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Dr. Bill Thomas

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July 18, 2008

Power-Up Friday: “Jim Crow” Dementia?

[Editors Note: Power-Up Friday is a weekly guest-blog by Dr. Al Power]

On July 7th, the Civil Rights Museum On Wheels, visited St. John’s Home. Van White, a Rochester, NY attorney, purchased a 1950s vintage bus from the movie set of “Hairspray”, and had it refurbished into an exact replica of the Montgomery city bus where Rosa Parks took a stand by staying seated.

Two days later, I was asked my opinion about whether people with dementia should live in specialized units or housing. In my upcoming book, I have a section that lists a number of reasons why I feel that the “dementia unit” is an idea whose time has come… and gone. But the biggest reason of all, I realized, is an issue of civil rights.

Most “memory care units”, as they are often called, are staffed by highly competent, caring people. But the basic concept stems from an institutional mindset that places people into an environment largely defined by their disease, not by who they are. It presumes that people with dementia are enough alike that they should share a common living space, and an approach to care and activities that reflects their illness more than their individuality. Segregating people due to a physical attribute – sound familiar?

Furthermore, there is a deep prejudice in elder care environments that is shared by other elders and families. “People with dementia should have good care – separate, but equal, and not in our neighborhood”. This reflects underlying fears and misconceptions about the disease, and sells short the potential for growth and engagement that still exists in people with dementia, as surely as it does in someone who is blind or has lost a limb.

In 1955, a widespread boycott of the Montgomery buses was begun. If everyone with dementia suddenly boycotted all segregated living environments, what changes would organizations make to regain their support?

Such a boycott is unlikely. Let’s make those changes anyway.

-- Dr. Al Power

Civil%20Right%20Bus.JPG
Bus%202.JPG

Posted by Kavan Peterson on July 18, 2008 11:48 AM
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July 16, 2008

Too Much Information?

Kevin Drum writes...

QUOTE OF THE DAY....From John McCain spokesman Taylor Griffin, distancing the campaign from remarks about Social Security made by the almost comically gaffe-prone Carly Fiorina:
"The lesson of history is that too many specifics at this point polarize the debate, that is the argument Carly was trying to make."

Uh huh. Mark Kleiman translates: "If we told the retirees how completely we plan to shaft them, they might not vote for us."

Posted by Dr. Bill Thomas on July 16, 2008 5:54 AM
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July 15, 2008

World's Oldest Blogger: Dead at 108

Remembering "The Life of Riley"

Wash Day A Century Ago...

You 21st century people live a different life than the one I lived as a youngster in the early 1900s. Take Washing Day, for instance. These days you just toss your dirty clothes into a washing machine, press a few switches, and it's done.

I remember scratching around to find a few pieces of wood to fire the copper for Mum. Sometimes I'd find a broken wooden fruit box that I'd split with a tommyhawk. Sometimes I'd gather some twigs and dead branches, and use them for firewood.

When the water in the copper began to boil, Mum would add a cupful of soap chips, and throw in a cube of Reckitt's Blue wrapped in a muslin bag to whiten the clothes. Then she put in all the dirty clothes, first rubbing out the stains with a bar of Sunlight soap. She used a corrugated washing board for that. .

Some time later, when the fire had gone out, Mum would haul the clothes, dripping wet, out of the hot water with a strong wooden copperstick, and that was jolly hard work. The clothes weighed a lot more sopping wet than when they were dry.

Then she would feed the wet washing into a machine called a mangle. It had two large rollers with a narrow gap between them, and a big metal wheel that had to be turned by hand. That was my job - and it was real hard work for a small kid.

We hung the clothes out to dry on a line strung between two trees and held up with a prop made from a forked branch. Sometimes a crow or a magpie would leave a visiting card on a clean sheet, which would have to be washed again.

Mum used to starch the collars and cuffs of Dad's shirts to make them stiff and neat. He was a big man, and she was proud of the way he looked in his Sunday best, with his freshly ironed shirt.

