Montana 55 Summer

Summer 2018

senior health good hikes

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normal aging

the magazine for montanans in their prime

publisher mike gulledge

editor emily petrovski

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55 Plus: You can still build muscle if you tire your muscles with training Story by Wina Sturgeon, Adventure Sports Weekly (TNS) It doesn’t matter how old you are; you can still build muscle. Studies have shown that even people in their 90’s can build bulk and strength if they lift weights.

In fact, any observer can factually state that the number of members 55 and older at commercial gyms is constantly increasing.

There are three essential things to keep in mind if you want to build more muscle at middle age and beyond: 1. You need to lift weights or work with stretch bands for the necessary resistance to create stronger muscles.

2. You can’t train like a 20-year-old anymore. At 55 and older, you can’t train every day, or even every other day, because your body requires more time to recuperate from each workout.

3. The principle of resistance training is even more important as you get older. You have to damage the muscles slightly; tire them out, so that they come back stronger when healing to deal with such potential damage in the future.

The New York Times quotes the published studies of Marcas Bamman, director of the Center for Exercise Medicine at the University of Alabama, as saying, ”Men and women in their 60s and 70s who began supervised weight training developed muscles that were as large and strong as those of your average 40-year-old. Older muscles will become larger and stronger if you work them.”

Bamman’s studies and others have also proven that there are biochemical processes that help bulk up older muscle fibers, but those processes can only be started by pushing the muscles until they are exhausted. Often, the typical four or 4

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five sets of ten to fifteen reps are not enough to genuinely tire the muscles.

Most gyms offer private trainers who can assess your physical condition and design a workout to improve it. Getting a customized workout is worth the money. Also, discuss ‘change-ups with the trainer.

But Bamman and other researchers don’t promise miracles. Working out with a carefully designed resistance program will rebuild decades of muscle loss, but not back to the sleek body of a 20-yearold. Resistance workouts may often erase the muscle loss of about two decades, but not much more.

However, there’s another reason to do regular resistance workouts—-no matter what your gender, no matter what your age. As people thinkstock get older, they begin to lose their muscle fibers. The fibers themselves die off. Since each muscle fiber is a source of strength and power, fewer of them will limit the amount of strength that can be rebuilt.

The loss of muscle fibers happen faster as folks age, and even faster for those who are sedentary. Regular exercise helps keep muscle fibers from dying off. In fact, while it’s well known that working out is an actual health issue, the newest research is showing that resistance training, and yes, even aerobic training can help prevent dementia. As well, working the body can also delay the onset of dementia.

That’s certainly worth the workout.

Wina Sturgeon is an active 55+ based in Salt Lake City, who offers news on the science of anti-aging and staying youthful at: adventuresportsweekly.com. She skates, bikes and lifts weights to stay in shape.

Voice and vote of Montana’s 55 and older community is powerful We don’t usually think about needing to encourage people age 55 and older to vote. Montanans 55 and older make up 46 percent of all the registered voters. Yet in a midterm election, like the upcoming one in November, voter turnout — even among seniors — declines. The 2018 election will be important to seniors, particularly in Montana. While other states may be red or blue, Montana is gray. Montana is one of the top states in the nation for the proportion of people 55 and older living here, and that percentage will only increase in the coming years.

Instead of looking forward to retirement as a time to enjoy life, many Montanans nearing retirement are approaching it with dread, wondering how they will make ends meet on a fixed income. They are concerned about whether their children and grandchildren will have opportunities for a bright future.

That’s why we formed Big Sky 55+.

Big Sky 55+ is an organization dedicated to giving voice to people who care about issues specific to seniors and encouraging people 55 and older to get involved in all levels of the democratic process. We want a Montana where people can grow old without worrying about whether they will have to skip meals or necessary medicine in order to make ends meet. Big Sky 55+ cares about future generations and wants all Montanans to have the opportunity for a good education without going into debt and to raise their families in healthy, thriving communities.

Who we elect will determine whether there will be cuts to Social Security and Medicare, whether veterans will get the services and care they need and deserve and whether older Native Americans have access to the quality health care. Too many seniors in Montana live in poverty or are in danger of falling into poverty because of one unexpected illness or expense. In 2016, seniors made up nearly a quarter of the visits to local food banks in Montana. Along with that, aging and poverty have disproportionate effects on Native American populations and women.

The voice and vote of Montanans 55 and older is powerful if we use it. We must let candidates know that we want a future in which people can grow old with dignity. We want quality healthcare available so people can live in their homes as long as possible. We will not allow Social Security and Medicare to be cut or privatized.

We’re lucky to live in Montana for many reasons: the quality of life, the value of neighbors helping neighbors and that one person’s vote can make a big difference. Many local and state elections are decided by just a few votes.

Montana needs your voice, your vision for the future and your vote to make it happen.

Big Sky 55+ advocates for issues of concern to Montanans 55 and older. Join the movement today and become a

Founding Member of Big Sky 55+. For more information, find us online at Big Sky 55+ and on Facebook.

By: Terry Kendrick, Board member of Big Sky 55+. Terry Kendrick is a long time women’s health advocate.

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Bunker Creek drainage as seen from the Swan Ridge Alpine Trail near Swan Lake. For outdoor enthusiasts traversing the southern section of the Alpine 7 Trail atop the Swan Mountain Range, even a smoky day, opens up sweeping views of the Swan Valley.

Photo by Sam Wilson/AP

5 Montana hikes for creaky knees Story by Brett French, for the Billings Gazette

If trudging up a steep, rocky mountain with a backpack isn’t your idea of fun, but you like getting out, here are five options for woodsy walks that won’t make your creaky knees cranky. Be warned, though, these are popular places — partly because the walking is easy — so don’t expect to be alone.

the short hike that’s just over a mile long and gains minimal elevation. The beauty of this 15,000-acre hiking-only area — which includes several other lakes to hike in to — is that you gain most of the elevation driving up to the trailhead.

Go as far or as little as you want, the views are great no matter what.

Jewel Basin Hiking Area:

Island Lake trail:

Located in the Swan Mountains about 15 miles northeast of Bigfork, this was the first place I took my daughter backpacking when she was about 3 years old. Although the view from the trail back down the mountainside into the Flathead Valley made her legs feel like jelly, she was up to

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Thirty-eight miles southwest of Red Lodge in the Beartooth Mountains, this trail provides entry-level access to a tundra-like environment at 9,400 feet above sea level.

Like Jewel Basin, all of the elevation gain comes from driving up and over the Beartooth Pass, which is a bucket-list

John Hart, left, and Jonah Brown run the rocky trail around the southern side of Scapegoat Mountain.

beauty of a drive. A well-trod trail takes off from the shores of the lake and continues on to nearby Night Lake and smaller beauties farther down the trail with little elevation gain or loss. Views of Lonesome Mountain are spectacular on clear days. There’s a campground at the trailhead if you want to linger amidst the beauty of the high mountain plateau.

South Fork Sun River:

It’s about 30 miles west of Augusta to reach the trailhead for this hike, one of the most popular entry points for the Scapegoat and Bob Marshall wilderness areas. That’s because this trail provides a route to the famed rock massif the Chinese Wall. You don’t have to limp in that far to see some fabulous country. Follow the river gently downstream to the perfect picnic spot. The water is so Bombay gin clear that you can see the bottom, even in deep holes.

Hyalite Lake:

This popular recreation area 20 miles south of Bozeman features a great walking trail that follows Hyalite Creek

Photo by Justin Grigg

upstream past a series of waterfalls. The first is Grotto, only a 1.5-mile handicap-accessible roundtrip up the trail. Those feeling their oats can continue the 5.5 miles to the peak for a spectacular view of the surrounding Paradise and Gallatin valleys. If that sounds like too much work, slip back down the road and follow the signs to Palisade Falls for a short walk, or drive back to Hyalite Reservoir and soak your toes or try your luck at fishing.

Lost Creek State Park:

It’s only a half-mile walk from the parking area to the overlook for the 50-foot high Lost Creek Falls in this 502acre park located about 11 miles northwest of Anaconda.

If that route doesn’t sate your hiking bug, follow the creek upstream for as far as you want as it wanders through the trees and across meadows below thousand-foot cliffs that rise to the north. The cliffs are home to mountain goats, bighorn sheep and large raptors like golden eagles. Camping is available in the park if you want to hang out for a couple of days.

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Changing the way we look at dementia Story by Judith Graham, Kaiser Health News In November, six people with Alzheimer’s disease and related types of cognitive impairment stood before an audience of 100 in North Haven, Conn.

One by one, they talked about what it was like to live with dementia in deeply personal terms.

Before the presentation, audience members were asked to write down five words they associated with dementia. Afterward, they were asked to do the same, this time reflecting on what they’d learned.

“Without exception, the words people used had changed — from ‘hopeless’ to ‘hope,’ from ‘depressed’ to ‘courageous,’ from ‘empty’ to ‘fulfilled,’” said Erica DeFrancesco, a 8

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clinical assistant professor of occupational therapy at Quinnipiac University who helped organize the event.

The session, followed by an hour-long discussion about dementia, is part of a new grass-roots movement in the U.S. aimed at educating people about Alzheimer’s disease and other forms of dementia, dispelling the painful stigma associated with these conditions and enhancing public understanding.

A centerpiece of that effort, known as “Dementia Friends,” began just over a year ago under the auspices of Dementia Friendly America, an effort spearheaded by 35 organizations across the country.

Currently, more than 13,200 people are registered as Dementia Friends in the U.S., and organizations in 14 states (Arizona, California, Connecticut, Hawaii, Illinois, Indiana, Maryland, Massachusetts, Michigan, Minnesota, Ohio, North Carolina, Virginia, Wyoming) are hosting events to sign up more.

Globally, almost 14 million people in 33 countries are involved in the movement, which originated in Japan.

To become a Dementia Friend, most people attend an hour-long presentation focused on several themes: Disease vs. typical aging. Alzheimer’s disease and other types of dementia are illnesses of the brain, not a natural consequence of aging.

