aging

“Here comes the 60-year career” proclaims the Wall Street Journal

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I’ve got news for the WSJ, this time is already here for many people:

Get ready for longer careers. Probably much longer.

Charlotte Japp is setting the groundwork for it. Since graduating from college 10 years ago, Ms. Japp has worked in marketing at three companies in different industries and simultaneously launched Cirkel, a startup that connects younger and older employees for two-way career support.

Currently head of platform at ff Venture Capital in New York, Ms. Japp, 32, doesn’t see her career as linear, and doesn’t picture her progression as moving up a single, well-defined ladder. Instead, she envisions her career as long and varied—a marathon that will involve changing directions, with stops and restarts along the way.

“I know I’m going to have a career over a very long stretch and it won’t be just one thing,” Ms. Japp says. “Plus there’ll be more fluidity between periods of work, school and family.”

Millennials like Ms. Japp, as well as the generations behind them, are starting to think about their careers in a totally different way from their elders. They have no choice: Because they are likely to live healthily into their 90s or longer, they must learn to navigate 60-year careers instead of the traditional 40-year span.

But such a change will require a new mind-set when it comes to planning a career. Instead of advancing vertically up a single path, for instance, people will need to move sideways—and even down at times—as they traverse different jobs and multiple careers. They will have to make sure they have adequate income to sustain themselves over lengthy lives. They will need to figure out where they derive the most job satisfaction so they don’t burn out after decades of working. They will have to keep acquiring new skills to avoid becoming obsolete. And, if they can afford to, they may want to take occasional career breaks to balance their personal and professional lives.

I have noticed an increasing number of people you see working retail are at the ages — 70s and 80s — that you might not have seen as much previously.

I think an extension of the active working age is a good thing. Some studies have shown pretty clearly that sitting around doing nothing is a sure way to mental and physical decline.

However, having to shlep up and down ladders at big box stores carrying 40-lb boxes is not something that someone in their 80s should be doing.

When I worked at Lowe’s we had a number of elderly associates severely injure their aged backs and joints doing things that people half their ages would not have issues doing. Retail needs to make allowances for these people.

According to Lowe’s “Bob Adams, 93, works five days a week, helping customers get started on exterior home projects.”

My gawd, it’s been 25 years since “Titanic” was released

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An email this morning from The New Yorker informs me that it’s been 25 years since the release of James Cameron’s blockbuster movie “Titanic”. (The New Yorker used the occasion to hawk the legendary Anthony Lane’s admiring review of the movie back in 1997.)

This is one of those points of information that, when it arrives, makes you stop to marvel at the arc of one’s life — what time lies behind you and (depending on health and fate) what time lies ahead of you.

It’s a trick of the mind that it seems to me that “Titanic” was released not so long ago. But it’s 25 years!

I decided to do a comparison.

Twenty-five years back from when I was 18 would have taken me to the following historical milestones in 1953:

  • Nikita Khrushchev wins power struggle in Soviet Union after the death of Josef Stalin.
  • An expedition led by Sir Edmund Hillary is the first to reach the summit of Mount Everest
  • James Watson and Francis Crick determine the structure of DNA
  • Alfred Kinsey publishes Sexual Behavior in the Human Female
  • First clear evidence linking lung cancer to cigarette smoking
  • Elvis Presley recorded his first song
  • TV Guide debuts; on the cover of the first issue are Lucille Ball and her newborn son, Desi Arnaz IV
  • The first color television sets appear selling for $1,175
  • Transistor radios start to appear for sale

25 years is indeed a long time.

These reminders keep arriving that you are an old person, but most importantly an old person in the eyes of the rest of the world. It can mess with your head. You are the age of your grandparents.

This can be the last great mindfuck of your adult life, this coming to grips with your identity as an elderly person. And the fact that your time left could be 1] extremely short, 2] 30-40 years out, or 3] anywhere in-between.