When we remember, we grow stronger...

(H/T Dorothea Johnson)

Posted by Dr. Bill Thomas on July 15, 2008 1:28 PM
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Hats Off

This is good advice...

Hats%20off.JPG

Posted by Dr. Bill Thomas on July 15, 2008 11:51 AM
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Race versus Age

Which is more likely to make a candidate less effective if elected president?

Obama's Race

McCain's Age

The answer should be that neither age nor race can be viewed as disqualifying characteristics per se, but...

More than 8 out of 10 Americans say Obama's race would make no difference in terms of his effectiveness in the White House. Of the rest, just as many say his being black would make him more effective as president as say it would make him less effective. Thus, as far the public is concerned, Obama's race appears to be a wash in terms of perceptions about his ability to serve effectively as president.

Now, in interest of fairness, there are probably some who answer this way but feel differently. Race, after all, is a sensitive subject. But I suspect the numbers wouldn't change that much.

John McCain's age, however, is a different story:

There is more expressed concerned about McCain's age. As is the case with Obama's race, the majority of Americans say that McCain's being 72 next January would not make any difference in terms of his effectiveness in the White House. But 23% say McCain would be less effective as a result of his age, while 11% say he would be more effective. The net result is a slightly negative view of the impact of McCain's advanced age.

This could be a guess, but I think that 23% number is going to increase in the fall when people start paying attention. I'm not trying to be an ageist about this, but as someone with an elderly parent, I do have my questions about someone taking on the toughest job in the world in his 70s...but that's just me. And at least 23% of the American population.

The whole post, with a nice graph is here.

Posted by Dr. Bill Thomas on July 15, 2008 6:41 AM
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Eldercare Learnings

This is an interesting and useful site. It is like a seedling and will grow over time.

Eldercare Learnings

The Eldercare Learnings website is dedicated to people who are committed to providing intensive care to their aging parents.

This site has been launched to encourage the sharing of eldercare stories. Share your stories---if you have lots of experience or if you are just getting started and feel somewhat overwhelmed. This community needs you!

The focus is on stories and stories have the power to change everything.

Posted by Dr. Bill Thomas on July 15, 2008 6:03 AM
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July 14, 2008

Monkhouse Mondays: Timeless Beauty

[Editor's Note: Eden Alternative Europe Coordinator Christa Monkhouse guest-posts on a weekly basis from across the Big Pond. Christa helped introduce the Eden Alternative to Europe, first in the UK, then Denmark, Austria, Germany, Switzerland and soon in Sweden, Finland and other European nations. Stay-tuned for regular updates on 'Monkhouse Mondays'.]

In Zürich the European soccer championship has just ended and with it the endless (female) celebrity photos in the newspapers. At a function recently, I was with some of them and noticed that I felt uncomfortable. They are my age (over fifty) and look thirty-something due to botox and surgery. I asked myself some questions: “If I am irritated, how do other people feel about this? What are we doing to the clues our looks reveal about our experience, worldliness and seniority? Do we compete with younger woman for looks? While they need guidance, admiration and support from us older women, do they need more “rivals” which are probably abound in their own generation? "

After this experience I decided to age gracefully. I want to look old, wise and warm. I don’t want to leave any doubt about who I am. I hope that I will be able to offer a warm smile and share wisdom gained from my rich life in gratitude. I want to become a timeless (not ageless) beauty like Mrs. Lydia R. from Switzerland, pictured here at age 94, intently listening to a lecture.