Scope of symptoms. Dementia triggers a wide array of symptoms, not just memory loss.

Quality of life. People with dementia can live well, often for years.

Maintaining identity and respect. People with dementia retain a sense of self and aren’t defined exclusively by this condition. Testimonials by people with dementia are sometimes, but not always, included.

“If we can change the way people look at dementia and talk about it, we can make a big difference in people’s lives,” said Philippa Tree, who spearheads a well-established Dementia Friends program in England and Wales, with about 2.3 million members, that has licensed its model to the U.S. “It’s about increasing awareness and empathy so that if you encounter someone in the community who needs some help, you have some basic skills,” said Meredith Hanley, project lead for Dementia Friends USA. William Anderson, chief of police for St. Cloud, Minn., went to a session of this kind late last year, with about 40 members of his department. One exercise — writing down all the steps involved in making a peanut butter and jelly sandwich — made an especially strong impression.

“I’d never thought about everything that goes into something that simple: taking the peanut butter and jelly out of the cabinet, unscrewing the tops, getting a knife, spreading the sides of the bread, putting the pieces on top of each other, cutting it down the middle,” Anderson said, adding that this was only a partial list.

“The point they were making was that folks with dementia might remember some of these steps but not others. At some point, they’ll get distracted or forget what they were doing and go on to something else. To me, that was eyeopening; it explained a lot.”

Now, Anderson thinks about “how we can make life more manageable for these folks, in simple ways.” An example: The St. Cloud Police Department’s building has a large vestibule, with two big glass doors. “If you have dementia, you’re going to walk into that vestibule and probably turn around in circles because the doors don’t have an identifier saying ‘police,’” he said, adding that introducing new signage is under consideration.

Committing to a concrete action — visiting or phoning a family member with Alzheimer’s regularly, watching out for a neighbor, volunteering with a community organization or trying to make public venues easier to navigate, for instance — is required to become a Dementia Friend, though spon-

sors don’t check if people follow through.

“This is a social action movement,” said Emily FarahMiller, executive lead for ACT on Alzheimer’s, a statewide effort in Minnesota to create dementia-friendly communities and disseminate best practices regarding dementia in health care settings.

More than 10,000 U.S. Dementia Friends come from Minnesota, which began recruiting residents for the program two years ago, before it became a national initiative.

This year, Minnesota ACT on Alzheimer’s leaders are working with African-American, Hispanic, American Indian, West African and Hmong communities in their state to make culturally sensitive adaptations to their programs.

And they’re piloting a modified version of Dementia Friends in several elementary schools “to create a dementia-friendly generation of youth,” Farah-Miller said.

Individuals can also earn a “Dementia Friends” designation by watching an introductory video on Dementia Friends’ USA website, as well as a second video about dealing with people with dementia in various settings such as restaurants, stores, banks, libraries, pharmacies, faith communities and public transportation.

If you encounter someone who seems confused and disoriented on a bus, train, taxi or subway, try to understand what that person might need, one of these videos advises.

Speak slowly, using short, simple sentences and give the person adequate time to respond. Remain calm and reassuring and avoid arguing or embarrassing the person who may have forgotten where they’re going.

Bob Savage, an 86-year-old diagnosed two years ago with Alzheimer’s disease, became a Dementia Friend last year and now speaks to groups in Connecticut that are promoting the program.

Some of what he tells them: “As soon as people learn you have Alzheimer’s, you’re stigmatized. People treat you different, like you don’t understand, and that’s very upsetting.”

Even if memory is lost, intuition and emotional understanding remain intact, Savage explained.

What he and other people with dementia want most is “emotional connection — that feeling of love that we had, that we may have lost” when a diagnosis was delivered and a sense of being a burden to other people descended.

In 2016, Savage moved to a campus in Southington, Conn., where 133 people with dementia reside in assisted living or a skilled nursing facility. Stephani Shivers, chief operating officer of LiveWell (formerly the Alzheimer’s Resource Center), which owns the campus, is leading Connecticut’s Dementia Friends initiative.

“What I’ve seen is that barriers seem to dissolve for people who attend” information sessions, she said. “Whether it’s ‘I’m not sure what to say to someone with dementia’ or ‘I’m nervous about being with someone with dementia,’ the ‘I don’t know what to do’ falls away.

“It becomes me relating to you, a person with dementia, as another human being — a human being living with a cognitive disability, just like people living with physical disabilities.”

9 montana55.com

Can you hear me now?

Senate bill aims to broaden access to hearing services Story by Michelle Andrews, Kaiser Health News

Last December, Deb Wiese bought hearing aids for her parents, one for each of them.

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She ordered them online from a bigbox retailer and paid $719 for the pair.

But her parents, in their 80s and retired from farming in central Minnesota, couldn’t figure out how to adjust the volume or change the batteries. They soon set them aside.

“Technology is not only unfamiliar but unwelcome” to her parents, Wiese said. “I don’t know what the answer is for people like that.”

Only 10 to 20 percent of people with hearing

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loss use hearing aids, according to studies. The high cost of hearing aids, difficulty adjusting to them, lack of access to care and the stigma associated with wearing them discourages people, said Barbara Kelley, executive director and CEO of the Hearing Loss Association of America, a patient advocacy group.

Last summer, President Donald Trump signed a law that directs the Food and Drug Administration to establish and regulate a new category of hearing aid to be sold over the counter for people with mild to moderate hearing loss. People will be able to buy products off the shelf without consulting an audiologist or hearing aid dispenser, and standards for online sales will be tightened. The agency has three years to develop safety and other consumer protection standards.

The National Academies of Sciences, Engineering and Medicine recommendedthat the FDA take that step in a 2016 report.

Although it should improve access, the new law doesn’t address one of the biggest barriers faced by the nearly 50 million people with age-related hearing loss: insurance coverage.

Neither traditional Medicare nor most private insurers typically cover hearing aids. Some Medicare Advantage plans provide some coverage, and some insurers may offer a discount if members use certain suppliers.

“Cost has for many years been the No. 1 problem in the calls, emails and letters we get,” said Kelley.

“People say, ‘I need hearing aids and I can’t afford them.’ It’s really heartbreaking.”

A bipartisan effort in Congress also could make it easier for Medicare

beneficiaries to get some hearing assistance. A bill introduced by Sens. Elizabeth Warren (D-Mass.) and Rand Paul (R-Ky.) in March would allow patients to visit an audiologist to get a hearing test to diagnose a hearing problem without first being referred by a physician or nurse practitioner. It would also allow audiologists to provide treatment for non-hearing-aid-related services like wax removal.

Under current law, Medicare generally reimburses audiologists for diagnosing hearing loss in older adults but not for treating it, including providing assistance to fit, adjust and learn to make the most of hearing aids. This bill would not change Medicare’s coverage of hearing aid services.

Losing the ability to hear well doesn’t just mean people have to turn the volume way up on their favorite TV shows.

Hearing loss is associated with depression, social isolation and an increased risk for cognitive decline and dementia in older adults.

Hearing aid prices vary widely, ranging from an average $900 to $3,100 apiece, according to a survey of hearing care professionals by the Hearing Review. On the high end, devices may be Bluetooth-enabled to stream wirelessly from people’s cellphones to their hearing aids, among other perks.

But not everyone needs or wants that much help. “Some people are very mildly impaired,” said Kim Cavitt, a billing and reimbursement consultant and former president of the

Academy of Doctors of Audiology who supports over-thecounter sales. “They don’t have a $3,000 problem, they have a $300 problem.”

Experts say they hope the over-the-counter hearing aid law, which has been referred to the Committee on Health, Education, Labor and Pensions, will spur competition and product innovation and bring down prices.

One of the reasons hearing aid prices are often high is because the devices are typically bundled with a service package to fit, troubleshoot and maintain them.

Disentangling the service from the devices would benefit consumers, said Nicholas Reed, a faculty member at the Cochlear Center for Hearing and Public Health at Johns Hopkins Bloomberg School of Public Health who has studied over-the-counter hearing devices that provide results comparable to hearing aids.

In addition to basic hearing-aid fitting and maintenance, hearing care professionals can help people learn strategies to hear better, Reed said. For example, people learn to sit with their back to a wall at a restaurant to eliminate the sound behind them so they can focus on listening to the person in front of them.

“The over-the-counter law will lower the cost and make hearing aids more accessible,” Reed said. “But if the services aren’t covered, people, especially older adults with health literacy issues, will stop using them.”

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Wallace D. Coburn:

Movie Star of the Milk River Country Story by Brian D’Ambrosio, for Montana 55 “Wallace D. Coburn, the original shoot -’em -up, watch - my - smoke, whoopee-ky-otee cowpuncher and movie star, is in town.”

The Honolulu Star-Bulletin trumpeted the May, 1917, arrival of northern Montana’s original cowboy poet and movie star in the islands.

Wallace, famous as a writer, rancher, daredevil, bronco-fighter, traveler, and entertainer, had gone to Hawaii to publicize his latest film “The Sunset Princess,” produced in Los Angeles.

Wallace was accompanied by his son, Robert, 16, and daughter Dorothy, 12, “also well known screen performers in western plays,” according to the Hawaiian newspaper.

His appearance “caused quite a sensation,” according to The Bear 12

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Paw Mountaineer, a Big Sandy, MT., newspaper, which kept tabs on Coburn, his wife, Mrs. Coburn, and “their two bright-eyed children.” Indeed, the Coburn name was a type of patent of nobility.

“The whole Coburn family are as essentially western and still as truly refined and as educated as he— which is the best. Mrs. Coburn knew the west when it was endless, unfenced stretches, just as well as her nervy mate; she has instilled in the two fine looking children the same spirit and all together they are striving for love of the west.”

According to The Bear Paw Mountaineer, Coburn liked it at the Pleasanton Hotel in Honolulu for there was running water in every room, “which

reminds him of the Big Muddy which ran (almost) all the year around in his great blue room up north for years — the blue sky above, the buffalo grass under foot and the walls—mile wide and cactus dotted; some sagebrush and greasewood, too.”