In truth, the end could come at any moment for any of our human bodies living beyond the years that nature most often afforded us for the majority of the time-span of human existence.

I notice that some people of my generation are having a particularly hard time of it. And who could blame us?

Many of us were only 21 when MTV appeared. Our youth was truly being chronicled for the first time on television and online. It seems like such a short time ago that I was hanging out with friends in the DJ booth at New York City’s Roseland Ballroom as some of the biggest names in music performed at all-night parties. But it wasn’t a short time ago. It was 40 years ago.

Nobody in their 20s cares what I think about anything. In fact, ageism is a dish served up by much of society, even other old people.

It’s that encroaching invisibility to much of the rest of the world that is most difficult for many of my friends. And I’ve noticed in my circle of acquaintances that it’s the guys who were considered most hot who are having the hardest time of it.

I totally get it.

Think about it. Not long ago you could walk through a bar or restaurant or mall and turn every head. Now you can’t get waited on in a coffee shop.

I feel for anyone going through this.

As for myself, I’ve now lived through two pandemics — first AIDS, now COVID — during which I was considered high-risk. I was sure, at the beginning of each, that I was going to die. That means I confronted my mortality for the first time in my early 20s.

After watching that many people die, twice in adulthood, I consider every day I am upright and healthy to be a gift.

So I don’t care much that people in their 20s don’t see me.

And this makes me one of the lucky ones: I love solitude and my own company. I am never truly alone because I have so many things to occupy my mind and time.

But, man, 25 years since “Titanic.”

Weird.

Cheri Oteri in SNL’s “Titanic” alternate ending.

Age discrimination is rampant, mostly unchecked

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Interesting — and disheartening — research out of the National Bureau of Economic Research.

It shows that, among other things, if you move to blinded job interviews and callbacks (where the interviewer cannot ascertain the age of the job applicant, job bias against older people, the older applicants are treated better:

There is other evidence of age discrimination in hiring from nonexperimental approaches. In data from a single company hiring across multiple stores, a change in hiring procedure from in-person interviews to age-blind online assessments was rolled out over time. The in-person interviews, in which the interviewer could assess age immediately, led to lower hiring of older applicants. Older applicants fared better in the age-blind online assessments, getting more interviews — likely because of more work experience — but adverse treatment of older applicants emerged after the interviews, when age became apparent.

Not a shock, obviously. But it does point to the reasons I know several poeple in my circle alone who are over 60 and cannot find a job outside the most menial positions. These are highly qualified, higher-level intelligence individuals who are still just as sharp as ever.

Untreated hearing loss is a major risk factor for later developing dementia

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The evidence is already pretty clear that moderate -to-severe untreated hearing problems in the elderly contribute toward the development of dementia. Exactly how, and on what progression timeline, is not clear.

But treating hearing loss issues in the elderly will likely save a lot of money down the road on dementia-related care and housing, according to this article in today’s Washington Post:

Hearing loss in middle age — ages 45 to 65 — is the most significant risk factor for dementia, accounting for more than 8 percent of all dementia cases, research suggests. A 2020 Lancet report calculated that hearing loss approximately doubles the risk of dementia, akin to the increased risk caused by a traumatic brain injury. In addition, because hearing ability exists on a continuum, even subclinical hearing loss can mean a greater risk for dementia.

As a way of reducing the occurrence of dementia, addressing hearing loss is a win-win, said Frank Lin, the director of the Cochlear Center for Hearing and Public Health at Johns Hopkins Bloomberg School of Public Health. “It’s really common, it’s treatable, and there are interventions that come at no risk” that are underutilized, he said.

Preserving our ability to hear is foundational to public health “strategies that can best optimize the health of older adult population, so older adults are living a long and full life till the very, very end,” Lin said.

There are several overlapping hypotheses for why hearing loss in middle age is associated with a higher risk of dementia.

