Applying for Medicare

November 30, 2011

A significant step in most people’s retirement is applying for Medicare.

After spending several days adjusting to the idea that I am actually old enough for Medicare, I decided to take the plunge. Actually, I am three months shy of my 65th birthday but Medicare suggests that one apply three months in advance.

You can apply at a Social Security Office or on-line. Since my blood pressure tends to surge while standing in lines in government offices, I opted for the on-line approach. I am pleased to report it worked well.

The entire process took just a few minutes and was mostly straightforward. The only quirky part was in the section describing what medical coverage I have now, and what I will have after age 65 from my previous employer. None of the boxes provided seemed to provide the opportunity to answer clearly. Fortunately there is a message box included in the on-line form which I was able to use to explain the situation. A push of the button and I was officially an applicant.

Today (about 10 days after applying) I received a “Notice of Award” telling me I am entitled to Medicare hospital and medical insurance beginning next year (I knew that). It also told me that “we will send you a Medicare card” and that “you can enroll in a Medicare prescription drug plan (Part D)” which I won’t do because my former employer’s plan is better.

More ominously, the notice also told me “The benefit in this letter is the only one you can receive from Social Security.” That is wrong since I am also entitled to a retirement benefit (at least until Congress takes it away) but I attribute the errant sentence to poor draftsmanship in the government letter writing department.

More interestingly, the letter then went on at significant length to tell me what to do if I disagreed with the decision to send me a Medicare card including filing an appeal, getting representation, seeking reconsideration, getting a hearing, appealing to the Appeals Council, filing suit in Federal Court and directed me to the enclosed pamphlet which described all of this in greater detail. Whew!

The questions I wanted answered most were how much is this going to cost me and what are my payment options. On these topics there was no information provided. I am assuming all of this will come in due course. Time will tell.

R. Kevin Price

© 2008-2011 R.K. Price


Brain Exercise in Retirement

September 23, 2011

A successful retirement is based on staying engaged intellectually, physically and socially. A subset of intellectual engagement is keeping the brain healthy. How can we do that?

Our brains are constantly changing. The brain that began reading this blog entry is not the same brain that will finish reading it. This is due to the brain’s plasticity – its ability to create neurons (cells that process and transmit information) and neural connections throughout our lives. Our brains change throughout our lifetimes and we can help shape those changes. With proper health care and physical and cognitive exercise we can even increase our intelligence levels.

Proper brain care begins with many of the same things that are important for the other parts of our body: healthy diet, appropriate body weight, physical exercise and adequate sleep.

Brain exercise requires using our memory. There are many types of memory, but, at the risk of oversimplification, there are two major categories of memory: short-term or working memory and long-term memory. We put information into our short term memory for use in the near term, e.g. phone numbers, directions, where we put our keys, the name of the person we just met, daily to-do lists, recipes. The more we work with information from our short term memory – use it multiple times, manipulate it, share it with others – the more likely it is to enter into our long-term memory. Long term memory is like a huge storage center full of interconnected information we have sent there as well as sensory and emotional experiences.

Working memory tends to be low in young children, high in middle adulthood and to decline with age. The decline is part of the normal aging process. The good news is that working memory can be improved with a deliberate effort.

We can begin that effort by simply paying attention. If we are not paying attention or maintaining a reasonable level of interest in what is going on around us, not much will be going on in working memory. Similarly, if we try to multitask or let ourselves be easily distracted our working memory will be weaker.

We also need to work with or manipulate our stored memories to strengthen our working memories. We do this naturally as we live our daily lives, setting goals and schedules, solving problems, handling changes in information, setting priorities, organizing etc.

