Markham's Behavioral Health

Unlike Fine Wine, Crabby People Don't Age Well

Reuters HealthDay reported on 02/15/08 on a study in Health Psychology which found that crabby, negative people don't age well.

Researchers who studied a survey of almost 700 older adults found that those who got along with their relatives, friends and neighbors were less likely to report health problems and physical limitations.

The findings don't prove a cause-and-effect relationship between social life and health. Still, "the take-home message is that conflict in your life may have important impacts on your physical health," said study lead author Jason T. Newsom, associate professor at the Portland State University School of Community Health in Oregon.

There's nothing really new about a supposed link between attitude and health, but Newsom said his study was unique, because it looked specifically at interactions between people. Newsom and his colleagues looked at the results of a multi-year national survey of people aged 65 to 90. A total of 666 people completed the survey, in which researchers asked them questions about their lives and their health. Many of the questions were designed to reveal whether the study participants were prone to have "negative social interactions" with other people, Newsom said. The questions asked whether "people have interfered or meddled in your personal matters, have they acted unsympathetically or been critical of you. We asked them in a very general way," he said.

The survey didn't ask whether the participants were the instigators of negative encounters -- by being crabby or cranky, for instance -- or the victims of others who made their lives difficult.

The researchers found that those who reported more negative social encounters suffered greater declines in health.

I have noticed this phenomenon in my personal as well as my professional life that people tend to age and die as they have lived. There is some idea that negative people "mellow" as they get older, but I don't see it. In fact, it seems to me that people's personality traits tend to become more accentuated. Negative people have less energy and become more isolated so they may appear more mellow but their interactions often continue to be problematic.

I remember B.F. Skinner, the pioneer of behavioral psychology pointing out that people can grow old gracefully or bitter. I choose gracefully.

Link: MedlinePlus: Unlike Fine Wine, Crabby People Don't Age Well.

What is the role of Elder in our current society?

In the letter from the editor, Sarah Ruth van Gelder, in the Fall, 2005 issue of YES! magazine says a number of good things like:

"In traditional cultures, elders have often been the ones who take a stand for the well-being of not just  themselves but of future generations."

and

"The good news is that the largest cohort of elders ever to live at one time has arrived. What we don’t know is what sort of leadership these elders will offer and what sort of life they will choose to lead."

and

"The truth is we need each other across the generations. And in this time of mounting crises, we need our elders to act as elders and take a stand for the next seven generations."

I have heard this idea before that the role of the elder is to take a stand for the next seven generations but it has taken on new meaning for me now as I reflect on my own aging and what I want to do yet before I die.

How will the Iraq war affect the next seven generations? Global warming? Not providing our children with health care? Locking up so many people of color in prison? Bashing and discriminating against immigrants who pick our crops? Moving to a global economy and screwing our neighbors out of jobs so Wal Mart stock stays high? The increasing disparity in our democracy where the government favors the rich top 1% and screws the rest of the people?

I think as we enter this campaign season choosing leaders for national leadership we should be thinking about the next seven generations and not our stock portfolios.

It's a question of values in the end - do we look out and speak up for the common good or do we protect what's ours?

Today I am adding a new category on my blog called "Elderhood". I will be exploring what it means to be an elder in our current society.

To Sarah Ruth van Gelder's whole commentary which I highly recommend, click on the link below.

Link: Letter from the Editor by Sarah Ruth van Gelder.

Love and Aging

WBUR in Boston has a great radio show called On Point, and on November 30, 2007, Jane Clayson filling in for the usual host, Tom Ashbrook, had a great show on Love And Aging which is well worth listening to. It lasts about 45 or 50 minutes. Here is a brief synopsis from the On Point web page:

They say love changes everything. But time changes love.

Just how much it can change became front page news last week, when the family of retired Supreme Court Justice Sandra Day O'Connor revealed that her husband had fallen in love with a fellow Alzheimer's patient.

And she was happy for him.

What happens to the part of ourselves that loves as the mind ages, and changes?

Our culture celebrates young love. But mature love is filled with passion too, even as our memories leave us. Seniors living for the moment - not the past.

This hour On Point: how we love when we grow old.

To go to the web page to listen on line or download the show, click on the link below.

Link: On Point : Love and Aging.

Improving the lives of people with Alzheimer's

On the Commonwealth Fund web site there is an interesting article about an activity which can be used in group settings with patients with Alzheimers involving a story telling activity.