Big Spreads and Nobility

Wallace David Coburn was born on May 31, 1872 in Northeast Montana, amongst one of the last and widest mixed-grass prairie landscapes in North America.

His father, Robert Coburn Sr., founded the Coburn Circle C Ranch in 1886, raising Wallace on one of the three “big spreads” that owned or controlled most of the range in southern Philips County. One account described

the Coburn ranch “spread out larger than many a European principality.”

Some of the earliest references to Wallace are several old newspaper ads selling farm machinery and implements, including two placed in the June, 1899, issue of Choteau’s “The Montanian (spelt with an i),” encouraging readers to head down to the “big store of Wallace D. Coburn, successor to McLean Bros. & Coburn.”

An article in Fort Benton’s The River Press newspaper on April 2, 1902 refers to an inquest into a murder on the Coburn ranch on Big Warm Springs Creek, where Wm. J. Allen was killed the previous Sunday afternoon by Chas. Perry, and from the evidence at the inquest it appears that the latter shot Allen to save his own life, “and that the affray was provoked by the dead man.”

The dilemma with Allen arose out of the fact that he and his father-in-law and another man named “Nosey” Clark were “tarred and feathered some eight or ten years ago by unknown parties while living on Big Warm Springs Creek, on the reservation, five miles above the Coburn ranch.”

They always suspected that the Coburn boys (Wallace and his brother Will) had some role in that, Allen proposed to Perry “that he should exercise his great influence with the Indians to get up a party in revenge, raid the Coburn ranches, massacre their owners and employees, and burn the buildings.”

This Perry declined to be part of, and he educated Wallace and Will Coburn of Allen’s vengeful proposition.

During and prior to the inquest “about 150 Indians camped near the Coburn ranch, and it was found out later that they were there to protect Perry, who, they feared, would be killed by certain squaw men and their half-breed sons, who were incensed at the death of Allen.”

ture Show at Malta. Co-owned with his wife, Ann Reifenrath Coburn, its walls were covered with many Indian relics and trophies, for Coburn from time to time was the grateful recipient of many rare and costly relics as an appreciation of “his kindness and sympathetic judgment toward the different tribes.” (It was reported that Wallace was familiarly known to various tribes as “Heymus,” or Iron Tooth, on account of a gold crown tooth in his mouth.)

In 1916, The Anaconda Standard described the Malta theater as “unique in that it is the only motion picture house in the United States whose walls, entrances and lobbies are adorned with Indian replicas and trophies of the hunt of such antiquity and rarity.”

According to the June 24, 1916, The Anaconda Standard, Coburn amassed one of the country’s largest collection of Indian artifacts, including war bonnets, war whistles, war clubs, war shields, tomahawks and lances “used by Indian chiefs just spoiling for a fight,” as well as “a buffalo skin pouch carried by an Indian in the Lewis and Clark Expedition in 1805.” Sacajawea, the noted scout, “may have fashioned it with her own hands.”

When Wallace Coburn’s son, Robert, was born in 1902, the Indians remained in council three days debating upon a name that should be good enough for the son of their friend. They decided upon Taton-ga-nosh, which interpreted is Standing Buffalo Bull.

If you have difficulty understanding words clearly over the phone, just fill out this form!

You may qualify for free assistive telephone equipment through the

“Rhymes from a Round-up Camp” Coburn maintained a fine friendship with an equally highly romantic character, artist Charles Marion Russell.

Russell and Coburn co-wrote the 1903 book “Rhymes from a Round-up Camp,” a cheery, lively, nostalgic collection of jingles and odes of the “Wild West” which sold by thousands. In addition to his co-authorship, Russell illustrated the collection.

An issue of Western American magazine published in the 1940s featured a photo of the pair and Charles Russell said: “Wallace D. Coburn is a blue-eyed, stalwart, laughterloving lad with a face like a Galway Blazer and a smile that is worth going miles to see. Horseman of the plains, mighty hunter, ranchman, cowpuncher, scholar, wit and poet, he rounds out his career as a Westerner by being the only White Chief of the Assiniboine-Sioux, his tribal name being Peta-kooa-honga, which means Cowboy Chief.”

Bison Motion Picture Show at Malta Coburn is said to have went into the movie business for two reasons: because, similar to roping horses, it was exciting, and to perpetuate and preserve the proceedings and clothing and deportment of the West for generations to come.

In the mid-1910s, Wallace opened the Bison Motion Pic-

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Great West Film Company at Zortman

In the mid-1910s, Coburn formed the Great West Film Company at Zortman, as well as a studio in St. Paul, Minnesota. “Primarily, the object of this company is to depict western life from real live scenes in a genuine western atmosphere,” reads one contemporary film publication of Coburn’s endeavor.

“At the present time many of the film companies throw western pictures on the screen containing “mail-order cowboys” and scenes lacking in local color and vividness and if the film company accomplishes what it has planned, it will, to an appreciable extent, revolutionize existing opinion in the minds of people who heretofore have been unable to obtain information about the West and westerners, first hand.”

Wallace was reputedly a crack shot and marksman, holding “the Montana state record for grizzlies,” having killed four at one time in the Larb hills, 50 miles from Malta.

Equally skillful with his pen, he wrote the scenario and took the leading role in its first production, “Yellowstone Pete’s Daughter.” Filmed at the Walter Coburn Ranch (Walter, Wallace’s half-brother, lived from 1889-1971 and he had a successful career as a Western writer) near the Little Rockies in 1916, twenty-two artists along with forty-five workmen arrived to work on the picture.

The camp was outfitted with horses and packstrings and the movie party stayed at the Great Northern Hotel in Malta. While most of the film was shot at the Coburn Ranch, a few of the scenes were shot in Malta. The name “Malta” was taken off the railroad station and replaced with “Butte.” John Shady’s livery barn was background for the departing stagecoach. One episode showed a thousand head of steers stampeded.

After filming the name of the picture was changed to “The Golden Goddess” and it was shown at the Bison Theatre. The Great West Film Company produced films for at least a couple of more years.

Somewhere along the line, Wallace permanently transitioned to California, where he appeared in a number of the early-day silent movies, including “The Bull’s Eye,” released in 1917, and “The Kaiser, the Beast of Berlin” (1918).

This Minneapolis Star-Tribune review of “The Sunset Princess” heralded Coburn for his realism as the leading man in the 1918 Great West Film Company production (now based entirely in St. Paul, MN.), “a thrilling drama of the old west.”

“Knowing that the day of the cowboy was done but wishing that it might live on forever in the eyes of centuries, Coburn has thrown his whole soul and ability into an accurate and interesting reproduction of the real life as he knew it and in this laudable effort he has been eminently successful.”

For several years, Coburn returned to the Circle C Ranch and other parts of Montana each summer; a Montana reporter from The Fallonite once provided this enjoyable dispatch straight from the terrain which Wallace knew intimately.

“When Coburn is on his ranch in Montana, he can’t make his feet or hands behave. Either he must be climbing up into 14

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the middle of a sun- fishin’ pinto to place his life and limbs in the hands of fate or else his index finger is itching on the trigger of his .30-30 up in the wilds on the trail of a grizzly. It is this indomitable defiance of conventionality that has won him a high niche in the movie game, and thrills and diversities of which have partially taken the place of the daring day of old before barbed wire from Chicago and dry-land farmers from Iowa and elsewhere chased the cowman after the red men—into the discard.”

Wallace Knew the Life The Circle C Ranch was eventually sold off and became part of the Matador holdings that stretched from Texas to Saskatchewan. (The Nature Conservancy struck a “complicated” deal to preserve the 60,000-acre Matador Ranch in 2000.)

Wallace lived out the remainder of his live in California, at one point he operated a western museum at Hollywood.

Some of the stories from his most enduring work, “Rhymes from a Round-up Camp,” were dramatized for the screen.

He died on March 15, 1954 in Los Angeles.

Perhaps this quote about Wallace from an entertainment pamphlet in 1918 would be a fitting, respectful epitaph: “He is one of the few men who actually know the life and can depict it properly in verse and on the screen.”

His daughter, Dorothy Coburn, also became a noted film actress, appearing in a chain of Hal Roach-directed shorts and early Laurel and Hardy silent films. Dorothy died May 15, 1978, in Los Angeles.

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Read all your medical statements If you suspect that you have been a target of any type of abuse, report it to Montana SMP!

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Montana SMP is a program coordinated by Missoula Aging Services and partnered with local Area Agencies on Aging. This project was supported, in part by grant number 90MP0233, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.

Mayo Clinic Q and A: Curious about acupuncture?

Story by Liza Torborg, Mayo Clinic News Network • illustration thinkstock

DEAR MAYO CLINIC: I started chemotherapy last month, and my health care provider suggested I try acupuncture for nausea. How does acupuncture work? Is there any risk to trying it?

ANSWER: Traditional Chinese medicine, including acupuncture, dates back more than 2,500 years. Acupuncture involves inserting thin, single-use, sterile needles through the skin to identify and correct imbalances within the body’s “energy” flow, called “qi” or “chi”. Acupuncture as a form of medical treatment has become more popular in the U.S. in recent decades, particularly as an adjunct to Western treatments or as part of an integrative system of care.

Evidence suggests that acupuncture may provide a range of health benefits.

It may be useful as a stand-alone treatment for some conditions, but, as in your case, it’s increasingly used as part of an integrative medicine approach in conjunction with conventional medical treatments.

In the U.S., acupuncture most often is used to treat acute and chronic pain disorders; emotional disorders, such as anxiety and depression; digestive complaints; and neurological conditions, such as migraine or stroke. It also has been used to treat respiratory conditions, gynecological disorders and infertility. There is also evidence to support its use to treat fatigue and addictions.

A general sense of well-being often is promoted through the balancing of the energy of the body. Thus, treatment can maintain that state of well-being.