-- Christa Monkhouse

Lydia%20R.jpg

Posted by Kavan Peterson on July 14, 2008 3:30 AM
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July 11, 2008

Social "Disgrace" Security Backlash

It has begun

Seniors for Obama

We know Obama has the "youth vote" thing going, and I suspect many Democrats think that seniors (particularly white seniors) are more inclined to support McCain and have written them off. I think that's a mistake - in just the past day, McCain has famously dismissed Social Security as a "disgrace," and in what I think is a monumental blunder, McCain was the ONLY senator missing from yesterday's vote in the Senate to prevent a devastating cut in payments to physicians treating Medicare patients. Even Ted Kennedy took a break from cancer treatment to show up and vote, for the first time since his diagnosis. Where was McCain? Campaigning.
So, the next time your elderly parents, friends, associates, or relatives express doubts about Obama and/or support for McCain, tell them that Obama took a break from the campaign trail to save Medicare but McCain couldn't be bothered. If they rely on Medicare as so many seniors do, they need to know this.

Posted by Dr. Bill Thomas on July 11, 2008 9:30 AM
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Power-Up Friday: Rekindling the Spark of Life

As promised, more on social capital and dementia:

Did everyone see the NY Times on 6/24? More and more people are recognizing the dangers of using antipsychotic medications in dementia.

In my last installment, I discussed how increased social capital leads to many improvements in quality of life and health outcomes, and that increased social integration may even slow memory loss.

We also saw the remarkable results that can occur with interactions that validate the person with dementia and facilitate his engagement with the world (see Jane Verity and Hilary Lee's video posted on Monkhouse Mondays 5/6/08). There is an important message here:

I believe that there are two major morbidities in dementia. The first is the well-recognized progressive damage to the brain cells that occurs as a result of the disease process. This is, as far as we know, irreversible, (though recent studies showing new nerve pathways in stroke patients may give us hope for future therapies).

But there is a second morbidity. This is the excess disability that is caused by our clinical approach to people with dementia. This arises from the defeatist view of the disease that causes us to socially isolate people with dementia, strip them of all autonomy, take a "declinist" attitude toward their future capabilities and resort to giving sedating medication. We often rationalize the latter as reducing suffering in what we view as terminal disease.

However, by creating transformed care environments that re-engage people with dementia and using skilled care partners to bring forth the capabilities they still possess - coupled with removal of those medications - we can effectively reverse their disease, bringing them to levels of function and engagement that they have not enjoyed in many months.

Cecil, who is seen speaking, singing and joking in the Spark of Life video, had not spoken for over a year before being involved in this program. His brain anatomy may not have changed, but one would have to conclude that his dementia had effectively been reversed, by removing these excess disabilities.

Make no mistake about it, these are truly life-saving interventions. While we struggle to find a cure for dementia, we must not overlook the very real transformation of people's lives that we can accomplish for millions of people today!

-- Al Power. MD, FACP
Eden Mentor
St. John's Home
Rochester, NY

Posted by Kavan Peterson on July 11, 2008 8:23 AM
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July 10, 2008

Gribbin on McCain

The Erickson School's Dr. Joe Gribbin has commented on my post on McCain's comments regarding Social Security.

Dr. Gribbin offers a generous interpretation of what McCain might have meant to say.

While it is possible that this is just a flubbed line, it is definitely true that McCain supports the same kind of privatization schemes that the Bush Administration wanted but did not get.

Here's Dr. Gribbin's comment...

Having studied closely the comments made and the positions taken by both candidates for president I can say with absolute certainty that what McCain meant to say (and he fumbled it) was that it is a disgrace that young people are supporting older generations without the certainty that the program will pay them 100% of promised benefits.
I strongly disagree with Dr. Thomas' characterization of McCain's position. While I think that the positions taken by both McCain and Obama are seriously lacking in addressing issues in such a way to equitably share the pain of resolving the financial issues with the program while preserving its core principles of social adequacy and social equity, it is patently unfair to state or imply that McCain is against Social Security. Ideology can be a dangerous and counter-productive thing when trying to heal this program.

--Dr. Joseph Gribbin
Former Associate Commissioner, Social Security Administration and currently Professor at the Erickson School of Aging Studies.

Dr. Gribbin feels that "it is patently unfair to state or imply that McCain is against Social Security"

Here are the key Social Security votes of the last 10 years...

