Since 2009, Paula has written the New Old Age, a column about aging and caregiving that appears twice monthly, online and in the print Science Times. It draws on research findings from major journals, interviews with expert sources and the experiences of elders themselves. The New Old Age has explored an array of topics pertinent to older adults: ageism, senior living options, health issues from alcohol abuse to vaccination, overdiagnosis and overtreatment, employment discrimination, the effects of COVID-19, end of life issues.
New Old Age
Susan Hartt describes herself as an incorrigible optimist, drawn to change and challenge. After a long, successful career in marketing and public relations, she had reason to feel financially confident in her older years.
But three years ago, a bank foreclosed on her modest house in Hamden, Conn. “I don’t think I’ve ever been as anxious in my life,” she recalled.
Ms. Hartt, 79, had encountered a combination of adversities. After a late-life divorce she called “amicable and equitable,” she had no retirement plan; it had seemed unnecessary because her husband had a “substantial” 401(k). Successive jobs had grown less lucrative, and her freelance work dried up during the recession.
Anne Cotton had enjoyed her years at an assisted living facility in Corvallis, Ore. But at 89, her health problems began to mount: heart failure, weakness from post-polio syndrome, a 30-pound weight loss in a year.
“I’m in a wheelchair,” she said. “I’m getting weaker. I’m having trouble breathing.” On Sept. 30, Dr. Helen Kao, her palliative care doctor and a medical director at Lumina Hospice & Palliative Care, determined that she qualified for hospice services — in which a team of nurses, aides, social workers, a doctor and a chaplain help patients through their final weeks and months, usually at home.
Ms. Cotton, a retired accountant and real estate broker, embraced the idea. “I’ve lived a very full life,” she said. “I’m hoping I’m near the end. I need the help hospice gives.” Her sister died in Lumina’s care; she wants the same support. For older patients, Medicare pays the cost.
In 2019, Dr. Richard Leiter, a palliative care specialist, met a patient and the man’s wife in the intensive care unit at Brigham and Women’s Hospital in Boston. The patient, in his 70s, had heart disease and kidney problems. But he had been living at home and doing reasonably well until sepsis, a life-threatening bloodstream infection, sent him to an emergency room.
He had already spent several days on a ventilator, requiring drugs to keep his blood pressure from plummeting. Now, “his kidneys were no longer working and he wasn’t waking up at all,” Dr. Leiter recalled, adding, “We were very worried that he wasn’t going to survive.”
When the kidney palliative care team — including a nurse-practitioner and a social worker, as well as a consulting nephrologist — met with the man’s wife to discuss treatment, it proposed what is known as a time-limited trial, in which life-sustaining treatment continues for an agreed-on period to see how the patient responds.
Mary Ann Boor could see her husband’s Alzheimer’s disease progressing, and her responsibilities as his caregiver intensifying.
For years, David Boor had carefully taken diabetes medications. But as he grew forgetful, Ms. Boor had to start monitoring the doses and timing. She took over the driving and then the finances; she had to begin helping him bathe and dress.
The Boors, retired high school teachers who moved to a lakefront retirement home in Huron, Ohio, were managing on their own. “Then, about the time I thought maybe I should look into home health aides, the pandemic struck and I was leery of people coming into the house,” Ms. Boor, 71, recalled.
In April, as the coronavirus was rampaging through the Northeast, Larry Churchill considered what he would do if the pandemic caused medical shortages. Should he, a 75-year-old, direct care to younger people before him if he got sick?
He was in a good position to raise the question. A bioethicist retired from Vanderbilt University, he published an essay on the Hastings Center’s bioethics forum saying that he intended to avoid hospitals if they became overwhelmed and forgo a ventilator if equipment grew scarce. When a vaccine became available, he would move to the end of the line.
Fortunately, Dr. Churchill has not had to face such decisions. He remains healthy, writing and teaching, and hiking in the Blue Ridge Mountains. And enough ventilators were produced to meet demand.