There are multiple scientific theories about how acupuncture works. It may work at the site of application or at a distance, with the help of sensory neurons that signal changes within the peripheral and central nervous system. One theory is that acupuncture may promote the release of the body’s own natural painkillers (endogenous

opioids), alleviating or easing pain.

Insertion of acupuncture needles also may block the transmission of pain signals through the nerves to the brain.

In addition, acupuncture may stimulate the release of certain brain and nerve chemicals that can ease symptoms of depression.

Acupuncture is generally safe when performed properly by an experienced practitioner. It has few side effects, especially compared to many drugs. The most common side effects of acupuncture are soreness and minor bleeding or bruising at the needle sites. Less common risks or complications are infection or, rarely, puncture of the lung.

Certain conditions may increase your risk of complications. Your chances of bleeding or bruising from the needles increase if you have a bleeding disorder or you take anti-clotting drugs, such as warfarin (Coumadin). So let your acupuncturist know if you are on any of these medications. Also, tell your acupuncturist if you have a pacemaker.

Acupuncture that involves applying mild electrical pulses to the needles may interfere with a pacemaker’s operation. If your white blood cell count is low, such as after certain types of chemotherapy, your health care provider may recommend against any disruption of your skin to prevent infection.

Each practitioner of acupuncture has a unique style. Your practitioner may ask you about your symptoms, behaviors and lifestyle. The practitioner may closely examine the parts of your body that are painful, or the strength, rhythm and quality of the pulse in your wrist.

This history gathering and physical exam will help your practitioner determine the type of acupuncture treatment that will help you the most.

This initial evaluation may take up to one hour. Subsequent appointments usually take about 30 to 60 minutes.

A common treatment plan typically

involves one or two treatments a week to start. The total number of treatments will depend on the condition being treated and its severity, but six to eight treatments are common. There’s evidence that acupuncture works best in people who expect it to work.

Acupuncture needles are thin, so insertion usually causes little discomfort.

However, you may feel a slight aching sensation that usually lasts less than 30 seconds. Between five and 20 needles are used in a typical treatment. Your practitioner may gently move or twirl the needles after placement, or apply heat or mild electrical pulses to them.

If at any time you have discomfort, let your practitioner know.

In most cases, the needles remain in place for 15 to 30 minutes while you lie still. There’s usually no discomfort when the needles are removed.

Some people feel relaxed and others feel energized after a treatment.

However, not everyone responds to acupuncture. If your symptoms don’t improve within a few weeks, acupuncture may not be right for you.

If you’re considering acupuncture, take the same steps you would to choose any health care provider. Ask people you trust for recommendations.

Check the practitioner’s training and credentials. Most states require that nonphysician acupuncturists pass an exam conducted by the National Certification Commission for Acupuncture and Oriental Medicine.

In addition, talk to the practitioner and ask what’s involved in the treatment, how likely it is to help your condition and how much it will cost. In some cases, insurance covers treatment.

A growing number of health care providers use acupuncture as part of their clinical practice, including specialists at Mayo Clinic. — Dr. Kirsten Paynter, Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix

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Ed and Marge Anderson opened Craigs Mart in Missoula to help people sell items on consignment that buyers might see on Craigslist or other online sites, or at the Craigs Mart site itself. The business helps sellers who may be too busy for the logistics of selling something, or who aren’t comfortable having strangers come to their home or meeting in a parking lot to sell an item.

Local couple in late 50s starts retail showroom for used goods without online hassle Story by David Erickson, for Montana 55 • Photos by Tom Bauer It’s never too late to start your own business, according to one Missoula couple with a thriving new endeavor in town.

Ed and Marge Anderson are both 59 years old and both graduated in 1977 from Missoula high schools. After long careers in various other industries and businesses, they decided to once again become business owners in January 2017. That’s when they opened Craigs Mart, a new retail concept that helps peer-to-peer buyers and sellers of 16

Summer 2018

everything from furniture to tools to exercise equipment make transactions safely and effectively.

It’s a brick-and-mortar shop at 3100 Brooks St. in Missoula where people can sell items on consignment to buyers who peruse pictures of the stuff on the website at www.craigs-mart.com.

Instead of having to exchange contact information with strangers and meet up in parking lots to exchange cash, Craigs Mart acts as a clearinghouse and broker for the deals. They even

handle the deliveries. So far they’ve sold hundreds of thousands of dollars worth of merchandise, they said.

“It’s a retail showroom where people can physically display things they would like to sell without having to be present themselves — items that they would normally put up on Craigslist but don’t feel comfortable with that for one reason or the other,” Ed Anderson said.

He said it’s attractive for people who live out of town.

“There’s way more buyers here than in Seeley Lake,” he since there are so many thrift stores in town, but just about added. “People that don’t have the time, they’re too busy to everything else from musical instruments to sporting goods answer emails and phone calls and meet up with people. It’s to toys and games can be found in the huge showroom. just an easy way for sellers to get together with buyers and “A lot of things are seasonal,” he said. “From January we kind of serve as an intermediary. We close the deal and through March we sell a heck of a lot of exercise equipnegotiate the price.” ment. In the winter we sold a lot of skis and in the last In fact, Anderson said his company will take photos of the couple months, once the golf courses opened, we just merchandise and actually put up a Craigslist ad for sellers, burned through clubs and speed carts. People come in and along with Facebook Marketplace and other online venues. want to sell snow tires in May. We tell them to hold on to “The Craigslist ad says, ‘I’ve got my table down at Craigs them until November and bring them back in and we’ll do a Mart, go down there if you want to see it and they’ll take rip-snorting job for you.” care of you,’ so that’s a huge source of customers that we Most of his buyers are younger people who are in “acquiget into the store,” he said. sition mode” looking for good-quality items.

They’ve got farm and garden equipment, antiques, appliMarge Anderson said she would encourage other people ances, arts and crafts, auto parts, beauty and health products, electronics, jewelry to start businesses later and all kinds of in life, because although other items. it takes energy, it’s reAnderson said he warding and a lifetime of wanted to start a experience helps with any business late in endeavor. life because he’s “To me the most interalways had the enesting part is you never trepreneurial bug. know what’s coming in “I’ve had sevthrough the door and eral businesses in people always have a story Missoula, so kind about why they’re selling of out of the last something and you get to thing and into this one,” he said. “This know the history of some was kind of born pieces that are really cool,” out of my own Marge Anderson said. “It’s frustration with given people some avenues Craigslist. I’ve had they otherwise might not Ed Anderson holds some of the artwork on consignment at Craigs Mart. The business uncomfortable have for selling somehandles the sale of nearly everything except mattresses, clothing and guns. experiences and I thing because they might thought there has be intimidated by having to be a better way. Guys that have that gene have to scratch someone come to the house or they don’t know how to put it.” it online.”

With retailers struggling because of online delivery For her, the best part of the job is the people. services like Amazon, Anderson says customers find good “They’re happy when they’re bringing something in and value his low prices. it’s being recycled and reused and repurposed back into soThere’s a very sustainable aspect to the businesses, he ciety,” she said. “A lot of times people really don’t even care added.

“Selling new things is not something I wanted to be a part how much they’re getting out of it. They just don’t want it of,” he said. “Why go buy a new one when there is someto go to a landfill. They want to give it a purpose. I’ve heard thing that will perform just as well out there? This saves that time and time again. They just want it back in circulatrees and saves waste from going to the landfill so it resotion.” nates with a lot of people. And we really do need buyers She said she’s taken joy out of watching her husband take and sellers to make it off. Stuff comes in and goes out every an idea he had and put it into action. day. We have 700 items.”

“I’m just glad he’s doing something he’s really passionate Not only does the sale of used items keep timber from beabout and seeing it through,” she said. “That is one of the ing cut down in rainforests for new furniture but it saves on biggest rewards, for me, is watching him take a little dream the fossil fuels needed for shipping costs. he had and making it work. So far so good.”

“We’re really a local solution,” he said. “We don’t ship Ed Anderson said he hopes to one day expand his busithings across the country like eBay. We’re really for local ness model to other towns. buyers and local sellers.”

“The need is pretty universal for a service like this,” he The store covers every Craigslist category but doesn’t carry mattresses and guns. They don’t really have clothing, said.

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If you’re 50-plus, you still need to exercise

By Mike Candelaria, Orlando Sentinel (TNS)

Scaling down exercise is OK as you age, but don’t stop.

And if you haven’t begun, heed the words of Elsie Sierra, 71: “You need to exercise.”

Mike Napoli has been running marathons and competing in Ironman triathlons since his 30s. Typically, he would race in one event monthly from March through November.

Not so much anymore.

Because of work travel and family — along with age — Napoli has a bit slower pace. He’s still a fitness enthusiast, for sure, including biking, running and cross-fit training multiple times a week. However, two of his weekly workouts at the Crossfit Milk District gym are with his 6-year-old granddaughter, and there are some moves he simply can no longer do, like pullups because of shoulder surgeries. So, he doesn’t try them.

“I scale (my workouts) back to make it as hard as possible on myself, but also not to the point we I’m going to hurt myself,” says Napoli, 53, a software developer in Orlando.

“I feel young. But some things don’t work like they used to. I just try to keep fit and stay challenged as best I can.”

Jamie Lynch is perhaps even more of a workout warrior. The 54-yearold is a nurse practitioner for cardiology practice (Orlando Health Heart Institute), which likely helped when in January he ran the Celebration Marathon’s 26-plus miles in 3 hours and 32 minutes and qualified for the 2019 Boston Marathon.

Self-described as a fitness “addict,” Lynch, 54, a Winter Park resident, can be found swimming and biking across Central Florida’s lake and roads, starting at 5 a.m. But he knows the clock is ticking toward inevitably slowing down and transitioning his routine while still trying to remain fit.

Because of eye-muscle weakness in his youth, he didn’t play sports growing up. As a young adult, he then found weightlifting, until his lower back and knees weakened.