"TimeSlips is a simple and inexpensive group storytelling technique that allows nursing home residents with Alzheimer's disease and related dementia to express themselves without relying on failing memories and deteriorating language skills. It has been shown to successfully engage residents, improve their ability to communicate, and gives them an opportunity to have fun and laugh. The technique also appears to improve relationships between nursing home residents and their caregivers."

The benefits of such a program are described in the article:

"A study of the TimeSlips method applied in one nursing home found that, over a period of weeks, residents' verbal communication skills improved, their depression lessened, and caregiving staff gained a better understanding of ADRD residents."

For more information click on the link below.

Link: Fund Digest> November/December 2005> November 17, 2005.

Sleep Pills May Do More Harm Than Good in Elderly

Reuters reported on November 11, 2005 on a study in the British Journal Of Medicine which found that the benefits of sleeping pills like Restoril and Ambien were not worth the side effects and potential adverse consequences of using them in people over 60. The researchers said something which I have believed and said for some time and that is, behavioral approaches and psychotherapy are more effective with fewer risks.

Compared with placebo, sedative use was associated with statistically significant improvements in sleep quality, total sleep time, and the number of nighttime awakenings, Dr. Usoa Busto, from the Centre for Addiction and Mental Health in Toronto, and colleagues note. However, the actual improvements were modest in scope.

Several adverse effects were more common with sedative hypnotics than with placebo, Busto's group reports in the British Medical Journal. Sedative use greatly increased the odds of thinking difficulties and daytime fatigue.

The likelihood of an untoward event was even greater in subjects who were at high risk for falls or mental impairments, the report indicates.

"Although the improvements in sleep variables obtained from prescription hypnotics are statistically significant ... the clinical benefits may be modest at best," the authors conclude. Behavioral therapies may be a better option for older people with insomnia, they add.

Link: MedlinePlus: Sleep Pills May Do More Harm Than Good in Elderly.

Sunset Story, the film

Where do social activists go to die? They go to Sunset Hall in Los Angeles.

Sunset Story is a documentary released in 2003 which follows the lives of Irja Lloyd and Lucille Alpert who become fast friends in this assisted living facility. Lucille finally dies at age 95 of esophogeal cancer and Irja is devastated to loose her friend, but Irja keeps on protesting.

I love this film about these two old ladies as they harvest the bounties of their lives in discussing their views of themselves, their neighbors, and the world.

I recommend this film.

Link: Sunset Story.

Assisted Living, the film

Assisted Living is a docudrama, distributed in 2003, which is fiction but set in a real setting.

"Assisted Living" chronicles a day in the life of Todd, a janitor who spends his days smoking pot and interacting with the residents for his own entertainment. Todd's detachment from his surroundings is compromised only by his unlikely friendship with Mrs. Pearlman, a resident who begins to confuse him with her son. On this particular day, Todd must choose whether or not to play the part. "Assisted Living" is shot and staged in a real nursing home and gains much of its unique effect and style from the participation of actual residents and staff members. During much of the film, it is impossible to distinguish between what is real and what is fiction."

There are times when this film is funny, and times when it is full of pathos just like real life. The depiction of staff and residents strike me as very real and fit with my experience of these kinds of facilities.

I recommend this film.
Link: Assisted Living (2003).

Spouse Caregivers More Likely to Scream at Patients

"Elderly, sick or disabled men and women who rely primarily on their spouse for care are more likely to be to be screamed at, threatened or otherwise subjected to potentially harmful behaviors than those whose care is not provided by a spouse, new study findings show.

Spouse caregivers are also more likely to subject their infirm husbands and wives to such behavior when they are themselves sick or when their spouse has many care needs.

"Elderly people taking care of a sick spouse are at higher risk of committing verbally and emotionally abusive acts when the spouse needs high levels of help and when the caregiver...is in poor health," study author Dr. Scott R. Beach, of the University of Pittsburgh, told Reuters Health.

"The stress and strain of caregiving can wear a person down to the point where the quality of care they provide is compromised," he added."

I have noted the heroic efforts of family members to care for a sick and infirm relative. These caregivers seem to have bought into some cultural idea that they are shirking their duty or not strong enough if they cannot provide for the needs of an infirm relative 24/7. I often tell them they could continue to function in this way if they were rich and could afford a housekeeper, cook, valet, butler, and a staff of 5 private duty nurses for round the clock every day of the week care. They laugh when I ask if they can afford this size of a private household staff.

