Sleep Medicine recommends nonpharmacologic interventions as the first line of treatment for insomnia. However, older adults often self-prescribe potentially risky OTC medications. According to the 2017 National Poll on Healthy Aging, about one in four older adults use OTC medications for sleep either regularly or occasionally. 

Several classes of prescription drugs included in the Beers Criteria are also sometimes prescribed for insomnia, including benzodiazepines (such as Xanax, Valium or Klonopin), Z-drugs (such as zolpidem or Ambien,) tricyclic antidepressants and barbiturates. 

But cognitive behavioral therapy, combined with good sleep hygiene, has been shown to be more effective in the long term than medications. So why aren’t physicians prescribing those? Jones’ situation provides some clues. After just two days, the medications cleared her system, and she was alert and cognitively functional. 

“But she remained worried about sleep,” said Pescatello. “Much of our education during her hospitalization focused on avoiding dangerous medication combinations and avoiding Advil PM altogether.”

Drugs listed in the Beers Criteria are potentially harmful—but not in all cases or for everyone. 

Nonpharmacological interventions often require spending more time with patients—a challenge for time-pressed general practitioners. They don’t work if patients don’t comply, a big hurdle for those with cognitive impairment. Sometimes patients insist on medications. 

To help address these challenges, the July update also includes links to resources that physicians can share with patients and their caregivers, such as a one-page patient infographic on managing GERD and digital apps like Insomnia Coach, which allow patients to self-administer cognitive behavioral therapy for sleep problems. 

The addition of nonmedicinal options reflects a general trend in geriatric medicine: deprescribing—discontinuing drugs that are either potentially harmful or no longer required, or reducing the dosage or frequency, always with medical supervision. 

Medications pose additional risks for older adults for a variety of reasons, according to Nguyen.

“As we age, physiological changes take place that affect how our bodies metabolize, or process, medications,” he said. “For example, the liver decreases in size and blood flow to the liver also reduces. Medications that pass through the liver may not be cleared as quickly.” That, in turn, increases the risk of adverse effects, which can range from mild to life-threatening. 

The Beers list is primarily a tool for medical providers. But patients can take steps to ensure their medications are being managed appropriately.

First, understand that Beers Criteria identifies drugs that are potentially harmful for older adults. That doesn’t mean that physicians should never prescribe them, Trombetta cautions. In some cases, patients and their physicians may decide jointly to accept the risks associated with a medication, if that’s the best option.

Some drugs on the list should be avoided only by older adults with specific health conditions, such as reduced kidney function; some should be avoided in combination with other drug treatments; and some must be dosed differently for older adults. The Beers list doesn’t apply to older adults in hospice and palliative care settings.  

Tips for Older Adult Patients

If you are taking a Beers Criteria medication, ask your physician if there are safer or more effective therapies. 

“Patients should never discontinue any medication without talking to their doctors first,” said Trombetta. “Ideally, the Beers list is a starting point to have a conversation.” 

Be sure you are clear on why you need each medication and why it was prescribed. Inform your physician if you suspect a medication is not working or if you experience side effects. 

Pharmacists can also serve as a helpful, and often readily available, resource. 

“If you’re experiencing side effects, and your physician is not immediately available, you can seek a quick consult with your pharmacist,” Nguyen said. “Likely, they can advise whether a reaction could be mild or needs medical attention right away. Pharmacists are still one of the most highly accessible health care providers, with extensive training to recognize significant drug interactions and potential inappropriate use.” 

Carefully review the information provided by your pharmacy for every drug you take, or consult a trusted source such as Medline Plus. 

Always consult your physician or pharmacist before taking any new OTC medication. Here again, the pharmacist can be a good resource. 

“Older people often see many different specialists, but most people use just one pharmacy,” said Trombetta. “If you’re just talking to a doctor, and he only knows what he prescribed, he doesn’t necessarily know what the specialist across town prescribed. The pharmacist gets to see the big picture.” 

Finally, understand that the Beers Criteria is a tool for medical providers, not a guideline for self-prescribing or self-deprescribing any medication. 

“The key is to be engaged in your own care,” said Trombetta. “Understand the things that you can do that don’t require medication, like lifestyle modifications. They don’t cost you anything; they just require a little motivation. If you can avoid taking a medication, in the long run you’re going to be much better off.” 

Programs That Provide Rehab at Home Are Making a Difference

They step up when patients need skilled nursing, and local nursing homes and rehab facilities have no beds available
Posted on by

What can a hospital do when patients don’t need more hospital care but aren’t yet well enough to go home, and there’s no place else to send them? Too often, the patients are simply stuck in the hospital. Some programs around the country are demonstrating that it’s possible to deliver rehab at home. Journalist Felice J. Freyer describes this new development and the different approaches programs are taking. Kaiser Health News posted her piece on March 12, 2025. It also ran in U.S. News & World Report. 

After a patch of ice sent Marc Durocher hurtling to the ground, and doctors at UMass Memorial Medical Center repaired the broken hip that resulted, the 75-year-old electrician found himself at a crossroads.

He didn’t need to be in the hospital any longer. But he was still in pain, unsteady on his feet, unready for independence.

Patients nationwide often stall at this intersection, stuck in the hospital for days or weeks because nursing homes and physical rehabilitation facilities are full. Yet when Durocher was ready for discharge in late January, a clinician came by with a surprising path forward: Want to go home?

Specifically, he was invited to join a research study at UMass Chan Medical School in Worcester, MA, testing the concept of “SNF at home” or “subacute at home,” in which services typically provided at a skilled nursing facility are instead offered in the home, with visits from caregivers and remote monitoring technology.

Durocher hesitated, worried he might not get the care he needed, but he and his wife, Jeanne, ultimately decided to try it. What could be better than recovering at his home in Auburn with his dog, Buddy?

Such rehab at home is underway in various parts of the country—including New York, Pennsylvania, and Wisconsin—as a solution to a shortage of nursing home and rehab beds for patients too sick to go home but not sick enough to need hospitalization.

Rehab at home is new. No federal standards have been set, and it’s not covered by most health insurance.

Staffing shortages at post-acute facilities around the country led to a 24 percent increase over three years in hospital length of stay among patients who need skilled nursing care, according to a 2022 analysis. With no place to go, these patients occupy expensive hospital beds they don’t need, while others wait in emergency rooms for those spots. In Massachusetts, for example, at least 1,995 patients were awaiting hospital discharge in December, according to a survey of hospitals by the Massachusetts Health & Hospital Association.

Offering intensive services and remote monitoring technology in the home can work as an alternative—especially in rural areas, where nursing homes are closing at a faster rate than in cities, and patients’ relatives often must travel far to visit. For patients of the Marshfield Clinic Health System who live in rural parts of Wisconsin, the clinic’s six-year-old SNF-at-home program is often the only option, said Swetha Gudibanda, MD, medical director of the hospital-at-home program.

