Some active seniors want to end their lives before there is any disabling illness

Here’s an op-ed in the New York Times, Aug. 31, by Paula Span, “A Debate over ‘Rational Suicide’”, link.

My take is that when I was growing up, most seniors didn’t live very long when they developed serious illnesses because not much could be done.  People did not have the expectation of a long period of disability at the end of life, so no one had to think about it this way.  

I had a piano teacher who went into the hospital in May 1958 with colon cancer, apparently.  She died in two weeks.  I do recall that everyone dreaded colostomy and no one lived very long with one.

Now, it’s pretty important to make your wishes known.  The trouble is that malpractice fears and Medicare policies often force physicians to look for developing asymptomatic disease and to treat them. 

But, screening for diseases (like colonoscopies) may really make sense when started early enough in middle age.  But I doubt that aggressive treatment later in life can make much sense.

  

My own father died of aggressive prostate cancer just before his 83^rd birthday (New Years Day, 1986).  But he was ill only for the last four weeks of his life. Until then, he did what he wanted.  He turned down what the most aggressive treatment would have been (essentially castration and feminization) as violating his own sense of sanctity.

John McCain's mother seems healthy at 106 years of age

Roberta Wright McCain, John McCain III’s mother, is now 106 years old and appears to be in amazing health for the circumstances.

Her biography includes eloping in Mexico in 1933 to a Navy ensign. 

My own mother died shortly after her 97^th birthday in December 2010, but had undergone coronary bypass surgery in May 1999.  At the time, at age 85, her life expectancy with the surgery was seven years. She got eleven, eight of them without much decline. The official cause of death would be aortic stenosis.

PBS examines the growing shortage of home care workers and challenges of unpaid family care

Here’s a rather sobering interview on PBS conducted by Paul Solman on the growing shortage of home care workers. 

It’s obvious that tighter legal immigration would tighten the shortage.

Martha Kwant, in particular, makes a point of the personal aspects.  Americans aren’t as willing to give up their privacy or expressive independence to care for elderly relatives as people in other cultures are.

There is also discussion of giving home care workers higher pay, benefits, and more training and more authority – but how will be pay for it?

Many seniors declare bankruptcy even before Social Security starts; many work in retail or pimpy sales jobs

Tara Siegel Bernard has a booklet-length article in the Sunday New York Times on Sunday Aug. 5, “Too Little, Too Late: Bankruptcy Books Among Older Americans”, link. 

She notes the numbers of filings in the year or two before Social Security eligibility, which creeps up.  More and more old people are taking minimum wage jobs in retail (with some risk of security to themselves).

I went through the “paying your dues” phase of job interviews for a few of these in the 2000s, even before I worked as a substitute teacher. 

Ironically many of the jobs are cheesy sales pyramids or multi-levels (starting out with hotel weekend sessions) in areas like cash flow.  Many of them are in debt collecting or credit counseling, of people in much worse shape than you are.  They call it, people skills.

Some were in “development” – raising money for non-profits, which has come to seem demeaning.

  

The established custom in the past of expecting salaried professionals to retire as early as 55, and then freezing pensions and replacing them with 401(k)’s with too much money in an employer’s own stock, is backfiring.  I came out of this OK but a lot of people didn’t.  I came out of 2008 OK because I saw it coming in time.  Is that capitalism?    (No, it wasn’t insider trading.  It was a feeling you can’t get something for nothing forever.)

New studies suggest anti-Alzheimer's drugs should be started much sooner; at age 85, 50% of people have symptoms

Science Daily reports on an accepted drug, memantine, which may halt the process of neuron destruction in Alzheimer’s disease long before there are symptoms. 

  

Moreover, the article explains and diagrams the process where amyloid beta oligomers enter brain neurons and prime the cells for death.

The article makes the startling claim that 50% of people at age 85 have symptoms of Alzheimer’s serious enough to lead to fatality in even five years if they don’t die of something else.

It also describes a loss of 30% of the cells in the cerebral cortex, responsible for “content” (not wakefulness) in brain function, as typical in Alzheimer’s.

My mother took Namenda (memantine) in the last year (2010) of her life (as well as Aricept).
  

I was told that when adults start on these medications, legally they cannot be left alone for significant periods. However that would not be true if the treatment is started before symptoms.

CNN has a distantly related story that regards Alzheimer’s as a malignant process that can be treated with immunotherapy.

More public pension recipients are likely to get stiffed

Public employee pension funds seem to keep drifting into deeper trouble, as Sarah Krouse writes in this article for the Wall Street Journal July 31.   Central Falls RI and San Jose CA get special attention.  The "Pension Hole" is bigger than Japan's economy.

Put bluntly, it looks like more former public employees will get stiffed.

It doesn’t seem as if PBGC  applies.

  

Charles Murray’s controversial proposal for Universal Basic Income back in 2016 would have eliminated Social Security and all other government handouts.  Not sure about public pensions.

What kinds of necessary elective surgery can be disruptive to productive seniors who live alone?

One big concern for a retired person who lives alone and needs to keep his own systems running (that is, in my case, a set of blogs), a major concern would be any elective surgery that requires any extended hospital stay or rehabilitation away from home (Medicare pays for 20 days, and typically most supplements handle up to about 100).  This can potentially become a very big deal.

Once you reach my age (75) there are really not that many situations where this is all that likely.  I don’t see ever having a bone marrow transplant.  But it is true that invasive procedures (like coronary bypass surgery) can extend lives considerably in many elderly;  when I was growing up they were not possible, so I did not internalize the idea of facing this.

In fact, my own mother had triple bypass surgery at age 85 in May, 1999 and I did not realize this was even possible at her age when it was proposed. She would have eight good years, and three more not so good.

The official cause of her passing in 2010 was aortic stenosis.  That means it is in the family, maybe.
  

Barbara Walters, former ABC 2020 host, had aortic value replacement surgery in the summer of 2010. She had reported some shortness of breath on climbing.  She reported that after the surgery she was quite weak for some time, and needed the summer before returning to any work.

The condition is likely to be confirmed by an echocardiogram even after minimal symptoms.

  

Sometimes lathroscopic surgery, which is much less invasive (through the groin) is possible for some of these problems, with a much shorter recovery.