In addition, there are simple exercises and games that can stimulate and enhance our working memories. The key is to manipulate information we already have stored. Some examples:

  • Recite the alphabet backwards.
  • Spell words backwards. Start with five letter words and work your way up to longer ones.
  • Take a brief look at a set of pictures and then try to describe what you saw in as much detail as possible.
  • Write down a series of numbers in the morning and try to remember them for the rest of the day.
  • Pick a letter of the alphabet and see how many words you can name that begin with that letter in the space of a minute.
  • Name the States from east to west, west to east, south to north, north to south
  • Play video games that require you to manipulate information.
  • Play card games – poker and bridge are particularly good.
  • Learn to dance or learn to dance a new step.
  • After you see a play or a movie, write down its essential plot line.

There are also books, courses and web sites that can be helpful. The Teaching Company offers a course in Optimizing Brain Fitness. The Lumosity website offers interesting and progressively challenging brain exercises.

R. Kevin Price

© 2008-2011 R.K. Price

Successful Aging in Retirement

June 30, 2011

“Successful Aging”  is a broader topic than “successful retirement.” We begin to age as soon as we are born and we all age at the same rate – if you and I are born on the same day, after 23,731 days we are both 65 years old.

But we may differ substantially on how much we have aged mentally and physiologically. Some of the difference can be traced to genetics and there isn’t much we can do about that (at least yet). But much of the difference results from the lifestyle choices we have made throughout our lives, and continue to make as we move into the future. Better lifestyle choices can help us age more
successfully and delay senescence.

But how do we define “successful aging”? Long life? No loss of mobility? Freedom from disease? Staying sharp mentally? Avoiding a nursing home? Remaining happy?

Robert Havighurst, writing in the first issue of the journal The Gerontologist in 1961, defined it as “adding life to the years” and “getting satisfaction from life.” R.C. Gibson said it entailed “reaching one’s potential” and achieving a level of physical, social and psychological well-being” that is pleasing both to yourself and others.

John Rowe and Robert Kahn in their book Successful Aging (Pantheon, 1998) define successful aging as the ability to maintain three key behaviors or characteristics:

1. low risk of disease and disease-related disability;
2. high mental and physical function;
3. active engagement with life.

Another way of putting it is that there are three essential components over which you have some control: physical, mental and social.

There is a plethora of research which demonstrates that to maintain physical well-being we need to exercise and live healthy life styles. We can also become informed about the physical aging process – what is normal and what isn’t. It is surprising how little most of us know about what to expect as we age and what we can do to offset age-related declines.

To maintain mental/cognitive well-being we need to exercise our brains in new and challenging ways. Ball-room dancing, solving challenging puzzles, learning a foreign language are all excellent activities. And it is important to note that recent research proves that you can continue to learn and develop at any age and stage of life. Don’t believe the old adage “You can’t teach an old dog new tricks”
because you can.

The third component of Rowe & Kahn’s model is that of remaining actively engaged with life. Remaining socially engaged or meaningfully connected can be harder if you are no longer in the workforce and your built-in social circle of co-workers is no longer available. There are many ways to fill that gap, ranging from joining clubs to spending more time with family, taking classes or
volunteering. Many individuals find that in retirement there is now the time for creativity, exploration, continued learning and for giving back.

So while successful aging and successful retirement are different topics, they are clearly related. Focusing on both aspects of growing older can help us fill our senior years with a sense of satisfaction, meaning, achievement,  fulfillment and well-being. That’s my definition of successful aging.

R. Kevin Price

© 2008-2011 R.K. Price

Top Ten Myths of Aging

March 30, 2011

At whatever age we retire (or even if we never retire), one inevitability is that we will continue to grow older. We will age. There are many myths and stereotypes that depict a negative image of growing older and these can affect our self image and attitude if we buy into them without critical analysis. So let’s briefly examine some of the top myths and stereotypes of aging:

Myth #1: All older adults are the same.

I Iike to say if you have seen one 65 year old, you’ve seen one 65 year old. Given the years of living and the diverse experiences a 65 has had, how can we really expect them all to be the same? Of course one reason for this stereotype is that it makes it easier for others to deal with older adults as a single group: the “old” or the “elderly.” But there are over 34 million people over age 65 today and another 76 million boomers coming along, do we really think they will be a homogenous group? They aren’t now and won’t be as they reach the ranks of “old”: our arbitrary but commonly accepted age 65.