McCain Voted for Bush’s 2006 Social Security Privatization Plan. In 2006, McCain voted for the Social Security Reserve Fund. The proposal would shift Social Security’s annual surpluses into a reserve account that would be converted into risky private accounts. [SCR 83, Vote #68, 3/16/06; SCR 83, Vote #68, 3/16/06]

In 2000 McCain Wanted to Divert Social Security Money to Private Accounts. The Wall Street Journal reported that “[a] centerpiece of a McCain presidential bid in 2000 was a plan to divert a portion of Social Security payroll taxes to fund private accounts, much as President Bush proposed unsuccessfully.” The plan would put workers’ retirement money into the risky market and reduce the amount of Social Security payments they would receive from the government. The plan would undermine the Social Security system. [Wall Street Journal, 3/3/08]

McCain STILL Proposes Privatizing Social Security—Despite What His Website Says. McCain told the Wall Street Journal he still backs a system of private retirement accounts that he supported in 2000 and President Bush pushed unsuccessfully. The Journal reported he “disowned” details of a proposal on his 2008 campaign website that says he would “supplement” the existing Social Security system with personally managed accounts. But when asked about the position change he denied it and promised to change the website to reflect his true position. “I’m totally in favor of personal savings accounts… As part of Social Security reform, I believe that private savings accounts are a part of it—along the lines that President Bush proposed,” McCain told the Journal.[Wall Street Journal, 3/3/08; Campaign Website, accessed 3/3/08]

McCain Might Raise the Retirement Age and Reduce Cost-of-Living Adjustments. “[T]he McCain campaign says the candidate intends to keep Social Security solvent by reducing the growth in benefits over the coming decades to match projected growth in payroll tax revenues. Among the options are extending the retirement age to 68 and reducing cost-of-living adjustments, but the campaign hasn’t made any final decisions. ‘You can’t keep promises made to retirees,’ said Mr. Holtz-Eakin, McCain’s chief economic aide.” [Wall Street Journal, 3/3/08]

McCain Supported Deep Cuts That Put Social Security Benefits at Risk. In 2005, McCain supported a Social Security plan that would require deep benefit cuts or a massive increase in debt. That same year, McCain voted against prioritizing Social Security solvency over tax cuts for the wealthy. [SCR 18, Vote #49, 3/15/05; S. Amdt. 144 to SCR 18, Vote #47, 3/15/05]

McCain Voted to Use Social Security Money to Pay Off National Debt. In 2003, McCain voted to use Social Security funds to pay off federal debt. [HJR 51, Vote #201, 5/23/03]

McCain Voted Against Protecting Social Security Solvency with a Strategic Reserve. In 2001, McCain opposed reducing tax cuts for the wealthy to create a strategic reserve for Social Security. In the same year, McCain voted against a proposal to create “lockboxes” to protect Social Security and Medicare. [H.R. 1836, Senate RPC, Vote #145, 5/22/01; S. Amdt. 29, Vote #22, 3/13/01]

McCain Voted to Replace Social Security with Risk-Based Investments. In 1998, McCain voted twice to replace Social Security’s guaranteed benefits with income from risk-based private investments. [SCR 86, Vote #56, 4/1/98; SCR 86, Vote #77, 4/1/98]

Are these the votes of a supporter of Social Security?

Posted by Dr. Bill Thomas on July 10, 2008 2:39 PM
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McCain's Not So--- Social Security

McCain is against social insurance programs. He thinks that the way Social Security was designed to operate and has operated since its creation is a "disgrace."

At a town hall meeting on Monday, McCain said:

Americans have got to understand that we are paying present-day retirees with the taxes paid by young workers in America today. And that's a disgrace. It's an absolute disgrace, and it's got to be fixed.

Steven Benen writes

OK, let’s take a deep breath here. Social Security is a pay-as-you-go system. Current workers pay into the system to provide benefits for retirees, and when those workers retire, the next generation will pay their benefits. That’s what Social Security is. That’s how it works. That’s how it’s always worked.