But the concept is new, an outgrowth of hospital-at-home services expanded by a COVID-19 pandemic-inspired Medicare waiver. SNF-at-home care remains uncommon, lost in a fiscal and regulatory netherworld. No federal standards spell out how to run these programs, which patients should qualify or what services to offer. No reimbursement mechanism exists, so fee-for-service Medicare and most insurance companies don’t cover such care at home.

The programs have emerged only at a few hospital systems with their own insurance companies (like the Marshfield Clinic) or those that arrange for “bundled payments,” in which providers receive a set fee to manage an episode of care, as can occur with Medicare Advantage plans.

In Durocher’s case, the care was available—at no cost to him or other patients—only through the clinical trial, funded by a grant from the state Medicaid program. State health officials supported two simultaneous studies at UMass and Mass General Brigham, hoping to reduce costs, improve quality of care and, crucially, make it easier to transition patients out of the hospital.

The American Health Care Association, the trade group representing more than 15,000 long-term and post-acute-care providers, calls “SNF at home” a misnomer because, by law, such services must be provided in an institution and meet detailed requirements. And the association points out that skilled nursing facilities provide services and socialization that can never be replicated at home, such as daily activity programs, religious services and access to social workers.

Rehab at home is not without hazards, and it’s critically important to choose the right patients for this care.

But patients at home tend to get up and move around more than those in a facility, speeding their recovery, said Wendy Mitchell, MD, medical director of the UMass Chan clinical trial. Also, therapy is tailored to their home environment, teaching patients to navigate the exact stairs and bathrooms they’ll eventually use on their own.

A quarter of people who go into nursing homes suffer an “adverse event,” such as infection or bed sore, said David Levine, MD, clinical director for research for Mass General Brigham’s Healthcare at Home program and leader of its study. “We cause a lot of harm in facility-based care,” he said.

By contrast, in 2024, not one patient in the Rehabilitation Care at Home program of Nashville-based Contessa Health developed a bed sore and only 0.3 percent came down with an infection while at home, according to internal company data. Contessa delivers care in the home through partnerships with five health systems, including Mount Sinai Health System in New York City, the Allegheny Health Network in Pennsylvania and Wisconsin’s Marshfield Clinic.

Contessa’s program, which has been providing in-home, post-hospital rehabilitation since 2019, depends on help from unpaid family caregivers. “Almost universally, our patients have somebody living with them,” said Robert Moskowitz, MD, Contessa’s acting president and chief medical officer.

The two Massachusetts-based studies, however, do enroll patients who live alone. In the UMass trial, an overnight home health aide can stay for a day or two if needed. And while alone, patients “have a single-button access to a live person from our command center,” said Apurv Soni, MD, an assistant professor of medicine at UMass Chan and the leader of its study.

But SNF at home is not without hazards, and choosing the right patients to enroll is critical. The UMass research team learned an important lesson when a patient with mild dementia became alarmed by unfamiliar caregivers coming to her home. She was readmitted to the hospital, according to Mitchell.

Some programs monitor patients mainly through technology. Others rely on visits from nurses, physical therapists, and home health aides.

The Mass General Brigham study relies heavily on technology intended to reduce the need for highly skilled staff. A nurse and physician each conduct an in-home visit, but the patient is otherwise monitored remotely. Medical assistants visit the home to gather data with a portable ultrasound, portable X-ray and a device that can analyze blood tests on-site. A machine the size of a toaster oven dispenses medication, with a robotic arm that drops the pills into a dispensing unit.

The UMass trial, the one Durocher enrolled in, instead chose a “light touch” with technology, using only a few devices, Soni said.

The day Durocher went home, he said, a nurse met him there and showed him how to use a wireless blood pressure cuff, wireless pulse oximeter and digital tablet that would transmit his vital signs twice a day. Over the next few days, he said, nurses came by to take blood samples and check on him. Physical and occupational therapists provided several hours of treatment every day, and a home health aide came a few hours a day. To his delight, the program even sent three meals a day.

Durocher learned to use the walker and how to get up the stairs to his bedroom with one crutch and support from his wife. After just one week, he transitioned to less-frequent, in-home physical therapy, covered by his insurance.

“The recovery is amazing because you’re in your own setting,” Durocher said. “To be relegated to a chair and a walker, and at first somebody helping you get up, or into bed, showering you — it’s very humbling. But it’s comfortable. It’s home, right?”

Brooke Shields Is Not Allowed to Get Old: Thoughts on Aging as a Woman

Posted on by

By Brooke Shields – Flatiron Books, 2025

Brooke Shields has spent a lifetime under public scrutiny—first as a child star and model, now as a woman navigating aging in the spotlight. Now 59, Shields feels more empowered than ever, rewriting the narrative on women and aging—on her own terms. In this memoir, she challenges societal pressures to maintain youthfulness and advocates for self-acceptance and authenticity. In deeply personal reflections, Shields recounts a painful miscarriage and complications from a cone biopsy that affected her fertility. She also shares a harrowing plastic surgery experience in which an unsolicited procedure left her feeling violated. Shields critiques the unrealistic standards imposed on women, encouraging them to embrace aging as a natural, beautiful process rather than a source of shame. 

 

Does Using Cannabis Become Riskier in Later Life?

More and more older Americans are using it 
Posted on by

It’s not clear what benefits cannabis offers, but there’s evidence that it can be harmful, journalist Paula Span reports in this wide-ranging column. Many older people assume it’s safer than smoking, but studies suggest that’s not true. KFF Health News  posted Span’s piece on June 9, 2025. Her story also ran in the New York Times. Funding from the Silver Century Foundation helps KFF Health News produce articles (like this one) on longevity and related health and social issues. 

Benjamin Han, MD, a geriatrician and addiction medicine specialist at the University of California-San Diego, tells his students a cautionary tale about a 76-year-old patient who, like many older people, struggled with insomnia.

“She had problems falling asleep, and she’d wake up in the middle of the night,” he said. “So her daughter brought her some sleep gummies”—edible cannabis candies.

“She tried a gummy after dinner and waited half an hour,” Han said.

Feeling no effects, she took another gummy, then one more—a total of four over several hours.

Han advises patients who are trying cannabis to “start low; go slow,” beginning with products that contain just 1 or 2.5 milligrams of tetrahydrocannabinol, or THC, the psychoactive ingredient that many cannabis products contain. Each of the four gummies this patient took, however, contained 10 milligrams.

The woman started experiencing intense anxiety and heart palpitations. A young person might have shrugged off such symptoms, but this patient had high blood pressure and atrial fibrillation, a heart arrhythmia. Frightened, she went to an emergency room.

Lab tests and a cardiac workup determined the woman wasn’t having a heart attack, and the staff sent her home. Her only lingering symptom was embarrassment, Han said. But what if she’d grown dizzy or lightheaded and was hurt in a fall? He said he has had patients injured in falls or while driving after using cannabis. What if the cannabis had interacted with the prescription drugs she took?