Then he found running until a move to triathlons (running, biking and swimming), which enabled him to better manage the stress loads on his body. Now, he awaits his next transition.

“I feel older every year,” Lynch says. “Pushing myself at the highest level I know that’s not likely to continue forever.”

He will eventually change his routine, but he won’t ever stop, Lynch quickly adds. “Bodies in motion stay in motion.

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… There’s nothing I like to do more than exercise. My wife says I’m a better husband when I do some training, conditioning,” Lynch says.

“If can’t run then walk. If can’t walk then swim. Find what you can do.”

Getting older, of course, is a life reality. Yet, so too is the need to continue to seek some level of fitness in your advancing years — adjusting as you go. People like Napoli and Lynch will certainly tell you as much, as does the International Council on Activity Aging.

The ICAA has a section on its website called Welcome Back to Fitness, starting with the very basics of getting a checkup, knowing your workout options and determining your participation style – all before actually exercising.

According to the American Heart Association, you should exercise 150 minutes a week of exercise, or 30 minutes a day at least five days a week. That includes people over age 50 — in fact, especially those people. The AHA points to a study released in 2017 that showed people with stable coronary heart disease who increased their habitual physical activity reduced their mortality rate — with the greatest benefits seen in sedentary people who began to move regularly.

In another 2017 study, researchers at University of California San Diego School of Medicine reported that elderly women who sat for more than 10 hours a day (with low physical activity) had biologically older cells compared to women who thinkstock are less sedentary.

That wouldn’t be news to Elsie Sierra, 71. After her husband died in 2002, she sat around and “did nothing for five years.” They used to run a half mile or so together as he battled with diabetes, but when he passed, she stopped.

Then about 10 years ago, after never having been to a gym, she joined one.

“Somebody told me I needed to change and asked ‘why don’t you go to a gym?’ ” Sierra recounts.

That gym was the South Orlando YMCA near her home.

Today, Sierra works out there Monday through Thursday for two hours plus some Friday mornings.

“When I first went there, I looked around and didn’t know what to do. Then I started cycling and got motivated,” she says.

Sierra moved from cycling to stair-stepping then to weight machines. Always thin, she now can lift a 30-pound barbell

over her head with each arm.

“I’m 71 and I can say that I feel like a 30-year-old. Nothing hurts,” Sierra says, noting the lone exception of tendonitis in her right thumb.

Also, her moods are better. “If I don’t go to the gym, my (adult) daughters tell me I get cranky. … My stress, I leave it here (at the gym),” she says.

“I don’t know what I would have been if I didn’t exercise.

I feel great.”

Sierra offers one succinct bit of advice to others: “You need to exercise.”

Need a place to exercise?

Any of the area’s large gyms, such as LA Fitness, 24 Hour Fitness, Planet Fitness, Youfit and the Central Florida YMCA, accommodate the 50-and-older crowd. For example, 24 Hour Fitness offers Silver & Fit classes, designed to increase flexibility, joint stability, balance, coordination, agility, muscular strength and cardiovascular endurance.

Also, an insurance-based program called Silver Sneakers typically is offered across Orlando. The low-impact classes use basic functional exercise movements and involve weights, resistance bands and body weight to help increase strength and range of motion.

According to Daun Yearwood-Davis, member experience director at the South Orlando YMCA, the 50-plus crowd gets catered to and represents an increasing sector of Y membership. The reason is that life reality: aging.

“It’s going to happen to us all, God willing,” YearwoodDavis says.

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Good friends might be your best brain booster as you age

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Story by Judith Graham, Kaiser Health News Ask Edith Smith, a proud 103-yearold, about her friends, and she’ll give you an earful.

There’s Johnetta, 101, whom she’s known for 70 years and who has Alzheimer’s disease. “I call her every day and just say ‘Hi, how are you doing?’

She never knows, but she says hi back, and I tease her,” Smith said.

There’s Katie, 93, whom Smith met during a long teaching career with the Chicago Public Schools. “Every day we have a good conversation. She’s still driving and lives in her own house, and she tells me what’s going on.”

Then there’s Rhea, 90, whom Smith visits regularly at a retirement facility.

And Mary, 95, who doesn’t leave her house anymore, “so I fix her a basket 20

Summer 2018

about once a month of jelly and little things I make and send it over by cab.” And fellow residents at Smith’s Chicago senior community, whom she recognizes with a card and a treat on their birthdays.

“I’m a very friendly person,” Smith said, when asked to describe herself.

That may be one reason why this lively centenarian has an extraordinary memory for someone her age, suggests a recent study by researchers at Northwestern University highlighting a notable link between brain health and positive relationships.

For nine years, these experts have been examining “SuperAgers” — men and women over age 80 whose memories are as good — or better — than

people 20 to 30 years younger. Every couple of years, the group fills out surveys about their lives and gets a battery of neuropsychological tests, brain scans and a neurological examination, among other evaluations.

“When we started this project, we weren’t really sure we could find these individuals,” said Emily Rogalski, an associate professor at the Cognitive Neurology and Alzheimer’s Disease Center at Northwestern’s Feinberg School of Medicine.

But find them they did: Thirty-one older men and women with exceptional memories, mostly from Illinois and surrounding states, are currently participating in the project. “Part of the goal is to characterize them — who

are they, what are they like,” Rogalski said.

Previous research by the Northwestern group provided tantalizing clues, showing that SuperAgers have distinctive brain features: thicker cortexes, a resistance to age-related atrophy and a larger left anterior cingulate — a part of the brain important to attention and working memory.

But brain structure alone doesn’t fully account for SuperAgers’ unusual mental acuity, Rogalski suggested. “It’s likely there are a number of critical factors that are implicated,” she said.

For their new study, the researchers asked 31 SuperAgers and 19 cognitively “normal” older adults to fill out a 42-item questionnaire about their psychological well-being.

The SuperAgers stood out in one area: the degree to which they reported having satisfying, warm, trusting relationships.

In other areas, such as having a purpose in life or retaining autonomy, they were much like their “normal” peers.

“Social relationships are really important” to this group and might play a significant role in preserving their cognition, Rogalski said.

That finding is consistent with other research linking positive relationships to a reduced risk of cognitive decline, mild cognitive impairment and dementia. Still, researchers haven’t examined how SuperAgers sustain these relationships and whether their experiences might include lessons for others.

Smith, one of the SuperAgers, has plenty of thoughts about that. At her retirement community, she’s one of nine people who welcome new residents and try to help make them feel at home. “I have a smile for everybody,” she said.

“I try to learn someone’s name as soon as they come in, and if I see them it’s ‘Good morning, how do you do?’”

“Many old people, all they do is tell you the same story over and over,” she said. “And sometimes, all they do is complain and not show any interest in what you have to say.

That’s terrible. You have to listen to what people have to say.”

Brian Fenwick, administrator of the Bethany Retirement Community where Smith lives, calls Smith a “leader in the community” and explains that “she’s very involved. She keeps us in line. She notices what’s going on and isn’t afraid to speak out.”

Fifteen years ago, Smith became a caregiver for her husband, who passed away in 2013. “All the time he was ill, I was still doing things for me,” she recalls. “You cannot drop everything and expect to be able to pick it up. You can’t drop your friends and expect them to be there when you’re ready.”

What she does every day, she said, is “show people I care.”

William “Bill“ Gurolnick, 86, another SuperAger in the study, realized the value of becoming more demonstrative after he retired from a sales and marketing position in 1999.

“Men aren’t usually inclined to talk about their feelings, and I was a keep-things-inside kind of person,” he explained.

“But opening up to other people is one of the things that I learned to do.”

With a small group of other men who’d left the work world behind, Gurolnick helped found a men’s group, Men Enjoying Leisure, which now has nearly 150 members and

has spawned four similar groups in the Chicago suburbs.

Every month, the group meets for two hours, including one hour they spend discussing personal issues — divorce, illness, children who can’t find jobs, and more.

“We learn people aren’t alone in the problems they’re dealing with,” Gurolnick said, adding that a dozen or so of the men have become good friends.

“Bill is the glue that holds the whole group together,” said Buddy Kalish, 80, a member of the group in Northbrook, Ill., a Chicago suburb. “He’s very, very caring — the first one to send out a thank-you note, the first one to send out a notice when there’s been a death in the family.”

Activities are another way of cultivating relationships for Gurolnick. On Mondays, he bikes 20 to 30 miles with more than a dozen older men — many of them from his men’s group — followed by lunch. On Tuesdays, he’s part of a walking group, followed by coffee. On Wednesdays, he goes to the Wenger Jewish Community Center in Northbrook for two hours of water volleyball. On Thursdays, it’s back to the JCC for pickleball, a racquet sport.

“You really get a sense of still being alive,” Gurolnick said, when asked what he takes away from these interactions. “You get a sense of not being alone.”

Without her best friend, Grayce, whom she’s known since high school, and friends who live in her condominium complex, Evelyn Finegan, 88, might have become isolated.

Another SuperAger, Finegan is hard of hearing and has macular degeneration in both eyes, but otherwise is astonishingly healthy.

“It’s very important to keep up with your friends — to pick up the phone and call,” said Finegan, who talks to Grayce almost daily and chats with four other friends from high school on a regular basis.

Today, the staples of Finegan’s life are her church; a monthly book club; volunteering at a resale shop in Oak Park, Ill.; socializing with a few people in her building; attending a club of Welsh women; and seeing her daughter, her son-in-law and grandchildren, who live in Oregon, whenever she can.

“It’s so nice to spend time with Evelyn,” said her upstairs neighbor, June Witzl, 91, who often drives Finegan to doctors’ appointments. “She’s very kind and very generous. And she tells you what she believes so you really feel like you know her, instead of wondering what’s on her mind.”

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The Long Goodbye: Coping with sadness and grief before a loved one dies Story by Judith Graham, Kaiser Health News For years before her death at age 96, Nancy Lundebjerg’s mother underwent a long, slow decline.

Arthritis made it hard for Margaret Lundebjerg to get around. After two hip surgeries, she needed a walker when she was out and about.