Then I gently say, "Maybe it's time to consider getting X the nursing care they require and you quit trying to do a humanly impossible job."

The study mentioned above appeared in the February, 2005 issue of the Journal of the American Geriatrics Society.

Link: MedlinePlus: Spouse Caregivers More Likely to Scream at Patients.

Gambling Among Older, Primary-Care Patients: An Important Public Health Concern

Laughing about the grandmotherly bingo queens might be funny until we find out that grandma just gambled away the rent, or didn't have enough money left after her loses for groceries or the light bill.

With the increase in gambling outlets whether they are lottery outlets, VLTs, casinos, or internet gambling, we will see an increase in problem gambling in our society in the coming years. This addiction hits especially hard on senior citizens with fixed incomes, time on their hands, who enjoy an "outing" on the bus to the casino as a way to cope with lonliness, and isolation.

Co-moribity with other substance abuse and psychiatric disorders is high.

The study published in the January, 2005 issue of the American Journal of Geriatric Psychiatry found that 2/3s of the study participants had gambled in the previous year, and for 10% it posed a problem with participants saying that they gambled $100.00 or more on a single bet, or bet more than they thought they could afford to loose.

"Of 843 screened patients completing the gambling questionnaire, 69.6% reported that they had participated in at least one gambling activity in the last year. At-risk gamblers were defined as those who reported having bet more than $100 on a single bet and/or having bet more than they could afford to lose in the last year. Of those responding, 10.9% were identified as at-risk gamblers. The strongest predictors of at-risk gambling behavior were being a binge drinker, presence of current posttraumatic stress disorder symptoms, minority race/ethnicity, and being a VA clinic patient. Subjects with mild-to-moderate cognitive impairment were just as likely as those without impairment to gamble and to report at-risk gambling behavior. At-risk gambling behavior was not significantly associated with gender, current or past depressive symptoms, or cigarette smoking."

Link: Gambling Among Older, Primary-Care Patients: An Important Public Health Concern -- Levens et al. 13 (1): 69 -- American Journal of Geriatric Psychiatry.

Bush's prescription drug benefit is Social Security's real problem

I didn't vote for President Bush but I keep trying to give him the benefit of the doubt because he is my President. But ever since reading Molly Ivins book, "Shurb" I have known that the guy is a bungler. Even with his MBA from Harvard, and my respect for Harvard has gone way down knowing that they granted this guy an MBA, he seems to bungle and bankrupt every thing he manages.

In this post, I will pass over the fiasco known as the Iraqi war which is bankrupting the U.S. and forcing our children and grandchildren into the greatest debt ever known in the history of the country. In this post, I want to point out what Alan Sloan says in the current issue of Newsweek (12/27 &01/03/05) about Bush's handling of Social Security.

"Bush talked about Social Security's being a $10.4 trillion problem. That's how much you'd have to give Social Security today for it to continue paying benefits indefinitely under its current formula. But the shortfall in Bush's Medicare drug program is $17 trillion. In other words, the problem that Bush himself created a year ago is two thirds again as large as Social Security's problem. What's more, the drug plan starts costing taxpayers big bucks just a year from now, in 2006. We'll borrow it, of course. Social Security, for all its flaws, will take in more than enough cash to pay for itself for a dozen years even if nothing changes. So which is a "crisis"? A $17 trillion problem that starts next year, or a $10.4 trillion problem that starts in 2018? You don't need a math genius to answer that question."

I will be eligible for Social Security in three years when I turn 62 or I could wait seven years until I turn 66. I am not that worried. I am guessing that my drugs and my pension check will be there for me. But when my oldest child, my daughter, Kate, reaches 62, 24 years from now in 2029, I'll probably be dead and gone, but maybe not, and what will there be for her? Probably a lot of laughs when we reminisce, if I am an 83 year old wise man, about the Presidency of one George Walker Bush back in 2005 and something.

We're going to have watch this guy and his administration like a hawk and let our congresspeople know what we think about his cockamamie policies. Talk to your friends too because there is strength in numbers. Remember, the U.S. is suppose to be a democracy for the people and by the people not a corporation run by the wealthy elite for the stockbrokers on Wall Street.

Link: MSNBC - Peddling a Crisis (The Wrong One).