“As a geriatrician, it gives me pause,” Han said. “Our brains are more sensitive to psychoactive substances as we age.”

In increasing numbers, Americans believe—wrongly—that cannabis is safer to smoke than cigarettes. 

Thirty-nine states and the District of Columbia now allow cannabis use for medical reasons, and in 24 of those states, as well as the district, recreational use is also legal. As older adults’ use climbs, “the benefits are still unclear,” Han said. “But we’re seeing more evidence of potential harms.”

A wave of recent research points to reasons for concern for older users, with cannabis-related emergency room visits and hospitalizations rising, and a Canadian study finding an association between such acute care and subsequent dementia. Older people are more apt than younger ones to try cannabis for therapeutic reasons: to relieve chronic pain, insomnia or mental health issues, though evidence of its effectiveness in addressing those conditions remains thin, experts said.

In an analysis of national survey data published June 2 in the medical journal JAMA, Han and his colleagues reported that “current” cannabis use (defined as use within the previous month) had jumped among adults age 65 or older to 7 percent of respondents in 2023, from 4.8 percent in 2021. In 2005, he pointed out, fewer than 1 percent of older adults reported using cannabis in the previous year.

What’s driving the increase? Experts cite the steady march of state legalization—use by older people is highest in those states—while surveys show that the perceived risk of cannabis use has declined. One national survey found that a growing proportion of American adults—44 percent in 2021—erroneously thought it safer to smoke cannabis daily than cigarettes. The authors of the study, in JAMA Network Open, noted that “these views do not reflect the existing science on cannabis and tobacco smoke.”

The cannabis industry also markets its products to older adults. The Trulieve chain gives a 10 percent discount, both in stores and online, to those it calls “wisdom” customers, 55 or older. Rise Dispensaries ran a yearlong cannabis education and empowerment program for two senior centers in Paterson, NJ, including field trips to its dispensary.

The industry has many satisfied older customers. Liz Logan, 67, a freelance writer in Bronxville, NY, had grappled with sleep problems and anxiety for years, but the conditions grew particularly debilitating two years ago, as her husband was dying of Parkinson’s disease. “I’d frequently be awake until five or six in the morning,” she said. “It makes you crazy.”

Looking online for edible cannabis products, Logan found that gummies containing cannabidiol, known as CBD, alone didn’t help, but those with 10 milligrams of THC did the trick without noticeable side effects. “I don’t worry about sleep,” she said. “I’ve solved a lifelong problem.”

In Ontario, there’s been an increase in ER visits and hospital admissions related to cannabis use among the middle-aged—and an even bigger increase among those 65 and up. 

But studies in the United States and Canada, which legalized nonmedical cannabis use for adults nationally in 2018, show climbing rates of cannabis-related health care use among older people, both in outpatient settings and in hospitals.

In California, for instance, cannabis-related emergency room visits by those 65 or older rose to 395 per 100,000 visits in 2019 from about 21 in 2005. In Ontario, acute care (meaning emergency visits or hospital admissions) resulting from cannabis use increased fivefold in middle-aged adults from 2008 to 2021, and more than 26 times among those 65 and up. 

“It’s not reflective of everyone who’s using cannabis,” cautioned Daniel Myran, MD, an investigator at the Bruyère Health Research Institute in Ottawa and lead author of the Ontario study. “It’s capturing people with more severe patterns.”

But since other studies have shown increased cardiac risk among some cannabis users with heart disease or diabetes, “there’s a number of warning signals,” he said.

For example, a disturbing proportion of older veterans who currently use cannabis screen positive for cannabis-use disorder, a recent JAMA Network Open study found.

As with other substance use disorders, such patients “can tolerate high amounts,” said the lead author, Vira Pravosud, PhD, a cannabis researcher at the Northern California Institute for Research and Education. “They continue using even if it interferes with their social or work or family obligations” and may experience withdrawal if they stop.

Among 4,500 older veterans (with an average age of 73) seeking care at Department of Veterans Affairs health facilities, researchers found that more than 10 percent had reported cannabis use within the previous 30 days. Of those, 36 percent fit the criteria for mild, moderate, or severe cannabis use disorder, as established in the Diagnostic and Statistical Manual of Mental Disorders.

There’s increasing evidence that cannabis can affect memory and cognition.

VA patients differ from the general population, Pravosud noted. They are much more likely to report substance misuse and have “higher rates of chronic diseases and disabilities, and mental health conditions like PTSD” that could lead to self-medication, she said.

Current VA policies don’t require clinicians to ask patients about cannabis use. Pravosud thinks that they should.

Moreover, “there’s increasing evidence of a potential effect on memory and cognition,” said Myran, citing his team’s study of Ontario patients with cannabis-related conditions going to emergency departments or being admitted to hospitals.

Compared with others of the same age and sex who were seeking care for other reasons, research shows these patients (ages 45 to 105) had 1.5 times the risk of a dementia diagnosis within five years, and 3.9 times the risk of that for the general population.

Even after adjusting for chronic health conditions and sociodemographic factors, those seeking acute care resulting from cannabis use had a 23 percent higher dementia risk than patients with noncannabis-related ailments, and a 72 percent higher risk than the general population.

None of these studies were randomized clinical trials, the researchers pointed out; they were observational and could not ascertain causality. Some cannabis research doesn’t specify whether users are smoking, vaping, ingesting or rubbing topical cannabis on aching joints; other studies lack relevant demographic information.

“It’s very frustrating that we’re not able to provide more individual guidance on safer modes of consumption, and on amounts of use that seem lower-risk,” Myran said. “It just highlights that the rapid expansion of regular cannabis use in North America is outpacing our knowledge.”

Still, given the health vulnerabilities of older people, and the far greater potency of current cannabis products compared with the weed of their youth, he and other researchers urge caution.

“If you view cannabis as a medicine, you should be open to the idea that there are groups who probably shouldn’t use it and that there are potential adverse effects from it,” he said. “Because that is true of all medicines.”

Living to 102

Posted on by

The end of June brought the 102nd birthday of a client-turned-friend who’s been in my life for about five years. I met Veronica through an accountant who hired me to work with some of his older clients, for whom he has power of attorney. This designation allows me to communicate with family about Veronica’s well-being, the needs of her live-in caregivers and the maintenance and upkeep of her home, as well as writing the checks. 

Veronica was impressively strong until last year, when things took a turn. She had dementia and mobility challenges and could no longer get out of bed unassisted, yet she could still pull out her mirror and put on lipstick until a few months ago. She was able to poke fun at me, so I knew the old Veronica was in there.

Her caregiver ensures Veronica’s daily needs are met. However, the decline in her health was rapid, so we had to make some decisions about her comfort, including installing a hospital bed and recliner in the first-floor living room. As the agent for the power of attorney, I am authorized to act on these purchases. 