Incontinence was a source of discomfort, as was the need to rely on aides to help her perform daily chores.

Little by little, Margaret became frail and isolated.

“There was a sadness to seeing my mother’s circle of life become diminished,” said Nancy Lundebjerg, 58, CEO of the American Geriatrics Society, who wrote about her experiences in the organization’s journal.

The anguish accompanying aging isn’t openly discussed very often, nor is its companion: grief. Instead, these emotions are typically acknowledged only after a loved one’s death, when formal rituals recognizing a person’s passing —the wake, the funeral, the shiva — begin.

But frailty and serious illness can involve significant losses over an extended period of time, giving rise to sadness and grief for years.

The loss of independence may be marked by the need to use a walker or a wheelchair. The loss of a cherished role may dishearten an older woman who is no longer

22

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able to cook dinner for her extended family, gathered at the holidays. The loss of shared memories may be painful for adult children when their older father is diagnosed with dementia.

And these are but a few examples.

Looming over everything is the loss of the future that an older adult and his or her family imagined they might have, often accompanied by anxiety and dread.

This pileup of complex emotions is known as “anticipatory loss.” “The deterioration of function, disability and suffering have their own grieving processes, but helping families deal with that isn’t built into the health care system,” said Dr. John Rolland, professor of psychiatry at Northwestern University’s Feinberg School of Medicine and author of “Families, Illness and Disability: An Integrative Treatment Model.”

Rolland and several other experts offered advice on how to deal with difficult emotions that can arise with frailty or serious illness:

Acknowledge Your Feelings “Grief starts the moment someone with a serious illness receives the diagnosis,” said Tammy Brannen-Smith, director of grief and loss services at Pathways, a hospice in Fort Collins, Colo. But it doesn’t stop there. Each time a capacity is lost — for instance, an older adult’s ability to negotiate stairs, to drive or to manage household finances — sadness and grief can arise afresh. Brannen-Smith encourages people to acknowledge their feelings and try to “normalize them, because people don’t understand that everyone goes through this.”

Talk Openly When families avoid talking about an aging parent’s frailty or serious illness, the person with the condition can become isolated and family relationships can become strained.

“My view is, you’re better off trying to get through whatever you’re facing together,” Rolland said.

When Rolland works with couples who are dealing with multiple sclerosis, for instance, he asks them to make

a list of things they’d like to discuss but don’t. “Usually, there’s about a 75 percent overlap, and it’s a tremendous relief to most people to find out they don’t have to keep things locked up inside,” he said.

“People who are facing serious illness think about what might lie ahead all the time,” Rolland said. “For a family member not to bring this up, for everyone to be off in their own grieving pockets, alone, isn’t helpful.”

Communicate Sensitively Abigail Levinson Marks, a clinical psychologist in San Francisco, regularly works with adults who have brain tumors, which can alter their thinking and wipe out their memories, as dementia does for millions of older adults.

“People with these conditions aren’t the same as they were before, but it would be heartbreaking for them to know that you didn’t see them as the same person,” she said. “So, the truth becomes something that cannot be named and that everybody avoids, for fear of shaming the person.”

In her practice, Marks asks “people to share what each person is going through and not worry about protecting each other from what they’re feeling,” she explained. “Because protecting each other leads to feeling more alone and magnifies the feelings of loss.”

For a caregiver of someone with dementia, that might mean saying,“Sometimes you might see a look crossing my face and think that I’m disappointed. It’s not that I’m upset with you. It’s that I’m sad that there are things that happened in our past that we don’t remember together.”

For someone who has suffered a stroke, it might mean encouraging them to open up about how hard it is to lose a measure of independence and be seen as someone who’s disabled.

Lean In How people respond to sadness and grief varies, depending on their personality, past experiences, the relationship they have with the person who’s frail or ill, and the nature of that

person’s condition.

“Sadness can make you cherish a person even more and appreciate small moments of connection,” said Barry Jacobs, a Pennsylvania psychologist and co-author of “AARP Meditations for Caregivers.”

Some people, however, can’t tolerate feeling this distress and end up distancing themselves from someone whose health is declining. Others might show up in person but focus on tasks instead of allowing themselves to connect emotionally.

If possible, lean in rather than letting yourself become distant. “Cherish the time that you have together,” Jacobs said. “Rather than pulling back, move toward the person and be as engaged with them as possible, particularly on an emotional level.” In the end, connection eases the pain of grief, and you’ll be glad you had this time with the person.

Seek Support “Don’t confront grief alone or in isolation,” said Alan Wolfelt, founder and director of the Center for Loss & Life Transition in Fort Collins, Colo. “Have people around you who are supportive and who will be present for you” — family members, friends, people from a support group, whoever is willing to be a companion through your journey through serious illness.

Ultimately, this journey will help shape how you ultimately experience a loved one’s death.

Wolfelt describes mourning his mother twice. “The day she was diagnosed with Alzheimer’s and all the days I watched her dwindle. And then, the day she died, I had to begin mourning again, at a whole other level.”

But Lundebjerg of the American Geriatrics Society found a measure of peace when her mother finally passed away, after two seizures and the family’s decision not to pursue further treatment. “It was OK that she died because she was ready — she had made that very clear. And I had come to peace, over a very long time, with the fact that this was going to be coming.”

23 montana55.com

New technologies help seniors age in place — and not feel alone Story by Gabi Redford, Kaiser Health Network

Nancy Delano, 80, of Denver has no plans to slow down anytime soon. She still drives to movies, plays and dinners out with friends. A retired elder care nurse who lives alone, she also knows that “when you reach a certain age, emergencies can happen fast.” So, when her son, Tom Rogers, talked to her about installing a remote monitoring system, she didn’t hesitate.

With motion sensors placed throughout the house, Rogers can see if his mom is moving around, if she’s sleeping (or not), if she forgot to lock the door and, based on a sophisticated algorithm that detects behavioral patterns, whether her activity level or eating habits have changed significantly, 24

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for instance.

“It gives both of us peace of mind, particularly as she ages and wants to live at home,” said Rogers, who lives near Washington, D.C., hundreds of miles away from her.

At $45-$60 a month (plus an upfront fee of $100 to $200), Alarm.com’s Wellness system is markedly less expensive than options such as hiring a home health aide to check on her or moving her into a retirement community. The average cost of nursing home care exceeds $95,000 a year, while assisted living and in-home care tops $45,000 annually, according to a 2017 Genworth Financial report.

The exorbitant costs of nursing home and assisted living

care are driving sales — and innovation — in the technology market, said Dr. Eric Topol, director of the Scripps Translational Science Institute and author of “The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care.”

For many, the technology offers not just the tools they need to continue to live at home, but newfound confidence and connectedness with faraway family and friends.

Topol calls it “monitored independence,” and it is changing how older generations age in America. “People want to be autonomous, irrespective of age,” he said.

That was certainly the case for Carol Smith, 83, who lives in the Carlsbad by the Sea retirement community in Carlsbad, Calif., with her husband, Ray, 84. “I’m in a wheelchair, so I depend on my husband a lot,” she said.

The Smiths were introduced to the Amazon Echo last February through a pilot program for seniors. Carol is now able to control lights and the thermostat. She can ask Alexa to remind her to take medications, or to call her brother or even to call for help.

“It gives her a great deal of independence,” Ray said. “If for some reason I have to be away, she’s able to function on her own. It’s keeping her safe, but closely related to that, it’s allowing her to be independently safe.”

Voice-assistive technologies like the Amazon Echo, Google Home and HomePod are likely to play a bigger role in helping seniors age in place, especially when paired with apps geared specifically for senior living, predicts Majd Alwan, executive director of the LeadingAge Center for Aging Services Technologies (CAST). AskMarvee, for instance, integrates with Amazon Echo via an online portal to allow seniors to immediately connect with family members for a quick check-in or if something more serious is going on. The Basic app is free; premium versions cost $15 or $20 per month.

LifePod, to be introduced later this year, takes voice-assisted technology a step further, said Laurie Orlov, founder of Aging in Place Technology Watch. It will allow users to engage with the device, much like Alexa, but will also periodically check in with them independent of a voice prompt, at preprogrammed intervals: Good morning, Nancy. Did you remember to take your medication?

For Mike Willis, 63, of Guelph, Ontario, getting regular medication prompts means the difference between staying healthy and ending up in the hospital — again. Willis takes 27 pills a day, most of them anti-rejection drugs to ensure that his body doesn’t reject the heart transplant he received 2½ years ago after contracting viral myocarditis. To keep it all straight, he uses Medisafe, an app that reminds him when it’s time to take his next dose, whether to take the pills with water or food, and what side effects might be attributable to the medication.

“After my transplant, I was a little confused, so I designated my wife, Linda, as a ‘MedFriend,’ which meant she got an alert when I didn’t take my medication,” he said. The app is free; the Premium version, with additional reminder

and Medfriend features, costs $4.99 a month.

Indeed, the ability to designate a loved one as a second set of eyes and ears can be comforting rather than intrusive, as Willis and Delano have discovered. And yet, there’s a fine line between technology that allows older adults to live independently, and technology that reinforces stereotypical images of aging as a slow decline toward death.

Until recently, Personal Emergency Response Systems (PERS) — made famous by the “Help, I’ve fallen and I can’t get up” TV ads — was the only reliable technology to help older adults who had fallen, says David Lindeman, director of the Center for Technology and Aging at the University of California-Berkeley.

By the end of this month, MedHab, a Texas company best known for its wearable insoles for rehab patients, will begin shipping MyNotifi, a medical alert wristband designed to detect falls and send an alert to a family member or friend.

“It looks like a watch, and Mom or Dad can invite anybody they want, family or friends, to get those alerts through the MyNotifi Fall Detection app,” said MedHab President and CEO Johnny Ross. The device is available for preorder at $299.

Similar fall detection technologies in various stages of testing include SafelyYou, which uses wall-mounted cameras and software algorithms to detect falls, and UnaliWear’s Kanega watch, which combines fall detection, voice-assisted emergency aid and medication reminders.