Myth # 2: Most older adults are lonely.

If you ask older adults about two-thirds say they are never or hardly lonely.

Of course we have to be careful here not to generalize because there are a number of factors such as age, health, marital status, living arrangements etc. that can have an impact. However, generally speaking, research has shown that while the number of casual friendships may decline somewhat, the number of close friendships tends to remain about the same. If you had a lot of close friends when you were younger, you will probably have a lot of close friends as you grow older; if you were more comfortable with a small circle of friends, that will probably continue to be true in your senior years.

Myth # 3: Older adults are unable to learn new things or “You can’t teach an old dog new tricks”.

This is probably one of the most damaging and insidious of the stereotypes because it affects what we expect of older adults and can affect what older adults think they can do themselves.

It has been clearly shown that older adults can continue to learn and do new things as they age. Yes, it may take an older person longer but they are just as able if given enough time and repetition. Also the way they are “trained” or taught to do something new can make a difference. They need to be able to “think things through” to achieve understanding

Lots of older people learn to navigate ATMs, smart phones, PCs, I-Pads, TIVOs, GPSs, digital cameras and the like. They do it by reading the manual rather than by the “trial and error” approach more common to younger people.

Myth # 4: Most older people are depressed.

The National Center for Health Statistics reports that about 5% of the U.S. population over the age of 12 is depressed at any point in time. The Centers for Disease Control estimates that between 1 and 5% of older adults suffer from depression. So the reality is: most older adults are NOT depressed and in fact the frequency of depression on older adults does not vary significantly from the population at large.

Myth # 5: Everyone becomes confused or forgetful if they live long enough.

This is not true. There are plenty of centenarians who are perfectly clear thinkers with fine memories.

It is true that illness and drug interactions, which can create delirium or confusion at any age, seem to have a greater impact on people over the age of 85. However, once the illness has passed or the drug interaction has been corrected the confusion usually dissipates also. The frequency of dementia also increases as we grow older: about 35% of adults over 85 have some degree of dementia. However, dementia is not a normal or inevitable result of the aging process.

Myth # 6: As your body changes with age, so does your personality.

The two (body and personality) are not connected. Your body will change with age. That is inevitable. Your personality – the mix of behavioral, social, emotional traits and characteristics that describe you as a person – may evolve somewhat as you mature, but your essential personality was pretty much formed by the time you graduated from your teenage years. Absent the onset of dementia, if you were a kind, pleasant, happy, gregarious person as a middle-aged adult, you will likely be the same person in your senior years. If you were a grumpy curmudgeon, that’s unlikely to change.

Myth # 7: Suicide is mainly a problem for teenagers.

Suicide is the third leading cause of death for young people ages 15 to 24. However, older adults are more likely to die by suicide than young people. Of every 100,000 people ages 65 and older, approximately 14 die each year by suicide. That figure is higher than the national average of approximately 11 suicides per 100,000 people in the general population.

Myth # 8: People begin to lose interest in sex around age 55.

The sex drive does decline as we grow older but it starts earlier, as early as age 30 for men, somewhat later for women. The decline is generally slow and gradual. It does not come to a screeching halt with grey hair. More than half of adults in their 60s and 70s are still sexually active as are a quarter of those in their 80s. The challenge for many is usually not lack of interest but the lack of a healthy partner or concerns over body image, performance anxiety or lubrication issues.

Myth # 9: Most older adults live in poverty.

In the early 1960s about one in three older adults lived in poverty. Since then, with the addition of Medicare and programs supporting housing, nutrition and transportation, along with the strengthening of Social Security and protections for private pensions, the living conditions for older adults have improved greatly. Only about one in ten live below the poverty line which is a slightly better result than for the population as a whole.