Still, I’m not authorized to make any medical decisions beyond arranging for a nurse to evaluate her. On Veronica’s 102nd birthday, this dear lady had no local family to help her engage a hospice provider. The health-care power of attorney, her 96-year-old brother, lives many hours away and was unable to quickly sign and get documents into the hands of the hospice provider to alleviate her suffering. All Veronica wanted for so many years was to die at home, but I couldn’t call an ambulance to take her to the hospital and put her in better hands. Veronica’s caregiver and brother insisted she stay in her home, not fully understanding that pain medication and palliative care would not contradict what Veronica’s DNR stipulated. 

Let this serve as a wake-up call for all of us. Ultimately, preparing for the future is an act of profound love and consideration. Prepare your end-of-life documents, and make sure your proxy understands your wishes. It’s about taking control of your narrative and ensuring your final wishes are clearly understood and easily executable. Don’t wait for a crisis to prompt these important conversations and actions. Take the proactive step today to organize your affairs. 

Nonnas

Posted on by

2025, United States, 109 min. 

After the death of his beloved mother, middle-aged Brooklyn lifer Joe Scarvella (Vince Vaughn) copes by cooking her Italian recipes. Warm memories of delicious food and living room bonhomie spur Joe to buy a shabby, vacant restaurant in Staten Island and hire nonnas—Italian grandmothers—to cook and summon those familial vibes. Yes, there’s a makeover scene. Yes, there’s a food fight in the kitchen. Despite its predictable emotional maneuvers, Nonnas shines in its depiction of four women (Brenda Vaccaro, Talia Shire, Lorraine Bracco and Susan Sarandon) (re)discovering their place in the world. “He’s not using me,” Vaccaro’s feisty character protests to an opponent of Joe’s restaurant. “He’s celebrating me.” The performances and camaraderie of the nonnas is the best part of this uplifting, well-intentioned drama-comedy. Based on a true story.

Eddie Winston Is Looking for Love

Posted on by

By Marianne Cronin – Harper Perennial, 2024

Eddie is a kindhearted, 90-year-old volunteer at a charity shop in Birmingham, England. Sentimental by nature, Eddie often sets aside donated items with emotional value—like old letters and photos—in case someone returns for them. When Bella, a pink-haired 24-year-old grieving the loss of her boyfriend, arrives to donate his belongings, she and Eddie form a bond. Eddie confesses he’s never been kissed, and Bella decides it’s time he gave love a chance. As they help each other heal, Eddie shares the story of Bridie, the married woman he once loved but could never be with.

This novel is more than just a love story—it celebrates friendship, loss, second chances and the enduring power of connection. The author brings a rich world to life, from Bella’s quirky friends to Eddie’s colorful wardrobe to a pet guinea pig named Pushkin. Heartfelt and charming, Eddie Winston Is Looking for Love is perfect for readers who believe it’s never too late to start again.

 

Aging Voices

How good habits, therapy and medicine can keep your voice strong
Posted on by

For the past 14 years, Darrell Rodenbaugh has played the lead in Scrooge – The Musical, an annual production by North Texas Performing Arts in Plano. The role is a marathon for 62-year-old Rodenbaugh: the company performs more than a dozen shows on consecutive nights, plus matinees on the weekends, with Rodenbaugh on stage, singing, dancing and speaking, for nearly the entire two-and-a-half-hour show. 

All of which he managed to handle until about five years ago, when his voice began to falter. 

“It was getting a little more raspy,” he said. “I was struggling to enunciate and hit some of the higher notes.” 

Rodenbaugh was noticing presbyphonia, or “aging voice,” changes in vocal quality that occur with aging. As people reach older adulthood, their voices tend to become breathy, weak or hoarse. They may lose the ability to project, and the voice may tire more easily. 

Rodenbaugh relies on his voice professionally, but voice problems can affect any older adult—and they are common. Research suggests that 19-29 percent of adults 64 and older experience a voice disorder at any given time, and for many, it impairs daily function and satisfaction with life. 

“The most common complaints I hear are, ‘People can’t hear me’ or ‘I have to repeat myself all the time,’” said Karen Goins, a speech pathologist who works with older adults in Dallas.

Often folks have no idea that there are voice doctors and things we can do that are specifically geared to helping older patients.

—Lesley Childs, MD

When voice issues make it harder to communicate and to socialize, that can lead to isolation and, in turn, depression and cognitive decline, according to Angela Van Sickle, PhD, a speech pathologist at Texas Tech University Health Sciences Center in Lubbock. 

“If friends or family can’t hear them, or can’t understand them, it’s frustrating, and it’s more work to communicate,” she said. “Some people start to feel like it’s too much work. They start to kind of close in and become more and more isolated.” 

Similarly, older adults who remain in the workforce may feel that voice issues hamper their professional productivity. 

However, while age-related changes may be inevitable, experts say older adults have options for keeping their voices strong, ranging from voice therapy and good health habits to medical interventions like injections and surgery. 

“Often, folks have no idea that there are voice doctors and things we can do that are specifically geared to helping older patients,” said Lesley Childs, MD, medical director at the Clinical Center for Voice Care at UT Southwestern Medical Center in Dallas.  

How Voices Change

The voice functions like a musical instrument. Sound emanates from the vocal folds, or vocal cords, housed in the larynx. Air pumped up from the lungs causes the folds to vibrate, creating sound that resonates in the open spaces inside the mouth, behind the nose and the back of the throat. 

Like the rest of the body, the larynx, vocal cords and lungs change with age. The larynx can become stiff. The vocal folds can atrophy, losing muscle tone, elasticity and moisture. The lungs, which act like a respiratory bellows to power the voice, lose capacity. With these changes, the voice starts to sound raspy, weak or breathy. That’s why it is often easy to tell that you’re talking to an older person on the telephone, just by the sound of their voice. 

Men’s and women’s voices tend to age differently, said Childs, who is also associate professor of laryngology, neurolaryngology and professional voice at UT Southwestern. 

“In men, the vocal folds become thin and slightly bowed, causing the voice to sound more breathy and weaker,” she said. “In females, the vocal folds become more dense, causing the voice to deepen.” 

Hormonal changes—lowered estrogen levels in women, falling androgen levels in men —seem to contribute.

Older people may develop a tremor, making the voice shaky. Neurogenic conditions such as Parkinson’s can impair the vocal cords or cause tremors. A stroke may trigger vocal cord paralysis or affect the part of the brain that controls speech. (Speech, the ability to articulate words, is differentiated from the voice, which produces the sound generated in the vocal cords.) Older adults also take more medications and have more health conditions, both of which can affect voices. 

Age-related voice problems occur at the same time many older adults experience hearing loss, making two-way communication even more difficult. Hearing loss can also contribute to voice issues. A person with impaired hearing may have difficulty calibrating their volume—either causing them to speak too loudly or too softly, depending on how they perceive their own voice. 