“If the goal is independent and connected living, we need solutions that are multifaceted and that connect people with their family, their doctors, their neighbors,” said Jody Holtzman, senior managing partner of Longevity Venture Advisors. “If the technology is framed in the context of fun and convenience, like Alexa, then people will start to buy these things.”

Carol Smith can’t imagine life without Alexa. When I read, “I just say, ‘Alexa, what does this word mean?’ Or I ask Alexa to play the song. Oh, and I’m a basketball fan, but if I can’t stay up late to watch the end of the game, I’ll ask Alexa what the score is the next morning. There are so many things you can ask her. She’s fun. And she’s always pleasant.”

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Is there such a thing as normal aging?

Story by Bruce Horovitz, Kaiser Health News

For 93-year-old Joseph Brown, the clearest sign of aging was his inability the other day to remember he had to have his pants unzipped to pull them on.

For 95-year-old Caroline Mayer, it was deciding at age 80 to put away her skis, after two hip replacements.

And for 56-year-old Dr. Thomas Gill, a geriatric professor at Yale University, it’s accepting that his daily 5½-mile jog now takes him upward of 50 minutes — never mind that he long prided himself on running the distance in well under that time.

Is there such a thing as normal aging?

The physiological changes that occur with aging are not abrupt, said Gill.

The changes happen across a continuum as the reserve capacity in almost every organ system declines, he said.

“Think of it, crudely, as a fuel tank in a car,” said Gill. “As you age, that reserve of fuel is diminished.”

Drawing on their decades of practice along with the latest medical data, Gill and three geriatric experts agreed to help identify examples of what are often — but not always – considered to be signposts of normal aging for folks who practice good health habits and get recommended preventive care.

The 50s: Stamina Declines Gill recognizes that he hit his peak as a runner in his 30s and that his muscle mass peaked somewhere in his 20s.

Since then, he said, his cardiovascular function and endurance have slowly decreased. He’s the first to admit that his loss of stamina has accelerated in his 50s. He is reminded, for example, each time he runs up a flight of stairs.

In your 50s, it starts to take a bit longer to bounce back from injuries or illnesses, said Stephen Kritchevsky, 57, an epidemiologist and co-director of the J. Paul Sticht Center for Healthy Aging and Alzheimer’s Prevention at Wake Forest University. While our muscles have strong regenerative capacity, many of our organs and tissues can only decline, he said.

Dr. David Reuben, 65, experienced altitude sickness and jet lag for the first time in his 50s. To reduce those effects, Reuben, director of the Multicampus Program in Geriatrics Medicine and Gerontology and chief of the geriatrics division at UCLA, learned to stick to a regimen — even when he travels cross-country: He tries to go to bed and wake up at the same time, no matter what time zone he’s in.

There often can be a slight cognitive slowdown in your 50s, too, said Kritchevsky. As a specialist in a profession that demands mental acuity, he said, “I feel I can’t spin quite as many plates at the same time as I used to.” That, he said, is because cognitive processing speeds typically slow with age.

The 60s: Susceptibility Increases 26

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There’s a good reason why even healthy folks age 65 and up are strongly encouraged to get vaccines for flu, pneumonia and shingles: Humans’ susceptibility and negative response to these diseases increase with age. Those vaccines are critical as we get older, Gill said, since these illnesses can be fatal — even for healthy seniors.

Hearing loss is common, said Kritchevsky, especially for men.

Reaching age 60 can be emotionally trying for some, as it was for Reuben, who recalls 60 “was a very tough birthday for me. Reflection and self-doubt is pretty common in your 60s,” he said. “You realize that you are too old to be hired for certain jobs.”

The odds of suffering some form of dementia doubles every five years beginning at age 65, said Gill, citing an American Journal of Public Health report. While it’s hardly dementia, he said, people in their 60s might begin to recognize a slowing of information retrieval. “This doesn’t mean you have an underlying disease,” he said. “Retrieving information slows down with age.”

The 70s: Chronic Conditions Fester Many folks in their mid-70s function as folks did in their mid-60s just a generation ago, said Gill. But this is the age when chronic conditions — like hypertension or diabetes or even dementia — often take hold. “A small percentage of people will enter their 70s without a chronic condition or without having some experiences with serious illness,” he said.

People in their 70s are losing bone and muscle mass, which makes them more susceptible to sustaining a serious injury or fracture in the event of a fall, Gill added.

Seventies is the pivotal decade for physical functioning, said Kritchevsky. Toward the end of their 70s, many people start to lose height, strength and weight. Some people report problems with mobility, he said, as they develop issues in their hips, knees or feet.

At the same time, roughly half of men age 75 and older experience some sort of hearing impairment, compared with about 40 percent of women, said Kritchevsky, referring to a 2016 report from the Centers for Disease Control and Prevention.

Another conundrum common to the 70s: People tend to take an increasing number of medications used for “preventive” reasons. But these medications are likely to have side effects on their own or in combination, not all of which are predictable, said Gill. “Our kidneys and liver may not tolerate the meds as well as we did earlier in life,” he said.

Perhaps the biggest emotional impact of reaching age 70 is figuring out what to do with your time. Most people have retired by age 70, said Reuben, “and the biggest challenge is to make your life as meaningful as it was when you were working.”

The 80s: Fear Of Falling Grows Fear of falling — and the emotional and physical blowback from a fall — are part of turning 80.

If you are in your 80s and living at home, the chance that you might fall in a given year grows more likely, said Kritchevsky. About 40 percent of folks 65 and up who are living at home will fall at least once each year, and about 1 in 40 of them will be hospitalized, he said, citing a study from the UCLA School of Medicine and Geriatric Research Education and Clinical Center. The study notes that the risk increases with age, making people in their 80s even more vulnerable.

By age 80, folks are more likely to spend time in the hospital — often due to elective procedures such as hip or knee replacements, said Gill, basing this on his own observation as a geriatric specialist. Because of diminished reserve capacities, it’s also tougher to recover from surgery or illnesses in your 80s, he said.

The 90s & Up: Relying On Others By age 90, people have roughly a 1-in-3 chance of exhibiting signs of dementia caused by Alzheimer’s disease, said Gill, citing a Rush Institute for Healthy Aging study. The best strategy to fight dementia isn’t mental activity but at least 150 minutes per week of “moderate” physical activity, he said. It can be as simple as brisk walking.

At the same time, most older people — even into their 90s and beyond — seem to be more satisfied with their lives than are younger people, said Kritchevsky.

At 93, Joseph Brown understands this — despite the many challenges he faces daily. “I just feel I’m blessed to be living longer than the average Joe,” he said.

Brown lives with his 81-year-old companion, Marva Grate, in the same single-family home that Brown has owned for 50 years in Hamden, Conn. The toughest thing about being in his 90s, he said, is the time and thought often required to do even the simplest things. “It’s frustrating at times to find that you can’t do the things you used to do very easily,” he said.

“Then, you start to question your mind and wonder if it’s operating the way it should.”

Brown, a former maintenance worker who turns 94 in May, said he gets tired — and out of breath — very quickly from physical activity.

He spends ample time working on puzzle books, reading and sitting on the deck, enjoying the trees and flowers. Brown said no one can really tell anyone else what “normal” aging is.

Nor does he claim to know himself. “We all age differently,” he said.

Brown said he doesn’t worry about it, though. “Before the Man Upstairs decides to call me, I plan to disconnect the phone.”

KHN’s coverage of these topics is supported by John A. Hartford Foundation andGordon and Betty Moore Foundation

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Senior health: How to prevent and detect malnutrition Malnutrition is a serious senior health issue. Know the warning signs and how to help an older loved one avoid poor nutrition.

Story by Mayo Clinic Staff,Mayo Clinic News Network

Good nutrition is critical to overall health and well-being — yet many older adults are at risk of inadequate nutrition.

Know the causes and signs of nutrition problems in older adults, as well as steps you can take to ensure a nutrient-rich diet for an older loved one.

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Problems caused by malnutrition Malnutrition in older adults can lead to various health concerns, including: • A weak immune system, which increases the risk of infections

• Poor wound healing • Muscle weakness and decreased bone mass, which can lead to falls and fractures • A higher risk of hospitalization • An increased risk of death In addition, malnutrition can lead to further disinterest in eating or lack of appetite — which only makes the problem worse.

How malnutrition begins The causes of malnutrition might seem straightforward — too little food or a diet lacking in nutrients. In reality, though, malnutrition is often caused by a combination of physical, social and psychological issues. For example: • Health concerns. Older adults often have health problems, such as dementia or dental issues, that can lead to decreased appetite or trouble eating. Other factors that might play a role include a chronic illness, use of certain medications, difficulty swallowing or absorbing nutrients, a recent hospitalization, a diminished sense of taste or smell, or abdominal issues, such as pain or bloating.

• Restricted diets. Dietary restrictions — such as limits on salt, fat, protein or sugar — can help manage certain medical conditions, but might also contribute to inadequate eating.

• Limited income. Some older adults might have trouble affording groceries, especially if they’re taking expensive medications.

• Reduced social contact. Older adults who eat alone might not enjoy meals as before, causing them to lose interest in cooking and eating.

• Limited access to food. Many older adults do not drive and may not have access to food or the right types of food.

• Depression. Grief, loneliness, failing health, lack of mobility and other factors might contribute to depression — causing loss of appetite.

• Alcoholism. Too much alcohol can interfere with the digestion and absorption of nutrients. Nutrients might also be lacking if alcohol is substituted for meals.

How to spot malnutrition The signs of malnutrition in older adults can be tough to spot, especially in people who don’t seem at risk — but uncovering problems at the earliest stage can help prevent complications. To detect malnutrition: • Observe your loved one’s eating habits. Spend time with your loved one during meals at home, not just on special occasions. If your loved one lives alone, find out who buys his or her food. If your loved one is in a hospital or long-term care facility, visit during mealtimes.