One hypothesis suggests that poor hearing increases the cognitive load on the brain, which needs to work harder, at the expense of other mental faculties, to decipher the garbled signals the ears send.

This may not be the best explanation, however, because those with hearing loss and declining cognition also struggle on tests that do not depend on hearing, said Tim Griffiths, a professor of cognitive neurology at Newcastle University in England.

Research on animals and humans has found that with the loss of hearing, the brain atrophies faster, especially in the temporal lobe — where key auditory and memory functions occur — potentially because of diminished use and stimulation.

Hearing loss may also cause aberrant activity in the temporal lobe, making it more susceptible to damage and pathologies associated with Alzheimer’s disease, Griffiths said.

In any case, the government finally got around to approving over-the-counter hearing aids — thanks Sens. Warren and Grassley and to the Biden administration — so let’s hope that more elders now get the hearing help they need.

Now what is really needed it to get Medicare and private insurance to cover these new, less expensive, assisted hearing devices.

Also see: Hearing aids are now sold over-the-counter. Here’s how to pick one.

Walmart is one place that is now offering over-the-counter hearing aids.

Starting and maintaining adult friendships can be hard

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Interesting article up at the NYT about friendships in adulthood and why those friendships — outside of the ones tied to your children and grandchildren — can be so hard to maintain. The Times interviews Dr. Marisa Franco, a psychologist who wrote the book “Platonic: How the Science of Attachment Can Help You Make — and Keep — Friends.”

First step: When you do meet people, help drown out self-defeating thoughts by starting out with the assumption that people like you.

New York Times: [Why is] assuming people like you is so important?

Franco: According to the “risk regulation theory,” we decide how much to invest in a relationship based on how likely we think we are to get rejected. So one of the big tips I share is that if you try to connect with someone, you are much less likely to be rejected than you think.

And, yes, you should assume people like you. That is based on research into the “liking gap” — the idea that when strangers interact, they’re more liked by the other person than they assume.

There is also something called the “acceptance prophecy.” When people assume that others like them, they become warmer, friendlier and more open. So it becomes a self-fulfilling prophecy. I never used to be much of a mind-set person until I got into the research. But your mind-set really matters!

Times: Still, putting yourself out there can feel nerve-racking. Any advice?

Franco: I suggest joining something that meets regularly over time — so instead of going to a networking event, look for a professional development group, for example. Don’t go to a book lecture; look for a book club. That capitalizes on something called the “mere exposure effect,” or our tendency to like people more when they are familiar to us.

The mere exposure effect also means that you should expect that it is going to feel uncomfortable when you first interact with people. You are going to feel weary. That doesn’t mean you should duck out; it means you are right where you need to be. Stay at it for a little while longer, and things will change.

Times: You also believe that it is critical to show and tell your friends how much you like them. Why is that?

Franco: Because we tend to like people who we believe like us. I used to go into groups and try to make friends by being smart — that was my thing. But when I read the research, I realized that the quality people most appreciate in a friend is ego support, which is basically someone who makes them feel like they matter. The more you can show people that you like and value them, the better. Research shows that just texting a friend can be more meaningful than people tend to think.

I know some people find texting to be impersonal, but I am the opposite. Whenever someone in our busy world takes the time to text me, it means a lot and it makes any day just a little more special.

Dr. Marisa Franco, author of Platonic: How Understanding Your Attachment Style Can Help You Make and Keep Friends Paperback

Alzheimer’s drug has Wall Street excited, but some researchers are still skeptical

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We ought not be surprised that the Wall Street Journal went all-in with its gush-y reporting about lecanemab, the Alzheimer’s drug from Biogen that has shown promise in clinical trials where other drugs of the same class have failed. Investors are drooling.

The reversal in investor sentiment is nothing short of massive. After so many drugs targeting amyloids had failed in clinical trials in recent years, there was growing skepticism of the “amyloid hypothesis,” the idea that targeting an unusual buildup of the protein in patients’ brains should slow dementia.