If McCain wants to argue that privatization is a good idea, fine. He’s wrong, but we can have the debate (again). But it appears that McCain is desperately in need of some kind of remedial Government 101 education, because he literally described the Social Security system as a “total disgrace.”

At this point, John McCain is starting to make George W. Bush look like a sophisticated policy wonk.

Now, I know what you’re thinking. Maybe McCain just slipped up. He was tired and said something he didn’t mean to say. This couldn’t possibly reflect his feelings on the Social Security system. He knows he’d lose Florida if it got out that he considers the system a “total disgrace.”

But it’s true. Here’s how he talked about Social Security on CNN yesterday morning:

“On the privatization of accounts, which you just mentioned, I would like to respond to that. I want young workers to be able to, if they choose, to take part of their own money which is their taxes and put it in an account which has their name on it. Now, that’s a voluntary thing, it’s for younger people, it would not affect any present-day retirees or the system as necessary. So let’s describe it for what it is. They pay their taxes and right now their taxes are going to pay the retirement of present-day retirees. That’s why it’s broken, that’s why we can fix it.” [emphasis added]

It’s literally breathtaking. As Nick Baumann put it, “McCain is saying, again, that the problem with Social Security is that Social Security is Social Security, instead of something else.”

Posted by Dr. Bill Thomas on July 10, 2008 6:42 AM
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July 9, 2008

Leisureville

The author digs into a little understood dimension of aging:

How does the segregation of Elders change the lives of the young?

NEW YORK (Reuters) - Most people see retirement communities as places where older people can keep busy while feeling safe, but a 39-year-old author says these "geritopias" have serious consequences for the rest of society.
In his new book "Leisureville," Andrew D. Blechman explores this issue, which piqued his interest when his neighbors decided to move to the world's largest gated community for the 55-and-older set.

Blechman, who has a young daughter, wondered why the couple was leaving a charming town in rural Massachusetts for a place where children can visit for no more than 30 days a year. But he later found that the "active adult" sector had become the fastest-growing part of the U.S. housing market.

During his own one-month stay at his former neighbors' new home in central Florida's The Villages, Blechman threw himself into the lifestyle of golf carts, a myriad of social activities, and bars where last call is at 9:45 p.m.

The author, whose previous book was about pigeons, says he enjoyed himself sometimes, but was disturbed by the insularity of such developments and their influence on local governments.

He spoke to Reuters about segregated living and the future of retirement communities.

Read the full interview here..

Posted by Dr. Bill Thomas on July 9, 2008 10:36 AM
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July 7, 2008

New Old Age

Jane Gross from the New York Times has a new blog.

It's called The New Old Age.

I like it so far.

Here are a couple of posts...

Coming Home for Herbie

The Car Key Conversation

It well written, loaded with content and is likely to become a frequent stop for all of us.

The New York Times done a good job in covering aging for the past few years and I think that this blog is a sign that the paper continues to see the issue as important.

So far, the focus is clearly on "Caring For Your Parents" and the legendary difficulties that such caregiving can entail.

Now for a quibble.

This quote from "Coming Home for Herbie," while clearly accurate, is a bit off key.

That was the moment, Ms. Winokur said, when she knew she was truly in charge, the role reversal complete. “The time for discussion was over, and I was like a parent talking to a child,” she said. “You can clean up your room or you can’t have dessert.”

(Emphasis Mine)

The idea that adult children experience a "role reversal" idea is both common and not very helpful. In my experience, this kind of thinking can easily lead to a profound loss of dignity on the part of the older relative. It can also make caregiving more, rather than less, burdensome.

It is better, I think, to conceive of the caregiving relationship as a new phase in the original parent child relationship.

Adult children are often relieved when I say to them, "You are still your mother's child and you will always be her child but the time has come for you to become a different kind of daughter/son."

