Wednesday, April 13, 2016

Quiz Apr14

1. Thanks to sanitation and other public health & clinical advances, by the mid-20th century just __% of people in industrialized countries died before age thirty. (4, 14, 20)

2. What's "embarrassing" about the progress of medicine and public health?

3. After age 85, __% of people in industrialized countries are toothless. (4, 20, 40)

OR, Around age 80, we lose up to __% of our muscle weight. (10, 25, 50)

OR, By age 85, __% of us have textbook dementia. (10, 20, 40)

OR, By age 50, __% of the average person's hairs have gone gray. (20, 40, 50)

4. The newest view is that we age due to random wear & tear, genetics, or what?

5. Is there (according to Silverstone) a single common cellular mechanism to aging?

6. What is "defrailulation"?

BONUS: What's "the prevailing fantasy," and how do geriatricians contradict it?

BONUS: What kinds of courses would Chad Boult like to establish in every med school, nursing school, school of social work, and internal-medicine training program?
==
Spotted yesterday at Parnassus Books in Nashville-

DQ
Everybody, please post at least one and be prepared to say a few words about it.

1. Would you personally rather have "the bottom drop out" at the end of a long and satisfying life, or experience a vertiginous descent such as depicted in the graph on p.27 or a "long slow fade" (28) ("instead of delaying the moment of the downward drop, our treatments can stretch the descent out...")? If the former, is this an argument for allowing elective euthanasia?

2. Do you dread becoming a needy nonagenarian who can't run a marathon (etc.)? Or do you accept the inherent restrictions and limitations of aging, and look forward to your rocking chair? (Think about Alice's typical day, 39... ALSO: see the cartoon I posted Sunday night. Is it funny to you, or sad, or what?)

3. If "the story of aging is the story of our parts," will the development of prosthetic enhancement technologies rewrite the story of our biological/cultural transformation? Or is this dream just another form of denial about our limitations?

4. Given the "normal" phenomenon of brain shrinkage and a corresponding decline in judgment and memory (etc.), should our culture be less indulgent of older people's stubbornness regarding their living situation in later life?

5. Do you agree with Montaigne and Gawande that aging is "unnatural"?

6. "Doctors don't like taking care of the elderly." (36) How do you feel about that? Is this an attitude medical training should challenge and try to eradicate? How?

7. What do you make of the high incidence of falling accidents among the elderly? (40) (In Let Me Be Frank With You Richard Ford wonders about this. "How bleeping far are these people falling?!")

8. With the higher risk of fatality among elderly drivers (53), why shouldn't everyone over age 75 be required to pass an annual driving test behind the wheel?
==
1. Who called old age a "massacre"?

2. What happened to Bella that severed her connection to Felix?
OR, What move restored a sense of control to Felix and Bella?

3. What is a "continuum of care" community?

4. What happened in 1935 to introduce greater security in the lives of ordinary Americans?

5. Who was Harry Truman? (Not Harry S...)

6. What was the original rationale for nursing homes, if not to help old people face dependency and manage their lives more effectively?

BONUS: AG says the goal that matters most to older people is what?

DQ:
1. "We do not like to think about" losing our independence in old age, and so we tend not to prepare for it. What kinds of preparations would you advise, for yourself and your patients?

2. What impairment associated with aging do you think would be hardest to cope with, or create the most difficulties for continued quality of life?

3. "It means something when you can move in and see all your things in their own places..." (60) What kinds of"things" can you not bear to imagine parting with, ever? The silver in your kitchen drawer, for instance? Shouldn't we all make an effort to simplify our material lives as we age?

4. Given the historical prevalence "poorhouses" (and their persistence in much of the world), should modern old age homes - even at their worst - be perceived as "frightening, desolate, odious" etc.? It could be worse, after all. Is this an insensitive thing to say?

5. Is it reasonable of old people to expect a lot more of life's last chapter than mere safety? (Friendship, purpose, freedom...) Can an institution ever really be a home?

6. Will you be a "feisty" old person? (75)
==
The sweet spot for exercise benefitsTwo new studies suggest that the ideal dose of exercise for a long life is a bit more than many of us currently believe we should get, but less than many of us might expect...

The sweet spot for exercise benefits came among those who tripled the recommended level of exercise, working out moderately, mostly by walking, for 450 minutes per week, or a little more than an hour per day. Those people were 39 percent less likely to die prematurely than people who never exercised. nyt

Mother Jones (@MotherJones)
The deadly corruption of clinical trials. One patient's tragic, and telling, story. bit.ly/RU9216pic.twitter.com/IzMEuOoDyI

Atul Gawande (@Atul_Gawande)
What's worse lung cancer or back pain? When Moneyball Meets Medicine. V good@nytimes piece on the concept of DALYs nyti.ms/1yLq5C6

43 comments:

  1. Discussion Question:

    In the situation of taking an elder’s keys away people are uncomfortable because it feels like there is a lack of respect. No one wants to take away the few freedoms the elderly have left. No one wants to be a bad guy or make the elder feel bad but at the same time it becomes a safety issue for the elderly person and the people around them. My grandmother is eighty years old and I continuously have the conversation with my father about him and my aunts and uncles taking away her keys. They think for the most part she is capable to drive and if they took her keys away she would have no other way to get around (She would if my aunt would be willing to take few minutes out of her day to help her run errands but that’s another story) because 2 of my aunts and uncle live in Dallas, Texas, my mother and father live in Lawrenceburg, Tennessee, and only one aunt and her husband live in the same town. I know it is a lot to ask of my aunt, uncle, and sixteen year old cousin but it would be much safer. I am afraid my grandmother will end up getting and a wreck and killing herself, if not someone else and being sued to no end. The reason my aunts, uncles, and father don’t see her driving as a problem is because when they visit they do the driving and not my grandmother. Both my mother and I have been in the car while my grandmother was and each time we have almost been in an accident. She just doesn’t understand the rules of the road like she used and she forgets to signals to drive safely. In this situation especially, since my aunts, uncles, and father won’t talk to my grandmother I do think it would be very beneficial to have a driving test for the elderly. If the family is too afraid of saying anything and potentially hurting feeling then it can be left up to a law. It may seem discriminatory but it’s for the safety of my family, my grandmother, and society.

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    Replies
    1. 8. With the higher risk of fatality among elderly drivers (53), why shouldn't everyone over age 75 be required to pass an annual driving test behind the wheel?

      Delete
  2. Here is a link with a few statistics about older drivers and the safety of driving with elders on the road.

    http://www.iii.org/issue-update/older-drivers

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  3. Quiz Question:

    What is the most serious health threat that the elderly who live alone face?

    pp. 40

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  4. Discussion Question:


    6. Will you be a "feisty" old person? (75)

    I don’t want to be a feisty old person. My father and I have the same view on this. I want to die before I become a burden on others whether they think I am or not. I don’t want to say that I wouldn’t be able to stand losing my independence but I just don’t want to trouble others. If I can’t take care of myself I don’t want others to have to do it or feel like they have to. If I am feisty it would be about just letting me die rather than doing everything for me. I don’t want to lose my mind or my physicality so all I can do is hope that my times comes before then. I can’t control what will happen but I want to say that if it came down to it I would at least put myself in a nursing home before it came to the point of my family telling me that I need to.

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  5. Quiz Question:

    What was (and still is) the major backlash of Medicare?

    pp. 71

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  6. Here is a link talking about the history of nursing homes and the reform that occurred then and now.

    https://www.youtube.com/watch?v=huGp62agFdc

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  7. DQ: "Doctors don't like taking care of the elderly." (36) How do you feel about that? Is this an attitude medical training should challenge and try to eradicate? How?

    Answer: "Doctors don't like taking care of the elderly." This notion is one that does not surprise me much. The reason for this is because, while this may be true to some degree, it is a generalized statement that does not encompass the mentality of all doctors. I am sure that there are doctors who would openly admit this fact; everyone is entitled to their own opinion on the matter. Doctors with these mentalities may be practicing in other fields of medicine due to their stance on the matter. If this is still an ongoing issue, then I feel that it should be one that medical training should challenge and try to eradicate. The problem with this lies in the fact that not all people—physicians or not—will change their views towards a more positive mentality. However, I feel that extensive care of the elderly is a method that would influence some of these doctor’s opinions

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  8. Quiz question: Who claims that, “We’ve got to do something,”; “Life for older people can be better than it is today.”

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  9. The lack of geriatricians in the U.S. continues to increase due to various reasons: the sadness it brings to many people, salary, frustration, etc. That leaves many to wonder, “Who Will Take Care of the Elderly?”

    http://health.usnews.com/health-news/patient-advice/articles/2015/04/21/doctor-shortage-who-will-take-care-of-the-elderly

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  10. DQ: What impairment associated with aging do you think would be hardest to cope with, or create the most difficulties for continued quality of life?

    Answer: Aging is a part of life that many people struggle with facing. Out of these people, only a handful continue to suppress the thought that our bodies weaken as we get older. It’s a thought that I still struggle to accept sometimes. I have often thought about what parts of my youthful ability I would miss most as time passes, and honestly—I do not think I have a definite answer. However, our ability to see is something that we take for granted as people, and so I feel that a decline in this sense will be one aspect of my life that is hard to cope with. Being able to witness life from a visual standpoint is one thing that I am appreciative of, so to know that one day dullness will settle in makes the future hard to cherish sometimes.

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  11. Quiz question: When speaking about age percentages in the U.S. thirty years from now, what does AG predict about the amount of individuals over eighty and under five?

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  12. A powerful message from, Dr. BJ Miller, over what really matters at the end of life:

    https://www.youtube.com/watch?v=apbSsILLh28

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  13. Quiz Question: How do we reward the work of geriatricians?

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  14. Quiz question: Why do Boult's colleagues no longer advertise their geriatric training?