The results released Tuesday were unequivocal though. The drug reduced cognitive and functional decline by 27%, compared with a placebo. The data, which haven’t yet been published in a peer-reviewed medical journal, hit all of the trial’s primary and secondary endpoints, with many analysts calling it a best-case scenario. Importantly, while the drug did show safety concerns such as brain swelling, it looked safer than other candidates now making their way through clinical trials, wrote Michael Yee of Jefferies.

The positive data make it likely that the Food and Drug Administration will grant Biogen accelerated approval in January, with full approval coming later next year. The bigger question for investors, patients and society is what the Centers for Medicare and Medicaid Services will do. Biogen’s last approved drug for the disease, Aduhelm, received the FDA nod, but CMS effectively killed its commercial prospects by restricting it due to lack of meaningful improvement in health outcomes.

Biogen’s Aduhelm is the first approved treatment for early stage Alzheimer’s patients that may be able to slow the disease. WSJ explains how the drug interacts with brain cells, and why some doctors aren’t ready to prescribe it yet.

This time will be different, with CMS unlikely to “dig in and refuse coverage” due to the highly successful clinical data, wrote Brian Skorney at Baird. With about 2 million Americans suffering from early-stage Alzheimer’s, the costs to the insurance program could be meaningful, leading to higher healthcare costs for most seniors. Just Tuesday, CMS had announced that premiums and deductibles would be declining next year due to lower-than-projected spending on Aduhelm specifically. Now, the government might find itself paying for another pricey Alzheimer’s drug instead.

Just how pricey will be another important question. Biogen has probably learned some hard lessons from the backlash it got to the Aduhelm launch at $56,000 a year, so expect it to price lecanemab at closer to $20,000.

Still, the costs—and the payoff for investors—are likely to be astronomical.

That last part really jumped out at me. They could cut the annual price by almost 2/3 and still make ungodly profits. That shows you how much money big Pharma makes when nobody is keeping tabs on the price they are charging.

And, as Caitlin Owens article in Axios notes:

Some in the research community continue to question the focus on anti-amyloid cures and say success fighting Alzheimer’s will come in combination therapies like those used for heart disease, cancer and hypertension.

“Amyloid-clearing drugs will provide an incremental benefit at best and there is still a pressing need for the next generation of drugs focused on other targets based on our knowledge of the biology of aging,” said Howard Fillit, co-founder and chief science officer of the Alzheimer’s Drug Discovery Foundation.

This is a nightmare scenario for Medicare: an expensive drug of limited benefit that will mean higher premiums for millions of Americans.

More adult grandchildren are choosing to live with their grandparents as roommates

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The New York Times has an article up noting what some see as a definite trend: adult grandchildren living with their grandparents:

Grandchildren and grandparents have their own discrete needs. The grandchildren, still in school or in low-paying, entry-level jobs are looking for deeply affordable housing with very tolerant landlords. The grandparents — not as young as they once were — may be contending with decreased mobility, health challenges and isolation.

Further, both sides of the age divide come to the table armed with their own skill sets. The grandchildren can demystify smartphones, Twitter and paying bills online. “They get to feel useful in the relationship. They can help the person they love,” Dr. Saltz said. In turn, their grandparents can share family lore and recipes, give the grandchildren a sense of their roots — and a sense of perspective.

Those in their early 20s don’t have the experience to know that life will go on, “and older adults can provide that context,” Ms. Butts said. “We’ve survived disasters before. We’ve survived diseases before. We’ve survived recessions before.”

Mr. Elson and Ms. David, 25, shared a home office and, occasionally, meals. When her grandparents decamped for a few weeks to their condo in Stuart, Fla., Ms. David sorted the mail and flagged the utility bills. “I came from living with three friends in a rowhouse in Washington, D.C., to living with people who were a lot older,” she said. “Different energy, right?”

Yes, but good energy. “I feel very fortunate and grateful to have had that housing option,” Ms. David said.