Myth # 10: Falls and injuries just happen to older adults.

Falls resulting in injury happen at any age. The group that has the least number of falls with injury is people age 25 to 44. Children under the age of 15 and adults between the ages of 65 and 74 fall twice as much as the 25 to 44 year olds. Falls with injury increase in the over age 75 population to about four times the rate of 25-44 year old adults. This means about one in ten adults over the age of 75 experiences a fall with injury each year.

What clearly does increase with age is the likelihood of being injured in a fall. Older bodies have thinner skin, less cushioning and more brittle bones than their younger counterparts and thus are more likely to sustain damage.

It is always helpful to have the facts to help form our opinions and to not let myths and stereotypes cloud our judgments about ourselves or others.

R. Kevin Price

© 2008-2011 R.K. Price

Weight Watching in Retirement

October 28, 2010

As we grow older several factors may affect our weight:

• Metabolism slowing
• Our sex
• Our proportion of muscle to fat
• Activity levels
• Heredity

“Metabolism” refers to the processes by which our bodies convert food into energy used to fuel, build and rebuild our bodies. The food we consume has a certain caloric content and the rate at which we burn that off while engaging in our daily activities reflects our metabolism. Our metabolism tends to slow down about five percent for each ten year period after age 40.

Men on average tend to burn more calories, or have a higher metabolism, than women.

People who have a higher proportion of muscle to fat tend to have a higher metabolism than their chubbier associates. Muscle “burns” more calories than fat (but note that exercise does not turn fat into muscle as some exercise machine purveyors would have you believe).

As people grow older their activities levels tend to decline. If their caloric intake remains the same, more calories are devoted to building fat than to supporting activities.

Heredity grants some lucky people a higher metabolism enabling them to consume higher caloric foods without adding excess pounds. People at the other end of the heredity spectrum seem to put on weight simply by being in the presence of the Fudgy Fudge Cake.

Bottom line: since our metabolism level will tend to decline as a normal aspect of aging, all else being equal, we will put on weight as we grow older unless we consume less or exercise more or both. It is a simple matter of calories in and calories out.

It can thus be beneficial to educate ourselves on the caloric content of the things we consume so we can make informed choices. It is also interesting to note that research seems to indicate that eating more frequently in smaller quantities helps maintain a higher level of metabolism than skipping some meals and then feasting.

And for exercise it is important to do both aerobic and strength building. Aerobic will expend calories but building muscle mass will increase our metabolic rate even while we are resting.

One should eat to live, not live to eat. – Cicero

A balanced diet is a cookie in each hand. – Unknown

R. Kevin Price

© 2008-2010 R.K. Price

Humpty Dumpty in Retirement

September 28, 2010

“Humpty Dumpty sat on a wall…”

Of course if you are an egg like Humpty, hanging out on the top of a wall is inherently dangerous whatever your age. As for humans, we are able to go through most of life, taking our tumbles and in many cases getting right back up, without needing “…all the King’s horses and all the King’s men…” to put us back together again or without even requiring a cast. But as we get older, falls become more dangerous.

Why is that and what can we do about it?

Older people fall more frequently than younger adults for a variety of reasons, e.g.

* Impaired vision
* Side effects of medications
* Reduced muscle strength
* Joint and muscle stiffness
* Balance issues
* Environmental factors such as home or community hazards
* Decreased feeling in the feet
* Deformity and/or pain resulting from osteoporosis and/or arthritis

While older adults don’t fall as often as infants learning to walk, about one third over the age of 65 who are living at home fall once a year or more. The frequency of falls in institutional settings is even higher. The majority of hospitalizations for people over the age of 50 result from falls.

Older adults are also more likely to break bones when they fall. This is due in large measure to increased frequency of osteoporosis.