Not better, not worse, just different...

Posted by Dr. Bill Thomas on July 7, 2008 8:04 AM
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Monkhouse Mondays: First we take Manhattan........

“They sentenced me to twenty years of boredom*
For trying to change the system from within
I’m coming now, I’m coming to reward them
First we take Manhattan, then we take Berlin”

Leonard Cohen’s song has long been the unofficial Eden-in-Europe anthem, starting small (with one home in Switzerland = Manhattan) then spreading out over Europe (= Berlin).

This song comes to life in Denmark, where national coordinators Aase Porsmose (aaseporsmose@mail.dk) and Karin Dahl (karindahl@stofanet.dk) are truly taking “Berlin”. Here is their report on bringing the Eden philosophy to “almost the whole country” of Denmark (Note: the charming Danish/English comes to you unedited):

“Our project involves 25 nursing homes from three municipalities across Denmark. The aim is quality-improvement for both residents and staff, due to a culture change to a new focus on every day living, health promotion and relationships. We challenge the present culture in Danish nursing homes. Even though we have worked with a Danish ‘Live and stay’ culture for several years the institutional culture is still dominating. We regard Eden as a necessary superstructure to eliminate the confirmed loneliness, boredom and helplessness.
In the project we have been on a 'preparation tour' to all of the homes making interviews with leaders, staff and users, board members and politicians. We also made 2-hours information meetings about both the project and Eden on the same day.

Right now we are teaching about 30 leaders and 300 chosen staff members their first 3 days course about Eden. In the autumn we make a second 3 days course for the 300 staff members who will have a process-role as 'Eden key-person'. The leaders will have three separate days during the project period, because we wish to be able to support them during the implementation.

We are also going to visit every nursing home 3 times in the education and implementation period, to support the local Eden-group during their Eden-process - the aim with these days is to support the educated Eden-key persons in a way that will make them able to continue the process without having to ask for help from us every now and then.

The project is financed by funds from the Danish Ministry of Social Welfare. More funds have been given to other smaller projects across the country which also involves the Eden principles.

The Eden power-team: Karin Dahl/Aase Porsmose/ nurtured by Jane Verity, Eden Scandinavia Mentor

Christa Monkhouse, Switzerland

*The editorial of the May 2008 Issue of the “International Journal of Older People Nursing” by Jan Reed (p 79 – 79) has the same title (Volume 3, Issue 2)

Posted by Kavan Peterson on July 7, 2008 6:28 AM
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July 3, 2008

Quarterstaff Revolution

The New York Times took a look at the research AARP was doing on walking canes in 1992...

Many people who use canes injure themselves because they don't do the necessary research before buying one. That is an early conclusion of a continuing study on canes sponsored by the American Association of Retired Persons.

According to Dr. Margaret Wylde, vice president of the Institute for Technology Development in Oxford, Miss., which is conducting the study, the conclusion is based on a review of recent medical and rehabilitation literature and on more than 1,000 letters solicited from A.A.R.P. members who are regular cane users.

Some of the most serious damage, Dr. Wylde said, can result from the cane's grip. Carpal tunnel syndrome, a painful ailment, can result from any repetitive motion like typing or using a cane.

There are two reasons people use walking canes.

1) To improve balance by providing a third contact point with the ground.
2) To redistribute weight away from an injured or arthritic lower limb.

As a physician I have never really liked walking canes. Here is one patient's experience...

I noticed several problems within the first five minutes. My triceps were quickly fatigued as they worked to hold my weight up. As a result, my scapula elevated to relieve the triceps, putting strain on my rotator cuff. This "shrugging" effect could be somewhat offset by lowering the height of the handle below my waist, which served to extend the arm and reduce the amount of elevation in the shoulder.
The handle of the cane was designed in such a way that the grip increased in broadness from the neck of the handle to the end, providing a wider, flatter surface where the palm would rest. Unfortunately, the result was not a more comfortable feel, but rather a terrible dorsiflexion combined with ulnar deviation in the wrist and a bruised hamate bone where the weight was concentrated. I felt tweaks of pain all day long in my wrist and shoulder which continued into the night, long after I had ended my experiment.