“The idea of young adults living with grandparents really solves a lot of social issues,” said Rachel Margolis, an associate professor of sociology at the University of Western Ontario in Canada who studies the demography of grand-parenthood. “Most older adults want to age in place, and they need help to do so.”

June Iseman, 90, shares quarters on the Upper East Side with her granddaughter Ally Iseman. “My granddaughter moving in with me means I’m not alone,” she said. “Even though she sleeps until 11 and goes to work at noon, the fact is, she’s here. Because I’m not 100 percent OK in terms of my health, that’s a good thing.”

The article adds that living with grandparents, sometimes as the sole parental figure, has been much more widespread among many children of color for a very long time.

Gov’t task force recommends wide U.S. screening for anxiety disorders

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In a first, a government panel recommends all adults under 65 be screen regularly for anxiety disorders.

Adults under the age of 65 should be screened for anxiety disorders and all adults should be checked for depression, a government-backed panel said, as many Americans report symptoms of these mental-health conditions following the height of the Covid-19 pandemic.

The draft guidance released Tuesday marks the first time that the United States Preventive Services Task Force has made a recommendation on screening adults for anxiety disorders. The move comes months after the task force issued similar draft guidance for children and adolescents.

“This is a really important step forward,” said Arthur C. Evans, chief executive at the American Psychological Association. “Screening for mental-health conditions is critical to our ability to help people at the earliest possible moment.”

The task force said that there wasn’t enough evidence on whether or not screening all adults without signs or symptoms ultimately helps prevent suicide. The group didn’t recommend for or against screening for suicide risk, but called for more research in the area.

The task force, a panel of 16 independent volunteer experts, issues guidance on preventive-care measures. Health insurers are often required to cover services recommended by the task force under a provision in the Affordable Care Act.

More than 30% of adults reported having symptoms of an anxiety disorder or depressive disorder this summer, according to estimates from the federal Household Pulse Survey. The percentage of U.S. adults who received mental-health treatment within the past 12 months increased to 22% in 2021, up from 19% in 2019, according to the Centers for Disease Control and Prevention.

Mental-health screening often occurs in doctor’s offices, where patients fill out questionnaires during routine checkups or other appointments. The goal is to spot at-risk people who might not be showing obvious signs, so that the person can get the correct diagnosis and potentially get connected to care before they reach a crisis point.

As for people over 65, the article notes that “some anxiety-disorder screening questionnaires emphasize issues with sleep, pain and fatigue, which also often increase with age.” So screening older adults for those risk factors might turn up a lot of older people who are, you know, just regular old, tired and creaky.

It does strike me that they ought to come up with different a different screening regimen for older people, rather than just deciding to not issue screening recommendations as all.

Nursing homes are tossing onto the street those patients who cut too much into their bottom line

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Have you ever heard of the term “facility-initiated discharges”?

I had not until I read this article in The Bulwark by Bill Lueders, writing about his mother:

Last fall, my then-97-year-old mother, Elaine Benz, was evicted from the senior living facility known as the Regency, in New Berlin, Wisconsin, where she had lived for ten years. My sister, Diane, was told on Thursday, October 28, that our mom would not be allowed to return the following morning, as planned, from a physical rehabilitation center to which she had been sent following a fall. The Regency had decided her needs had gotten too great.

It was a staffer at the rehab center and not someone from the Regency—officially ProHealth Regency Care Communities New Berlin—who broke this news to Diane. As she recalls, the staffer told her that the Regency would turn Elaine “away at the doors” if the center tried sending her back. We needed to find her a new place to live.

That’s it! That’s all it took. The facility looked for any excuse to get his mother out the door. Once out the door, they just refused to let her back in.

A 97-year-old woman!