How Voice Therapy Works

For those with vocal disorders, the first line of treatment is voice therapy with a speech language pathologist. 

“The exercises aim to restore vocal strength by rebuilding muscle tone,” said Van Sickle.

Just as the abs and glutes need regular exercise to stay strong, so do the muscles in the voice. Voice therapy helps patients learn proper breathing techniques and find ways to optimize volume and reduce strain. Van Sickle often prescribes a series of exercises developed by voice-therapy pioneer Joseph Stemple, with separate regimens for male and female voices. Similar to vocal warm-ups that singers and actors follow, these involve holding a single note or pitch glides—starting low and sliding to a higher note, and vice versa.

Specialized voice-therapy programs are also available for people with Parkinson’s and other age-related voice issues.

“Patients with Parkinson’s may feel like they’re yelling, because they have to put in extra effort to speak, but they’re actually talking too softly,” Van Sickle said. “These programs help people to recalibrate the volume of their voices.” 

Other Interventions

Even at the age of 88, Jan Steele says her voice hasn’t changed much. She credits her 42 years as a member of the Rich-Tones, an 80-person women’s barbershop chorus in Dallas. The group rehearses for three hours each week and performs in concerts and international competitions, three of which they’ve won. 

“I’m very disciplined about my vocal exercise,” Steele said. “I sing in the shower and around the house. I practice scales and repertoire, and of course go to weekly rehearsals. I think a mature voice needs to sing every day. If you don’t use it, you lose it.”

Experts agree: singing can be a form of natural voice therapy. 

“The folks that we see that are doing really well are generally using their voice a fair amount, without overusing it,” said Childs. “Singing is good for expansion of the breath support. We actually recommend singing to a lot of our patients.”  

Here are other steps experts recommend for vocal health and longevity.

Stay hydrated. Drink plenty of water, especially when exercising. Childs likes caffeine-free teas, served warm, not hot. She advises patients to avoid alcohol and caffeine, or to balance intake of either with additional water. 

Practice “external hydration.” A home humidifier, especially in winter or dry climates, can be helpful. (Thirty percent humidity is recommended.) For professionals who use their voices, Childs also recommends a portable saline nebulizer designed specifically for voice support, such as Vocal Mist, to add moisture to the throat. 

Address bad habits. A persistent cough can lead to vocal problems. Some people develop a habit of frequently clearing their throats, for example, which irritates the vocal folds. Van Sickle helps patients in that situation learn to swallow or take other steps when the urge to clear their throat crops up. 

Manage allergies and allergy medicine. Allergies can cause inflammation in the larynx, leading to hoarseness. Antihistamines may dry out the nasal and breathing passages. For people with congestion or post-nasal drip, Childs prefers guaifenesin (Mucinex is a popular brand), an expectorant that helps loosen and clear mucus from the airways. Avoid pseudoephedrine (D) or dextromethorphan (DM) formulations, which can cause dryness.

Use assistive devices. Van Sickle never teaches class for more than an hour or two, even in a small classroom, without a microphone. Personal amplification devices can be used in situations where a public address system is not available. 

Exercise regularly. Exercise increases stamina and muscle tone, as well as improves posture and breathing. 

Practice good breathing techniques. Support the voice with deep breaths from the chest. 

Socialize in quiet places. Trying to talk over a noisy room can cause frustration and strain the voice. Childs encourages patients to consider acoustics when making plans. “If they go out to dinner at a restaurant, for example, I advise them to choose a quiet restaurant, or a booth in the corner, next to a wall, where it’s likely to be easier to hear and be heard,” she said. 

Maintain good posture. Goins works with patients’ posture, because good posture can facilitate better breath support, which helps in speaking. Van Sickle also encourages patients to always face the person they’re speaking with. “There are so many important cues that we get from a speaker’s facial expressions,” she said.

Rest the voice. While exercising is helpful, resting is important, too, especially for anyone who uses their voice extensively. Avoid vocal extremes, such as screaming or whispering. Childs notes that vocal strain is dose related. The longer a person speaks, and the louder, the more likely they are to strain the voice. It’s important to take breaks before and after any challenging speaking situations. 

Medical Interventions 

Most age-related voice issues are not serious and respond well to therapy. But for persistent symptoms, it’s a good idea to see an otolaryngologist or ear, nose and throat (ENT) specialist for a medical evaluation to rule out other medical conditions such as gastroesophageal reflux (GERD) or cancer of the larynx.

Typically, a medical workup for voice issues begins with an examination of the larynx and the vocal folds. This may involve a videostroboscopy, which Childs calls the “gold standard” for a thorough workup. A scope, inserted through the mouth or nose, uses strobe lights to examine vocal tissue. 

For those struggling with atrophy (thinning), Childs may inject fillers to “fatten up” the vocal cords. For a more permanent solution, she can surgically place implants (usually made of Gore-Tex) into the vocal cords to bulk them up. Botox injections may help calm vocal tremors by relaxing overactive muscles. If GERD is diagnosed, dietary changes or medications are recommended to help reduce flare-ups and minimize irritation in the throat. 

“I’m hopeful more people will realize that there are some options for them,” Childs said, adding that most large cities in the United States with major academic medical centers offer voice centers—multidisciplinary teams of fellowship-trained otolaryngologists, speech pathologists and other specialists focused on voice therapies.  

Scrooge’s Redemption 

When his voice issues arose, Rodenbaugh began working with a vocal coach who prescribed voice and breathing exercises. He started exercising with a trainer, adding cardio to boost his breath support. To help prevent sinus infections and inflammation, he irrigates his nasal passages regularly with saline. When he’s performing, he hydrates constantly before, during and after each show. 

Now, Rodenbaugh says, his voice is as strong as ever—he’s even hitting a few high notes he couldn’t hit before. This fall, he’ll return as Scrooge in NTPA’s 15th season, marking the troupe’s record-setting 125th performance of Scrooge: The Musical. 

“At this age, singing is not about pushing harder, it’s about being smarter,” he said. “Caring for your voice really means caring for yourself and your whole body.” 

Honey, Sweetie, Dearie: The Perils of Elderspeak

Those who use it may mean well, but they’re more likely to meet resistance
Posted on by

Elderspeak is a kind of baby talk sometimes used when speaking to older people, especially those living with dementia. Elderspeak is common and it’s alienating. Journalist Paula Span reports that in one study, nursing home staff used elderspeak in 84 percent of interactions with residents. She has suggestions for what to do about it.  KFF Health News posted Span’s column on May 9, 2025. Funding from the Silver Century Foundation helps KFF Health News produce articles (like this one) on longevity and related health and social issues.  

A prime example of elderspeak: Cindy Smith was visiting her father in his assisted living apartment in Roseville, CA. An aide who was trying to induce him to do something— Smith no longer remembers exactly what—said, “Let me help you, sweetheart.”