Aside from design problems, there were several functional problems as well. For instance, each step was accompanied by a jarring vibration which was transferred up the entire length of the arm every time the rubber cane tip struck the concrete. The swing of the cane often had to be initiated by a flick of the wrist, resulting in a constant repetitive oscillation between ulnar and radial deviations. Furthermore, adjusting the cane to the correct height was difficult due to a simultaneous push of a button and pull of the shaft requiring relatively dexterous fingers; arthritic hands would be pitifully ineffective.

PREDICTION!

Elders of today and tomorrow are going to give up on the cane, abandoning it in favor of the quarterstaff.

Gandalf the Grey carried about with him a spike brown staff which served partly as an agency of his power, as can be seen when he faced the Balrog in Moria. Besides functioning as a useful walking stick, it was also thought to symbolise what he was and his position in the Istari.

There are three reasons that I think elders can and will retire the old time walking cane and embrace the quarterstaff.

1) The cane places the greatest strain on the smallest muscles and joints (the wrist and forearm) repetitive use can easily lead to wrist and forearm injury.

2) The quarterstaff transfers the weight into the shoulder girdle itself. The shoulder joint and its surrounding muscles are much better prepared to handle the load than are the wrist and forearm.

3) Imagine a scene, an older woman using a bent top walking cane crosses a building lobby, trying to make the elevator before the doors roll closed. Now imagine that scene with the older woman striding across the lobby with a seven foot oak quarterstaff at her side. People hold the door open not because of chivalry, not out of a desire to help little old ladies but rather because she just looks so damned cool.

Elders are obligated to give younger people clues about how deep and mysterious elderhood can be.

I would like an any elders or elders to be who read this post to go out and get a walking staff. Go out in public with it and follow your normal routine and have somebody take a picture of you using it. Send the photo to Ronni.

I'll close my appeal with a quote from one of America's greatest walkers...

"Although the vast majority of walkers never even think of using a walking staff, I unhesitatingly include it among the foundations of the house that travels on my back. I still take my staff along almost as automatically as I take my pack. It is a third leg to me - and much more besides. On smooth surfaces the staff helps maintain an easy rhythm to may walking and gives me something to lean on when I stop to stand and stare. Over rough going of any kind, from tussocky grass to pockety rock, and also in a high wind, it converts me when I am heavily laded from an insecure biped to a confident triped. ... It may well be, too, that the staff also gives me a false but subconsciously comforting feeling that I am not after all completely defenseless against attack by such enemies as snakes, bears and men."

- Colin Fletcher, The Complete Walker III, 1984, p. 78

Posted by Dr. Bill Thomas on July 3, 2008 6:42 AM
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July 2, 2008

European "Baby Bust"

[Editor's Note: The following is a guest-post from ChangingAging blogger Al Power]

Before I share my promised post about social capital and dementia, I’d like to point out a fascinating article in Sunday’s New York Times Magazine, and hopefully get some comments from our community “across the pond."

This article concerns the current “Baby Bust” in Europe, where birth rates have dropped to record lows. A birth rate of 2.1 babies per woman is considered the number needed to maintain a country’s population. This is currently our number in the US. In Europe, however, the level has dropped significantly, and is only 1.3 in southern and Eastern Europe.

There is an interesting contrast between these countries and northern Europe, where the rate is relatively higher at 1.8. The southern countries have more women who stay home after childbirth, yet the birth rate is lower. Social scientists suggest the reason is that although these countries have more traditional views about childrearing, they have fewer social supports.

By contrast, the Scandinavian countries have more social welfare in the form of maternity and paternity leave, childcare coverage, etc. It is felt that these social supports actually encourage women to have more children.