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  15. Quiz question: What is the average rent for a year in a retirement community?

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  16. 5. Do you agree with Montaigne and Gawande that aging is "unnatural"?
    I do not agree that aging is unnatural. If things did not age we would not have fine wine, good cheese, or classic sitcom characters. What about mountains? A mountain ages by being eroded by wind, water, and temperature, and isn't that a natural occurance? Just like a mountain our bodies are being eroded, although by inside and outside forces, by natural processes.

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  17. Here is a discussion question: like my mountain what would use as a metaphor for the human body?

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  18. Discussion question: do you believe there is any merit in controlling another person's life for the greater good of humanity? Is this inherently evil?

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  19. 8. With the higher risk of fatality among elderly drivers (53), why shouldn't everyone over age 75 be required to pass an annual driving test behind the wheel?

    I feel like this takes away a person's independence, and would most likely offend or affect those you take the keys away from. The need to do it, however, is there. Just as a person with epilepsy isnt allowed to drive because of the risk they pose, as should someone who a threat to not only themselves, but to others. If something like this were to happen, an alternative would have to be put in place, whether that be family takes the responsibility, or there be a sort of public transportation. Unless there is a comparable alternative, it would be quite unfair to the person.

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  20. 5. Is it reasonable of old people to expect a lot more of life's last chapter than mere safety? (Friendship, purpose, freedom...) Can an institution ever really be a home?

    I feel that once safety is achieved and assured, that friendship, purpose, and freedom are the next feasible route. I think assuring safety allows those in latter stages of life to be as happy as possible. If organized and ran the correct way (as a home rather than a hospital), then it can easily be a home for anyone. Being in a safe place is as good as a home as long as it feels as so.

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  21. http://www.glynndevins.com/insights/2011/12/10-powerful-senior-living-statistics/

    Here are some cool statistics about senior living.

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  22. QQ:

    What did Erving Goffman compare nursing homes to?

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  23. Quiz Question

    What two revolutions have modern medicine given us?

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    Replies
    1. “ In a sense, the advances of modern medicine have given us two revolutions: we’ve undergone a biological transformation of the course of our lives and also a cultural transformation of how we think about that course.”

      Delete
  24. Quiz Question

    What is the "rectangular oration of survival?

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    Replies
    1. “As medical progress has extended our lives, the result has been what’s called the “rectangularization” of survival. Throughout most of human history, a society’s population formed a sort of pyramid: young children represented the largest portion—the base—and each successively older cohort represented a smaller and smaller group. In 1950, children under the age of five were 11 percent of the US population, adults aged forty-five to forty-nine were 6 percent, and those over eighty were 1 percent. Today, we have as many fifty-year-olds as five-year-olds. In thirty years, there will be as many people over eighty as there are under five. The same pattern is emerging throughout the industrialized world.”

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  25. Discussion Question

    On page 48, Gawande says that what buoyed Felix was purpose. What do you think your purpose will be once you no longer have the capabilities that you do now?

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  26. DQ:

    Should elderly individuals be required admittance into nursing-homes or administered assisted-living conditions if their health conditions permit it? what if they object to it?

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  27. Quiz Question:

    Approximately how many Americans fall and break a hip annually?

    (pg. 40)

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  28. "We do not like to think about" losing our independence in old age, and so we tend not to prepare for it. What kinds of preparations would you advise, for yourself and your patients?

    I would argue that losing our independence is not inevitable and we should rather make choices that will ensure our ability to maintain our independence. There are plenty of elderly people that die with their independence and if we treat our bodies well we can achieve this as well.

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  29. DQ: After reading the story of Felix and Bella, do you think you would be able to make the sacrifices Felix gave as a care-giver.

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  30. Here's a video from a guy who has worked in both a hospital and nursing home as a nurse and the differences between the jobs
    https://www.youtube.com/watch?v=jOmmLOMg4Pc

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  31. Caleb, Robby, and Gavin:
    We talked about whether assisted living should be mandatory and some of the problems with it being obligatory.

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  32. Me, Darcy, and Phillip continued the discussion on taking old people's keys.

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  33. Heather, Sarah, Addison, and Nick:
    We feel that anyone over the age of 70 should have an eye exam to renew their driver's license

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  34. Here is a cool infographic that compares nursing homes to assisted-living facilities. http://www.skillednursingfacilities.org/images/vs-assisted-living.jpg

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  35. DQ: To what extent were you aware of the specific physiological declines of aging people?

    I was not at all aware of all of the specific things that cause old people to become weaker and have more problems. To be honest, I always looked down on people who were old and didn't have optimal health; I thought to myself, "they just aren't taking good care of their bodies." I now know that the human body naturally, gradually deteriorates. That part of the chapter was very enlightening for me.

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  36. QQ: What abnormal body part did the Geriatrics colleague of AG always examine closely?

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  37. Me and Kayleah Bradley discussed the types of activities that old people find worthwhile and if these activities would be considered safe to the younger generation.

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