Lueders has had to become an expert regarding this common practice as he fights to protect his mother:

But in general, I learned, there is nothing unusual about it. What happened to my mother happens to elderly people in America all the time. A facility will conclude that a patient has become too much work or is no longer a good deal financially and find a way to get rid of her. Often, as with Elaine, nursing homes and other senior care facilities evict residents while they are temporarily moved to another facility.

Nicole Shannon, a frontline attorney for the Michigan Elder Justice Initiative, told me how this sometimes works: “The nursing home will say, ‘Well, it sure seems like you need a psychiatric consult, we’re gonna send you to the hospital.’ The hospital turns around and says, ‘You know, this person does not require psychiatric care. You can go back to your nursing home now,’ and the nursing home says ‘Nope, no thanks, you’re no longer welcome here.’”

Shannon’s group has seen cases in which nursing home residents have had discharges approved for transfers to a homeless shelter, to the home of an unwilling relative, to a house that no longer existed because it had burned down, and to an apartment the person no longer rented.

On November 18, the day after we found a new place for Elaine to live, the Office of Inspector General for the U.S. Department of Health and Human Services released a forty-page report on problems regarding “facility-initiated discharges.” It noted that “discharge/eviction” was from 2013 to 2019 the single most frequent complaint recorded by the federal Long-Term Care Ombudsman Program, which operates in all fifty states and the District of Columbia.

The report says that several of the ombudsmen surveyed “volunteered that nursing homes have said that they would rather accept a deficiency or enforcement penalty than keep the resident.” Other ombudsmen “opined that stronger enforcement actions could help to reduce these discharges.”

I cannot imagine being 97 years old and essentially being told that, while you were at some bogus pretext appointment somewhere, we’ve locked you out of your home and, good luck, whatever the state can do to us is nothing compared to what it costs us to keep you in your home.

You might also want to see this article from last April detailing how Wall Street private equity has been gobbling up the nursing home industry.

We are all going to end up living in a Wall Street-owned dystopian society because, while the rest of us are wasting our time fighting about the southern border and drag queen story hours, America is being sold to the highest billionaire bidder.

Bill Lueders’ mother, Elaine Benz.

Promising results from initial study of possible new way to stimulate memory in older adults

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So, this is interesting news about a possible new way to stimulate memory in older people:

Pulsing electrical currents through the brain for 20 minutes can boost memory for older adults for at least a month, according to a new study.

Around 8 percent of people in the US get diagnosed with Alzheimer’s disease or dementia as they get older — significantly impairing their memory — and an even larger group of older adults has some degree of age-related memory loss. This new study is only a first look at a potential solution. But easy, quick treatments like this one could become even more important as the world’s population rapidly ages — especially if future research shows that it can help with more serious cognitive conditions.

The brain stimulation done in this study, published Monday in Nature Neuroscience, came from a swim cap-like device studded with electrodes positioned to deliver the electric current to specific areas of the brain. The research team was interested in two main areas: one that’s linked with working memory (which holds information temporarily and overlaps with short-term memory) and another linked with long-term memory.

The research team divided 60 participants between the ages of 65 and 88 into three groups: one group wore the device but didn’t get any electrical stimulation; the second received stimulation in the region associated with working memory; and the third received stimulation in the area associated with long-term memory. For four consecutive days, the participants received the treatment (or fake treatment) while performing a memory task where they were read a list of 20 words and asked to recall them. The researchers looked to see how often they remembered the words at the beginning of the list (long-term memory) and the end of the list (working memory).

Both working and long-term memory improved over the course of the four days, the study found. “We watched the memory improvements accumulate over time with each passing day,” said study author Robert Reinhart, a professor in the department of psychological and brain sciences at Boston University, during a press briefing. And participants still had improved memory one month later.

And it might have applications to other neurodegenerative conditions.

Too early to tell, of course.

But if it’s in Nature Neuroscience, there’s a pretty good chance that some high-caliber reviewers thought it to be interesting enough to publish in that high-impact journal.

You can read the rest of the The Verge article at this link.