Osteoperosis is a condition is which our bones become more porous. Bone tissue regularly goes through a process of breaking down and reforming. As we enter middle age the reforming process normally slows and our bones gradually become more porous, less strong and more susceptible to fracture.

While osteoporosis occurs naturally as part of the aging process, it tends to occur more frequently in women, lighter-skinned individuals, sentient people, smokers, people with inadequate volumes of calcium and vitamin D in their diets and those who consume significant amounts of alcohol.

Vitamin D is essential for strong bones. Our bodies need it to absorb calcium and phosphorus during our digestive processes. Calcium and phosphorus help build strong bones. We can get Vitamin D from a few foods we consume, by exposing our skin to sunlight and through supplements.

There are not a lot of outwardly visible symptoms of osteoporosis. Some people lose height or may develop a stoop or “dowager’s hump.” But one of the most common symptoms is the breaking of a bone, particularly in the spine, hip or wrist.

There are simple, non-invasive screening tests for osteoporosis and osteopenia (a condition that reflects deficient bone density but not yet at the level of osteoporosis).

So, if the risk of falling increases as we get older, as does the risk of serious injury from falling, what can we do to reduce those risks? A lot!

* Have regular eye exams and wear corrective lenses as needed. Have eye conditions such as glaucoma and cataracts treated as recommended by your physician.
* Understand the side effects of any medications you are taking and the interaction of your medications with other things you may consume. For example, some medications when combined with alcoholic beverages result in dizziness.
* Exercise on a regular basis. Weight bearing exercises that strengthen your muscles also strengthen your bones. Walking is excellent. Yoga and Tai Chi can help with flexibility and balance as well as muscle strength.
* Maintain your weight in an appropriate range.
* Consume alcohol only in moderation. If you smoke, stop.
* If you sometimes feel dizzy when you stand after sitting or lying down, make it a habit to stand up slowly and allow your mind and body a moment to adjust before setting off.
* Wear sensible shoes with non slip soles, a firm grip of your foot and low heels that provide a solid platform for your feet. If you have orthotics, use them as advised by your physician.
* In your living space, assure that there is adequate lighting; tripping hazards (throw rugs, loose carpets, extension cords, clutter etc.) are eliminated; night lights are placed in bedrooms, bathrooms and the hallways in between them; grab bars are in bathrooms; stairs have railings and nonslip treads; use cordless phones to increase mobility. (See the “Home Sweet Home” section for more information on how to safeguard your home).
* If it is prudent for you to use a walker or cane for assistance, by all means do so.
* If you are at particular risk for falling you may want to consider wearing a padded hip protector. It may not sound cool, but professional football players and top female college basketball players wear them for protection, why not you?
* Consume adequate volumes of calcium and vitamin D to maintain bone health. Most authorities recommend at least 1,200 milligrams of calcium and 600 milligrams of vitamin D. Food sources of calcium include milk, yogurt, cheese, green leafy vegetables (broccoli, kale, spinach, turnip and collard greens), peas and beans, salmon, sardines and fortified juices). Food sources of vitamin D are few and include fortified milk, salmon, tuna and sardines.

People also produce Vitamin D through exposure of the skin to sunlight. However, as we get older this process becomes less effective and therefore supplements can be helpful. If you choose to take a supplement, it may make sense to take one that combines calcium and vitamin D.

Consult with your physician. If appropriate for you, there are medications that can assist with bone reformation.

It may also be helpful to reflect might happen if you do fall. How would you get up? Is there a phone within reach of the floor if you are not able to get up? Should you carry a cell phone with emergency numbers set up on speed dial? Should you wear a device that allows you to push a button to call for help?

Finally, the fear of falling hovers over many older adults. It restrains their activities and thus makes it harder to build the strength and flexibility to avoid falling in the first place. While it is important to understand the risks of falling and to not behave like Humpty Dumpty we cannot let the fear of falling restrain us from living our lives to the fullest. As Marie Curie (1867-1934) said: “Nothing in life is to be feared. It is only to be understood.”