There is also an attitudinal change occurring, especially in Germany and Austria, where greater than 1 in 8 young women feel the ideal number of children to have is “none”.

Rates are also dropping significantly in Japan, Korea and Thailand, and to a lesser extent worldwide. It is felt that the higher US level is due to (1) a more conservative, religious-based view on family size, and (2) greater flexibility with work hours and return to work after long absences offsetting the fewer social supports available here.

With the population aging, this fans the flames of concern about the inability of the workforce to support our elders. Many countries are encouraging people not to retire as early as people do in much of Europe. Incentives, financial and otherwise, are also being given to have more kids.

Of course, many people do not see this trend as a bad thing, especially in terms of environmental impact. And those of us who blog on these pages would look at the last quote, “You can’t have a country where everyone lives in a nursing home”, as further evidence of the need to change aging and raise social capital.

-- Al Power

Posted by Kavan Peterson on July 2, 2008 8:09 AM
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Arkansas Green House

Some good news in Arkansas...

"One size doesn't fit all," Congressman John Boozman, a strong advocate for improvements to senior care, told a group gathered to celebrate the first shovels of dirt turned for the Green House Assisted Living project in November. "These are the kinds of projects that really do change people's lives."
Now that the finishing touches are being put on the exteriors of the first four Green Houses, a stateof-the-art assisted living environment at Legacy Village, the calls are rolling in. For the past several months, visual progress on the Green Houses has prompted a growing list of seniors and their loved ones to inquire about what will be the first project of its kind in Arkansas.

The Green House model was developed by Dr. Bill Thomas, a nationally recognized geriatrician dedicated to eliminating institutionalstyle nursing homes in America. The Green House success story began with the opening of Thomas' pilot project in Tupelo, Miss., in 2002. There are now 10 such projects across the country.

Posted by Dr. Bill Thomas on July 2, 2008 6:22 AM
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July 1, 2008

Co-Housing Explained

Here is a sharp short video that does a good job of explaining Co-housing-- what it is and how it works...

Click Here to Watch'

(h/t Alex M)

Posted by Dr. Bill Thomas on July 1, 2008 6:14 AM
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June 30, 2008

Monkhouse Mondays: Normal or deficient – a matter of perspective!

My husband Lowell (Canadian) told me this story over breakfast (Sunday, summer morning, sitting outside, in sunny Switzerland near Lake Zürich).

During the early 1970’s he was working with a Canadian provincial government and they were attempting to implement the ideas of the Syracuse University Professor Wolf Wolfensberger who had written the book Normalization. They were developing the requisite services so that people with disabilities could live in the community and not in institutions. Once when visiting a Hutterite Colony with his boss, they saw a young man with Down-Syndrome. At that time this young man would have quite likely been living in an institution if not living on the commune. The boss asked the colony’s headman to tell him about “the young man over there”. The headman responded by saying "who, John the cattle herder?" That, in a nutshell, described the solution.

I drew immediate parallels to how we should treat our Elders today. Readers are invited to respond with their ideas and impressions.

-- Christa Monkhouse

Posted by Kavan Peterson on June 30, 2008 9:29 AM
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June 27, 2008

Power-Up Friday: Eden Care Partner Award

[Editor's Note: Guest-post from Al Power below]

Rochester New York's ABC affiliate, WOKR-TV, featured Eden International Care Partner Award recipient Gregory Payne on their "Bright Spot" to close the evening news on 6/25.

Known to those at St. John's Home as "Greg Grounds", Payne convenes a weekly "Green Thumb Society", helping the elders to start seedlings, and to plant flower and vegetable gardens at the home. The group also pots plants to deliver to visitors, and to those who cannot participate.

Greg read Bill's book, "In the Arms of Elders" several months ago, and became an instant Eden Champion. His work, (which as the news report suggests, comes straight from the heart), has touched the lives of all who live and work at St. John's.

To see the video, click here, and click on the 6/25/08 Bright Spot.

-- Al Power

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