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
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.
Joey Himelfarb estimates that in his 25 years in sales, hawking everything from Hewlett-Packard computers to cars and swimming pools, he has been laid off or downsized at least a half-dozen times.
The most recent occasion came in April, when he got a call from the chief executive officer of the start-up in northern Virginia that had hired him 10 months earlier. The company sells systems that extract data from video. Mr. Himelfarb worked remotely from his apartment in Belle Mead, N.J. “I was working my tail off,” he said. “We were busy.”
But now, the boss told him, because of the coronavirus pandemic, the company could no longer afford his mid-five-figure salary.
Come January, there may be many more people like Mary Prochaska.
Ms. Prochaska, 73, a retired social worker in Chapel Hill, N.C., has advanced chronic kidney disease and relies on dialysis to filter waste from her blood while she awaits a kidney transplant, her second. But she no longer visits a dialysis center three times a week, the standard treatment. There, nurses and technicians monitored her for four hours while a machine cleansed her blood.
Instead, she has opted for dialysis at home. “It’s easier on your body and better for your health,” she said. “And far better than exposing yourself to whatever you might get from being in a group of people” at a center during a pandemic.