“He just gave her The Look—under his bushy eyebrows—and said, ‘What, are we getting married?’” recalled Smith, who had a good laugh, she said. Her father was then 92, a retired county planner and a World War II veteran; macular degeneration had reduced the quality of his vision, and he used a walker to get around, but he remained cognitively sharp.

“He wouldn’t normally get too frosty with people,” Smith said. “But he did have the sense that he was a grown-up and he wasn’t always treated like one.”

People understand almost intuitively what “elderspeak” means. “It’s communication to older adults that sounds like baby talk,” said Clarissa Shaw, PhD, a dementia care researcher at the University of Iowa College of Nursing and a co-author of a recent article that helps researchers document its use. “It arises from an ageist assumption of frailty, incompetence and dependence.”

Its elements include inappropriate endearments. “Elderspeak can be controlling, kind of bossy, so to soften that message, there’s ‘honey,’ ‘dearie,’ ‘sweetie,’” said Kristine Williams, PhD, a nurse gerontologist at the University of Kansas School of Nursing and another co-author of the article. “We have negative stereotypes of older adults, so we change the way we talk.”

Or caregivers may resort to plural pronouns: Are we ready to take our bath? There, the implication “is that the person’s not able to act as an individual,” Williams said. “Hopefully, I’m not taking the bath with you.”

Sometimes, elderspeakers employ a louder volume, shorter sentences or simple words intoned slowly. Or they may adopt an exaggerated, singsong vocal quality more suited to preschoolers, along with words like “potty” or “jammies.”

With what are known as tag questions—It’s time for you to eat lunch now, right—”You’re asking them a question but you’re not letting them respond,” Williams explained. “You’re telling them how to respond.”

Studies in nursing homes show how commonplace such speech is. When Williams, Shaw, and their team analyzed video recordings of 80 interactions between staff and residents with dementia, they found that 84 percent involved some form of elderspeak. 

“Most of elderspeak is well intended. People are trying to show they care,” Williams said. “They don’t realize the negative messages that come through.”

For example, among nursing home residents with dementia, studies have found a relationship between exposure to elderspeak and behaviors collectively known as resistance to care.

“People can turn away or cry or say no,” Williams explained. “They may clench their mouths shut when you’re trying to feed them.” Sometimes, they push caregivers away or strike them.

She and her team developed a training program called CHAT, for Changing Talk: three hour-long sessions that include videos of communication between staff members and patients, intended to reduce elderspeak.

It worked. Before the training, in 13 nursing homes in Kansas and Missouri, almost 35 percent of the time spent in interactions consisted of elderspeak; that share dropped to about 20 percent afterward.

Furthermore, resistant behaviors accounted for almost 36 percent of the time spent in encounters; after training, that proportion fell to about 20 percent.

A study conducted in a Midwestern hospital, again among patients with dementia, found the same sort of decline in resistance behavior. 

What’s more, CHAT training in nursing homes was associated with lower use of antipsychotic drugs. Though the results did not reach statistical significance, due in part to the small sample size, the research team deemed them “clinically significant.”

“Many of these medications have a black box warning from the FDA,” Williams said of the drugs. “It’s risky to use them in frail, older adults” because of their side effects.

Now, Williams, Shaw and their colleagues have streamlined the CHAT training and adapted it for online use. They are examining its effects in about 200 nursing homes nationwide.

Even without formal training programs, individuals and institutions can combat elderspeak. Kathleen Carmody, owner of Senior Matters Home Health Care and Consulting in Columbus, OH, cautions her aides to address clients as Mr. or Mrs. or Ms., “unless or until they say, ‘Please call me Betty.’”

In long term care, however, families and residents may worry that correcting the way staff members speak could create antagonism.

A few years ago, Carol Fahy, PhD, was fuming about the way aides at an assisted living facility in suburban Cleveland treated her mother, who was blind and had become increasingly dependent in her 80s.

Calling her “sweetie” and “honey babe,” the staff “would hover and coo, and they put her hair up in two pigtails on top of her head, like you would with a toddler,” said Fahy, a psychologist in Kaneohe, HI.

Although she recognized the aides’ agreeable intentions, “there’s a falseness about it,” she said. “It doesn’t make someone feel good. It’s actually alienating.”

Fahy considered discussing her objections with the aides, but “I didn’t want them to retaliate.” Eventually, for several reasons, she moved her mother to another facility.

Yet objecting to elderspeak need not become adversarial, Shaw said. Residents and patients—and people who encounter elderspeak elsewhere, because it’s hardly limited to health care settings—can politely explain how they prefer to be spoken to and what they want to be called.

Cultural differences also come into play. Felipe Agudelo, PhD, who teaches health communications at Boston University, pointed out that in certain contexts a diminutive or term of endearment “doesn’t come from underestimating your intellectual ability. It’s a term of affection.”

He emigrated from Colombia, where his 80-year-old mother takes no offense when a doctor or health care worker asks her to “tómese la pastillita” (take this little pill) or “mueva la manito” (move the little hand).

That’s customary, and “she feels she’s talking to someone who cares,” Agudelo said.

“Come to a place of negotiation,” he advised. “It doesn’t have to be challenging. The patient has the right to say, ‘I don’t like your talking to me that way.’”

In return, the worker “should acknowledge that the recipient may not come from the same cultural background,” he said. That person can respond, “This is the way I usually talk, but I can change it.”

Lisa Greim, 65, a retired writer in Arvada, CO, pushed back against elderspeak recently when she enrolled in Medicare drug coverage.

Suddenly, she recounted in an email, a mail-order pharmacy began calling almost daily because she hadn’t filled a prescription as expected.

These “gently condescending” callers, apparently reading from a script, all said, “It’s hard to remember to take our meds, isn’t it?”—as if they were swallowing pills together with Greim.

Annoyed by their presumption, and their follow-up question about how frequently she forgot her medications, Greim informed them that having stocked up earlier, she had a sufficient supply, thanks. She would reorder when she needed more.

Then, “I asked them to stop calling,” she said. “And they did.”

Using Artificial Intelligence – Who, Me?

Posted on by

Anyone connected to the outside world has heard of artificial intelligence (AI). You don’t need to understand how it works to use it—in fact, you’re probably already using it. 

AI is a computer system that can perform tasks typically requiring human intelligence, such as decision-making and problem-solving. Siri and Alexa use AI. Google Search utilizes AI to comprehend and respond to your queries. Robotic floor sweepers, such as Roomba, use AI to map the room and avoid obstacles like table legs or your sleeping dog. 

I’m on the school board, so the seminars I attend often address students using AI to cheat (they can and they will) and how teachers and administrators can optimize the tools offered by AI, which are many. I’m not an educator, so many of those AI offerings don’t apply to me, but I do use ChatGPT, Gemini and Co-pilot. For help with writing, I use Grammarly and Claude.