• Watch for weight loss. Help your loved one monitor his or her weight at home. You might also watch for other signs of weight loss, such as changes in how clothing fits.

• Be alert to other red flags. In addition to weight loss, malnutrition can cause poor wound healing and dental diffi-

culties. It may also cause weakness, which can result in falls.

• Know your loved one’s medications. Many drugs affect appetite, digestion and nutrient absorption.

What you can do about malnutrition Even small dietary changes can make a big difference in an older adult’s health and well-being. For example: • Engage doctors. If your loved one is losing weight, work with his or her doctors to identify — and address — any contributing factors. This might include changing medications that affect appetite, suspending any diet restrictions until your loved one is eating more effectively, and working with a dentist to treat oral pain or chewing problems.

Request screenings for nutrition problems during routine office visits, and ask about nutritional supplements. You might also ask for a referral to a registered dietitian.

• Encourage your loved one to eat foods packed with nutrients. Spread peanut or other nut butters on toast and crackers, ripe fruits, and cooked vegetables. Sprinkle finely chopped nuts or wheat germ on yogurt, fruit and cereal.

Add extra egg whites to scrambled eggs and omelets and encourage use of whole milk. Add cheese to sandwiches, vegetables, soups, rice and noodles.

• Restore life to bland food. Make a restricted diet more appealing by using lemon juice, herbs and spices. If loss of taste and smell is a problem, experiment with seasonings and recipes.

• Plan between-meal snacks. A piece of fruit or cheese, a spoonful of peanut butter, or a fruit smoothie can provide nutrients and calories.

• Consider a supplement. A nutritional supplement can supply extra nutrients your loved one may not be getting from food. Discuss which type is best with your loved one’s doctor or dietitian.

• Make meals social events. Drop by during mealtime or invite your loved one to your home for occasional meals.

Encourage your loved one to join programs where he or she can eat with others.

• Encourage regular physical activity. Daily exercise — even if it’s light — can stimulate appetite and strengthen bones and muscles.

• Provide food-savings tips. If your loved one shops for groceries, encourage him or her to bring a shopping list, check store flyers for sales and choose less expensive brands. Suggest splitting the cost of bulk goods or meals with a friend or neighbor, and frequenting restaurants that offer discounts for older adults.

• Consider outside help. If necessary, hire a home health aide to shop for groceries or prepare meals. Also consider Meals on Wheels and other community services, including home visits from nurses and registered dietitians. Your local Area Agency on Aging or a county social worker also might be helpful.

Remember, identifying and treating nutrition issues early can promote good health, independence and increased longevity. Take steps now to ensure your loved one’s nutrition.

29 montana55.com

what we know and don’t know about memory loss after surgery Story by Judith Graham, Kaiser Health News • illustration thinkstock Navigating Aging focuses on medical issues and advice associated with aging and end-of-life care, helping America’s 45 million seniors and their families navigate the health care system.

Two years ago, Dr. Daniel Cole’s 85-year-old father had heart bypass surgery. He hasn’t been quite the same since.

“He forgets things and will ask you the same thing several times,” said Cole, a professor of clinical anesthesiology at UCLA and a past president of the American Society of Anesthesiologists.

“He never got back to his cognitive baseline,” Cole continued, noting that his father was sharp as a tack before the operation. “He’s more like 80 percent.”

The old man likely has postoperative cognitive dysfunction(POCD) — a little-known condition that affects a substantial number of older adults after surgery, Cole said.

Some patients with POCD experience memory problems; others have difficulty multitasking, learning new things, following multistep procedures or setting priorities.

“There is no single presentation for POCD. Different patients are affected in different ways,” said Dr. Miles Berger, a POCD specialist and assistant professor of anesthesiology at Duke University School of Medicine.

Summer 2018 30

Unlike delirium — an acute, suddenonset disorder that affects consciousness and attention — POCD can involve subtle, difficult-to-recognize symptoms that develop days to weeks after surgery.

Most of the time, POCD is transient and patients get better in several months. But sometimes — how often hasn’t been determined — this condition lasts up to a year or longer.

Dr. Roderic Eckenhoff, vice chair for research and a professor of anesthesiology at the Perelman School of Medicine at the University of Pennsylvania, told of an email he received recently from a 69-year-old man who had read about his research.

“This guy — a very articulate man — said he was the intellectual equal of his wife before a surgery 10 years ago, a significant operation involving general anesthesia. Since then, he’s had difficulty with cognitively demanding tasks at work, such as detailed question-and-answer sessions with his colleagues,” Eckenhoff said. “He noticed these changes immediately after the surgery and claims he did not get better.”

There are many unanswered questions about POCD. How should it best be measured? Is it truly a stand-alone condition or part of a continuum of brain disorders after surgery? Can it be prevented or treated? Can it be

distinguished in the long term from the deterioration in cognitive function that can accompany illness and advanced aging?

Some clarity should come in June, when a major paper outlining standard definitions for POCD is set to publish simultaneously in six scientific journals and scientists will discuss the latest developments at a two-day POCD summit, according to Eckenhoff.

Here’s what scientists currently know about POCD: Background. POCD first began to be studied systematically about 20 years ago. But reports of patients who appeared cognitively compromised after surgery date back about 100 years, Eckenhoff said.

An influential 1955 report in The Lancet noted common complaints by family or friends after someone dear to them had surgery: “He’s become so forgetful. … She’s lost all interest in the family. … He can’t concentrate on anything. … He’s just not the same person since.”

How to recognize the condition.

There is no short, simple test for POCD. Typically, a series of neuropsychological tests are administered before and after surgery — a time-consuming process. Often, tests are given one week and again three months after surgery. But the tests used and time frames differ in various studies.

Studies also define POCD differently, using varying criteria to assess the kind and extent of cognitive impairment that patients experience.

How common is it? The first international study of older adults with POCD (those age 60 and older) in 1999 suggested that 25.8 percent of patients had this condition one week after a major non-cardiac surgery, such as a hip replacement, while 9.9 percent had it three months after surgery.

Two years later, a study by researchers at Duke University Medical Center,published in the New England Journal of Medicine, found that 53 percent of adults who had heart bypass surgery showed significant evidence of cognitive decline when they were discharged from the hospital; 36 percent were affected at six weeks; 24 percent, at six months; and 42 percent, five years after their operations.

Another Duke study of older adults who had knee and hip replacements found that 59 percent had cognitive dysfunction immediately after surgery; 34 percent, at three months; and 42 percent, at two years.

Other studies have produced different estimates. A current research project examining adults 55 and older who have major non-cardiac surgeries is finding that “upwards of 30 percent of patients are testing significantly worse than their baseline 3 months later,” according to its lead researcher, Dr. Stacie Deiner, vice chair for research and associate professor of anesthesiology, geriatrics and palliative care, and neurosurgery at the Icahn School of Medicine at Mount Sinai in New York City.

Vulnerabilities. The risk of experiencing POCD after surgery is enhanced in those who are older, have low levels of education or have cognitive concerns that predate surgery. Adults age 60 and older are twice as likely to develop POCD as are younger adults — a development that increases the risk of dying or having a poor quality of life after surgery.

“People who are older, with some unrecognized brain pathology, or people who have some trajectory of cognitive decline at baseline, those are the patients who you’re going to see some change in one, two or three years out,” said Charles Hugh Brown IV, assistant professor of anesthesiology and critical care medicine at Johns Hopkins Medicine.

Researchers have examined whether the type of anesthetic used during surgery or the depth of anesthesia — the degree to which a patient is put under — affects the risk of developing POCD. So far, results have been inconclusive.

Also under investigation are techniques to optimize blood flow to the brain during surgery.

Mechanisms at work. What’s responsible for POCD? The drugs administered during anesthesia or the surgery itself?

Currently, the evidence implicates the stress of surgery rather than the anesthesia.

“Most surgery causes peripheral inflammation,” Eckenhoff explained. “In young people, the brain remains largely isolated from that inflammation, but with older people, our blood-brain barrier becomes kind of leaky. That contributes to neuroinflammation, which activates a whole cascade of events in the brain that can accelerate the ongoing aging process.”

At Mount Sinai, Deiner has been administering two-hourlong general anesthesia to healthy seniors and evaluating its impact, in the absence of surgery. Older adults are getting cognitive tests and brain scans before and after. While findings haven’t been published, early results show “very good and rapid cognitive recovery in older adults after anesthesia,” Deiner said. The implication is that “the surgery or the medical conditions surrounding surgery” are responsible for subsequent cognitive dysfunction, she noted.

Advice. Currently, most patients are not told of the post-surgical risk of POCD during the process of informed consent. That should change, several experts advise.

“Beyond question, patients should be informed that the ‘safety step’ of not undergoing surgery is theirs to choose,” wrote Dr. Kirk Hogan, professor of anesthesiology at the University of Wisconsin-Madison School of Medicine and Public Health, in an article published earlier this year.

“Each patient must determine if the proposed benefits of a procedure outweigh the foreseeable and material risks of cognitive decline after surgery.”

“Surgery is a good thing — it improves quality of life — and most older patients do really well,” said Brown of Hopkins. “Our trick is to understand who we really need to identify as high-risk and what we can do about modifiable factors.

“If you’re older and suspect you have cognitive issues, it’s important to let your family physician as well as your surgeon and anesthesiologist know that you’re concerned about this and you don’t want to get worse. That should open up a conversation about the goals of surgery, alternatives to surgery and what can be done to optimize your condition before surgery, if that’s what you want to pursue.”

“We want people to know this does happen but not be too concerned because, typically, it does go away,” said Eckenhoff. “That said, don’t try to make cognitively demanding decisions in the first 30 days after an operation. And make sure your caregivers are prepared to help with anything from paying bills and balancing the checkbook to ensuring that you’re caring for yourself adequately and communicating well with your doctor.”

KHN’s coverage of these topics is supported by Laura and John Arnold Foundationand Gordon and Betty Moore Foundation

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