R. Kevin Price

© 2008-2010 R.K. Price

“Here’s to you!”…in Retirement

August 30, 2010

Behold the rain which descends from heaven upon our vineyards, and which incorporates itself with the grapes, to be changed into wine; a constant proof that God loves us, and loves to see us happy.” — Benjamin Franklin

Ben was a wise man who left us with many insights into the human condition in addition to his work in science and government. The record doesn’t indicate whether he noted any changes in the effects of alcohol as we grow older, but modern science has.

Research surveyed by The National Institute on Alcohol Abuse and Alcoholism (NIAAA) suggests that sensitivity to alcohol’s health effects may increase with age. One reason is that older people may achieve a higher blood alcohol concentration than younger people after consuming an equal amount of alcohol. This results from an age-related decrease in the amount of body water in which to dilute the alcohol. Therefore older people are at increased risk for intoxication and adverse effects even if their volume of alcohol consumption does not increase from when they were younger.

Aging also results in the body producing fewer liver enzymes with which to metabolize or break down the alcohol once it enters the body. This, combined with the fact that older bodies have a greater percentage of body fat (which does not absorb alcohol), further supports the view that alcohol has a greater impact on older bodies than younger ones.

There are a number of other areas in which the use of alcohol may affect the aging body:

• Drinking more than two alcoholic beverages a day may contribute to higher blood pressure and a number of other problems.
• Alcohol can interact with a wide variety of drugs, enhancing the effect of some and reducing the effectiveness of others.
• Alcohol use may reduce our sense of balance and reaction times and increase the likelihood of falls and accidents. Note that a driver’s crash risk per mile increases starting at age 55, and exceeds that of a young, beginning driver by age 80. In addition, older drivers tend to be more seriously injured than younger drivers in crashes of equivalent magnitude.
• Drinking large amounts of alcohol can contribute to weaker bones (osteoporosis) and increase the likelihood that falls will result in broken bones. The incidence of hip fractures among seniors increases with alcohol consumption.
• Alcohol increases our body’s production of uric acid and interferes with the kidney’s efforts to eliminate it. This can aggravate gout.
• Stomach acid production is stimulated by alcohol which can be problematic for people who have acid reflux disease.
• If you are a member of the Viagra generation, alcohol may inhibit the blue pill’s effectiveness. As Shakespeare put it: “It provokes the desire, but it takes away the performance.”

How serious are these concerns? A UCLA study of people over the age of 60 concluded that over one third were at risk for excessive alcohol consumption or from the harmful effects of alcohol in combination with certain diseases or medications. People with higher incomes were at greater risk than those with lower incomes; people over age 80 had half the risk of those aged 60-64; people without a high school education were at a much higher risk than the better educated.

Is there any value in alcohol for an aging body (beyond the normal pleasures of consumption)? Yes. Many researchers believe that drinking alcohol in moderation can help lower cholesterol and reduce the likelihood of heart attacks and adult diabetes. It may even help reduce risk of dementia.

There is no universally agreed on definition of “moderate drinking”. The U.S. Government defines it as “one drink a day for women and two drinks a day for men” with a “drink” consisting of one 12 ounce beer, 5 ounces of wines or 1.5 ounces of 80 proof liquor. The NIAAA says for people over age 65 it consists of seven drinks a week and no more than three in a day for both men and women using the same definition of drink.

Of course the effects of alcohol in individuals can vary significantly depending on age, sex, size, health and any medications taken. Effects can also vary based on how fast the alcohol is consumed and whether it is taken with food.

Bottom-line, alcoholic beverages may, as Ben Franklin says, be evidence that God loves us, but as with everything else we have been given we must use it wisely and in particular, with respect to alcohol, recognize that as we age its effects get stronger.

Men are like wine – some turn to vinegar, but the best improve with age”. – Pope John XXIII

R. Kevin Price

© 2008-2010 R.K. Price