There are many fun uses for AI. I’m at my laptop right now, wearing a pair of glasses I bought online. With AI, I “tried on” pair after pair by simply uploading a photo of my face without glasses and choosing frames I thought might be a good fit. It was fun! 

I’ve generated a business photo—it’s not perfect but I’ll continue to tweak it. I’ve requested help with choosing colors that suit me. (No black or stark white, but yes to cream, ivory or taupe, as well as warm colors like coral and terracotta). Next up: different hairstyles.

If you’re not into makeup and clothes, there are other, less superficial ways to use AI. I take a supplement that I only buy when it’s on sale. Noticing that other brands were selling for less, I asked ChatGPT to compare two of them side by side. There wasn’t enough difference in the formulas, so now I’m buying the generic. And recently, when my orthopedist sent MRI results that I didn’t understand, I copied them into an AI search* and asked, “Help me understand this.” These examples are only scratching the surface of what AI can do: plan a party, organize a seating chart or virtually rearrange your furniture. 

As for the accuracy of the results, I know I can’t always trust what it spits out. It’s human that way.

*Always consult with your primary care physician before making any health care decisions.

The Heart of Winter

Posted on by

By Jonathan Evison – Dutton, 2025

From the start—a blind date—Abe and Ruth were opposites, a conservative pragmatist and a free-spirited poetry lover. But even through the devastating loss of a child, infidelity and personal sacrifices, their love has endured for 70 years. As the book begins, he’s turning 90; she’s just a couple of years behind. One timeline is the present day, another explores their history, filled with heartbreak and joy. 

Abe and Ruth have three living adult children who—like anyone else—face challenges but are committed to each other, even when they disagree. Just when Abe accepts that he’s enjoying his last birthday, ever-independent Ruth receives a debilitating cancer diagnosis. As her treatment leaves her physically dependent on Abe for the first time, the children threaten to move her into assisted living, doubting the best intentions of their father. 

Set on their Bainbridge Island farm, this is a story of the ebb and flow of a decades-long marriage. It reminds us that a relationship is not made up of the number of years together, but of the seemingly incidental moments and experiences that are shared.

 

Lonesome Dove

Posted on by

1989, USA, 360 min. (four 90-minute episodes)

In this classic miniseries, former Texas Rangers Augustus McRae (Robert Duvall) and Woodrow F. Call (Tommy Lee Jones) are whiling away their remaining years in Lonesome Dove, TX, a wisp of a town that features little more than dust and boredom. Then their old, rakish associate, Jake Spoon (Robert Urich) shows up. The future, he says, lies in verdant, unsettled Montana. Itchy for action, Call immediately organizes a cattle drive. The affable, silver-tongued Gus, forever devoted to the stoic Call, joins him. The dangerous trek is a last run at macho relevance for Call and a dip into nostalgia for McRae, but both men carry emotions that dwarf any frontier. The people who enter their lives—including a hapless Arkansas sheriff (Chris Cooper), an orphaned teenage farmhand (Rick Schroder) and a no-nonsense farm wife (Anjelica Huston), who once loved Gus—slowly and memorably showcase the duo’s vulnerability. Jones and Duvall are exceptional in this bittersweet meditation on mortality and the end of the Old West. Based on Larry McMurtry’s novel. 

 

Golden Years? Social Inequality in Later Life

Posted on by

By Deborah Carr – Russell Sage Foundation, 2019

Aging in the United States is more challenging for some than others. Imagine a man living in a stable, suburban home with his wife as he ages into older adulthood. Now imagine how this man’s aging experience might look different if he were living in unsafe housing conditions, had income below the poverty line, had several chronic illnesses, was unmarried or in prison. 

Golden Years? Social Inequality in Later Life is a thoughtful integration of decades of sociological research to illustrate ways that systemic disadvantages across the lifespan can affect how long and how well someone lives. Deborah Carr, PhD, a distinguished professor of sociology at Boston University, has dedicated her career to exploring ways that later-life health and well-being are impacted by social factors like poverty, marriage, labor-force participation and loneliness. 

This book is rather textbook-like, ideal for someone who hopes to take a deep dive into the most up-to-date sociological research regarding aging in the United States. It is packed with eye-opening facts and figures about the ways our systems and policies could be changed to better serve us all—especially our aging Americans. 

Slow Living

Posted on by

As I’ve rounded the corner into my 90s, I’ve felt more and more impatient with my own, slowing pace. 

I not only walk more slowly these days, I think more slowly and don’t get as much done. I can work at the computer for four or five hours, but beyond that, my eyesight and brain fuzz out. I have a hard time forgiving myself for this.

I can still take advantage of a spurt of adrenaline when I need to. I can get in and out of the shower in half the usual time. Or let’s say I’m supposed to meet someone on the other side of my retirement community’s campus, and I’m running late, as usual—if I lean forward over my walker and speed-walk, I can get there, out of breath but on time. And impatient that it’s taken so much effort to do that.  

Imagine how surprised I was, then, to learn that there’s a global slow living movement, dedicated to persuading people to slow down. We live in a world, its leaders say, that pressures us to work faster and cram more into every day. In our culture, fast is good; slow is disparaged. As actress Carrie Fisher said, these days, even instant gratification takes too long. 

Today’s slow living movement is a cousin to the slow food movement, which came first and began in 1986 as a protest against fast food after McDonald’s opened a restaurant in Rome. The protesters were determined to preserve local, traditional foods, along with the practice of eating at a reasonable pace with pleasure and in good company. 

Since then, more than a dozen other movements have also focused on slowing down. For example, slow parenting gives children free time to discover their own interests and develop at their own speed. Slow gardeners focus on the process of growing things, using all five senses. Slow fashion means buying fewer clothes and choosing those that are well-made and will last. Slow thinking involves being totally there in the present moment, fully absorbed in everything you’re experiencing. 

At first, it seemed to me that the pitch for slowing down must be meant for young and middle-aged people. Those of us in our later years are apt to be slow already—and not by choice. But as I learned more about slow living, I changed my mind. 

Slow movements are about choosing to live a more relaxed and unhurried life. About doing things thoroughly and carefully, not rushing through them. About pausing to savor the present moment. About making deeper connections with others. 

I had assumed that people my age don’t have to be advised to live slowly. Many of us—relieved, for the first time, of the stress of the working world—are already taking advantage of the opportunity to taper off. But I am my father’s daughter. I remember a few months after he retired, he told me happily that he was so busy now, he couldn’t imagine how he ever found the time to go to work. I’ve known others like him. I, too, like walking fast and being busy. I’m enormously proud of the fact that at 90, I’m still gainfully employed. 

But what will happen when I’m not? That’s a scary question.

One other, central thing slow living recommends is figuring out what’s most important to you and making room in your life for more of that. So, unexpectedly, I’m asking myself a big question. Aging has slowed me down, but it hasn’t stopped me. After I retire, what do I want to do with the time and energy I still have? What do I want the rest of my life to be about? 

I don’t have answers yet, but I’m working on it. Meanwhile, if I think of myself as someone engaged in slow living, perhaps I won’t feel so impatient. 

Millions of Aging Americans Are Facing Dementia by Themselves

They live alone, and for about half of them, it’s a struggle to shop, cook or even bathe without help
Posted on by

Our health care system is built on the assumption that when older people need help, their families will look after them. What about the more than 4 million seniors who live alone and have cognitive impairment or dementia? Journalist Judith Graham describes their precarious situation in this article she wrote for KFF Health News, which posted it on October 15, 2024. It also ran on the Washington Post. Funding from the Silver Century Foundation helps KFF Health News develop articles (like this one) on longevity and related health and social issues. 

Sociologist Elena Portacolone, PhD, was taken aback. Many of the older adults in San Francisco she visited at home for a research project were confused when she came to the door. They’d forgotten the appointment or couldn’t remember speaking to her.

It seemed clear they had some type of cognitive impairment. Yet they were living alone.

Portacolone, an associate professor at the University of California-San Francisco, wondered how common this was. Had anyone examined this group? How were they managing?

When she reviewed the research literature more than a decade ago, there was little there. “I realized this is a largely invisible population,” she said.

Portacolone got to work and now leads the Living Alone With Cognitive Impairment Project at UCSF. The project estimates that at least 4.3 million people 55 or older who have cognitive impairment or dementia live alone in the United States.

About half have trouble with daily activities such as bathing, eating, cooking, shopping, taking medications, and managing money, according to their research. But only one in three received help with at least one such activity.

Compared with other older adults who live by themselves, people living alone with cognitive impairment are older, more likely to be women, and disproportionately Black or Latino, with lower levels of education, wealth and homeownership. Yet only 21 percent qualify for publicly funded programs such as Medicaid that pay for aides to provide services in the home.

With no one looking after them, older people with dementia can become malnourished, and they’re susceptible to scams. 

In a health care system that assumes older adults have family caregivers to help them, “we realized this population is destined to fall through the cracks,” Portacolone said.

Imagine what this means. As memory and thinking problems accelerate, these seniors can lose track of bills, have their electricity shut off, or be threatened with eviction. They might stop shopping (it’s too overwhelming) or cooking (it’s too hard to follow recipes). Or they might be unable to communicate clearly or navigate automated phone systems.

A variety of other problems can ensue, including social isolation, malnutrition, self-neglect and susceptibility to scams. Without someone to watch over them, older adults on their own may experience worsening health without anyone noticing or struggle with dementia without ever being diagnosed.

Should vulnerable seniors live this way?

For years, Portacolone and her collaborators nationwide have followed nearly 100 older adults with cognitive impairment who live alone. She listed some concerns people told researchers they worried most about: “Who do I trust? When is the next time I’m going to forget? If I think I need more help, where do I find it? How do I hide my forgetfulness?”

Jane Lowers, PhD, an assistant professor at the Emory University School of Medicine, has been studying “kinless” adults in the early stages of dementia—those without a live-in partner or children nearby. Their top priority, she told me, is “remaining independent for as long as possible.”

Seeking to learn more about these seniors’ experiences, I contacted the National Council of Dementia Minds. The organization last year started a biweekly online group for people living alone with dementia. Its staffers arranged a Zoom conversation with five people, all with early-to-moderate dementia.

He explains he can’t expect one of his children to take him in and become a dementia caregiver—an extraordinarily stressful commitment.

One was Kathleen Healy, 60, who has significant memory problems and lives alone in Fresno, CA. 

“One of the biggest challenges is that people don’t really see what’s going on with you,” she said. “Let’s say my house is a mess or I’m sick or I’m losing track of my bills. If I can get myself together, I can walk out the door and nobody knows what’s going on.”

An administrator with the city of Fresno for 28 years, Healy said she had to retire in 2019 “because my brain stopped working.” With her pension, she’s able to cover her expenses, but she doesn’t have significant savings or assets.

Healy said she can’t rely on family members who have troubles of their own. (Her 83-year-old mother has dementia and lives with Healy’s sister.) The person who checks on her most frequently is an ex-boyfriend.

“I don’t really have anybody,” she said, choking up.

David West, 62, is a divorced former social worker with Lewy body dementia, which can impair thinking and concentration and cause hallucinations. He lives alone in an apartment in downtown Fort Worth, TX.

“I will not survive this in the end—I know that—but I’m going to meet this with resilience,” he said when I spoke with him by phone in June.

Since his diagnosis nearly three years ago, West has filled his life with exercise and joined three dementia support groups. He spends up to 20 hours a week volunteering, at a restaurant, a food bank, a museum and Dementia Friendly Fort Worth. 

Still, West knows that his illness will progress and that this period of relative independence is limited. What will he do then? Although he has three adult children, he said, he can’t expect them to take him in and become dementia caregivers—an extraordinarily stressful, time-intensive, financially draining commitment.

“I don’t know how it’s going to work out,” he said.

She once found it hard to ask for assistance, but with no family nearby, she now routinely relies on friends and hired help. 

Denise Baker, 80, a former CIA analyst, lives in a 100-year-old house in Asheville, NC, with her dog, Yolo. She has cognitive problems related to a stroke 28 years ago, Alzheimer’s disease and serious vision impairment that prevents her from driving. Her adult daughters live in Massachusetts and Colorado.

“I’m a very independent person, and I find that I want to do everything I possibly can for myself,” Baker told me, months before Asheville was ravaged by severe flooding. “It makes me feel better about myself.”

She was lucky in the aftermath of Hurricane Helene: Baker lives on a hill in West Asheville that was untouched by floodwaters. In the week immediately after the storm, she filled water jugs every day at an old well near her house and brought them back in a wheelbarrow.  Though her power was out, she had plenty of food and neighbors looked in on her. 

“I’m absolutely fine,” she told me on the phone in early October after a member of Dementia Friendly Western North Carolina drove to Baker’s house to check in on her, upon my request. Baker is on the steering committee of that organization.

Baker once found it hard to ask for assistance, but these days she relies routinely on friends and hired help. A few examples: Elaine takes her grocery shopping every Monday. Roberta comes once a month to help with her mail and finances. Jack mows her lawn. Helen offers care management advice. Tom, a cab driver she connected with through Buncombe County’s transportation program for seniors, is her go-to guy for errands.

Her daughter Karen in Boston has the authority to make legal and health care decisions when Baker can no longer do so. When that day comes—and Baker knows it will—she expects her long term care insurance policy to pay for home aides or memory care. Until then, “I plan to do as much as I can in the state I’m in,” she said.

Much can be done to better assist older adults with dementia who are on their own, said Elizabeth Gould, MSW, co-director of the National Alzheimer’s and Dementia Resource Center at RTI International, a nonprofit research institute. “If health care providers would just ask ‘Who do you live with?’” she said, “that could open the door to identifying who might need more help.”