Drinking in Assisted Living - The New York Times

How likely is an assisted living resident to have a drinking problem?

The short answer is: nobody really knows. But a study by a University of Pittsburgh team, recently published in Research on Aging, provides some useful clues. More than 800 aides working in assisted living facilities in Pennsylvania were asked in a questionnaire about behaviors they had observed, or had evidence of, in the elderly people they cared for. Their responses suggested that:

-Nearly 70 percent of assisted living residents drank alcohol.
-More than a third drank daily.
-Twelve percent had abused alcohol (defined as drinking enough to cause “physical or psychosocial harm”) in the past three months.
-Almost 20 percent had experienced an apparent influence on their health from alcohol use in the past three months.

You might ask why the researchers relied on reports from nursing aides, who provide the bulk of hands-on care in assisted living, instead of asking residents themselves. One reason, admitted Nicholas Castle, a leading health policy researcher at the University of Pittsburgh, is that the team didn’t have the money to train and pay interviewers for an extensive multistate investigation that would provide a deeper understanding of this largely overlooked issue. That’s one limitation of this approach.

But as many readers pointed out the last time we talked about drinking and aging, denial is not just a river. “People tend to underestimate their consumption,” Dr. Castle said. He was not sure that residents would provide more accurate information than nursing aides, who are deeply involved with residents. “They tend to know what’s going on,” he said.

Alcohol misuse or abuse does not appear to increase with age, but it may have more serious consequences for people in their 80s, as the great majority of assisted living residents are. Their tolerance for alcohol changes; the amount they have drunk daily for years can become more intoxicating, more apt to cause falls, depression, high blood pressure and other accidents and illnesses.

In assisted living, too, most people take multiple medications and also show at least some cognitive decline. “With their changing metabolism and the possible interactions with prescription drugs, they may not need to drink a lot to have problems with alcohol,” Dr. Castle said.

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'The Talk' is never easy - Autoweek

The discussion with my father was, to be frank, painful. No, not that discussion--the birds-and-the-bees talk was a cakewalk compared with the one in which I asked him to stop driving. I had been thinking that we needed to talk for a while. He was in his late 80s, and his eyesight and hearing were declining, not to mention his reflexes. I had ridden with him in his pickup on a short drive from his house to the hardware store, and it had me terrified. It was as if he was on autopilot, not really noticing the world around him.

I worried for his safety and the safety of others. He lived in a rural area, and his ability to drive represented freedom and independence. After my mom died, he was eating most of his meals out of the house and that represented the bulk of his social activity, and he needed to be able to drive. Public transportation is nonexistent where he lived, and after a lengthy discussion, we came up with a compromise we could both live with: He wouldn't drive out of town, and he would not drive at night. When he wanted to visit our house, about 40 miles away, we would go and get him.

My dad was a member of what has become known as the Greatest Generation. He fought in Europe in World War II and was a self-made man. He was a strong man in every sense of the word. His son telling him that he shouldn't drive anymore was not something he thought he'd ever hear. It's not something I thought I'd ever have to say to him, either.

I tried using logic on him, repeating the words back to him--parents love that stuff--that he told me when I first got my driver's license. I remember him telling me that driving a car is one of the most serious things I'll ever do, just before handing over the keys to the olive-green 1968 Pontiac Catalina that had been the family car. He told me that when I was behind the wheel, I was responsible not only for my actions, but that I had to look out for the other guy.

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Sleep Apnea Linked to Silent Strokes, Small Lesions in Brain - Science Daily

People with severe sleep apnea may have an increased risk of silent strokes and small lesions in the brain, according to a small study presented at the American Stroke Association's International Stroke Conference 2012.

"We found a surprisingly high frequency of sleep apnea in patients with stroke that underlines its clinical relevance as a stroke risk factor," said Jessica Kepplinger, M.D., the study's lead researcher and stroke fellow in the Dresden University Stroke Center's Department of Neurology at the University of Technology in Dresden, Germany.

"Sleep apnea is widely unrecognized and still neglected. Patients who had severe sleep apnea were more likely to have silent strokes and the severity of sleep apnea increased the risk of being disabled at hospital discharge."

The researchers found:

-Ninety-one percent (51 of 56) of the patients who had a stroke had sleep apnea and were more likely to have silent strokes and white matter lesions that increased risk of disability at hospital discharge.

-Having more than five sleep apnea episodes per night was associated with silent strokes.

-More than one-third of patients with white matter lesions had severe sleep apnea and more than 50 percent of silent stroke patients had sleep apnea.

-Even though men were more likely to have silent infarcts, correlations between sleep apnea and silent infarcts remained the same after adjustment for such gender differences.

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Bargaining for a Child’s Love - The New York Times

ECONOMIC malaise and political sloganeering have contributed to the increasingly loud conversation about the coming crisis of old-age care: the depletion of the Social Security trust fund, the ever rising cost of Medicare, the end of defined-benefit pensions, the stagnation of 401(k)’s. News accounts suggest that overstretched and insufficient public services are driving adult children “back” toward caring for dependent parents.

Such accounts often draw on a deeply sentimental view of the past. Once upon a time, the story line goes, family members cared for one another naturally within households, in an organic and unplanned process. But this portrait is too rosy. If we confront what old-age support once looked like — what actually happened when care was almost fully privatized, when the old depended on their families, without the bureaucratic structures and the (under)paid caregivers we take for granted — a different picture emerges.

For the past decade I have been researching cases of family conflict over old-age care in the decades before Social Security. I have found extraordinary testimony about the intimate management of family care: how the old negotiated with the young for what they called retirement, and the exertions of caregiving at a time when support by relatives was the only sustenance available for the old.

In that world, older people could not rely on habit or culture or nature if they wanted their children to support them when they became frail. In an America strongly identified with economic and physical mobility, parents had to offer inducements. Usually, the bait they used was the promise of an inheritance: stay and take care of me and your mother, and someday you will get the house and the farm or the store or the bank account.

But of course what was at stake was never just an economic bargain between rational actors. Older people negotiated with the young to receive love, to be cared for with affection, not just self-interest.

The bargains that were negotiated were often unstable and easily undone. Life expectancies were considerably lower than they are now, but even so, old age could easily stretch for decades. Of course, disease, injury, disability, dementia, insanity, incontinence — not to mention sudden death — were commonplace, too. Wills would be left unwritten, deeds unconveyed, promises unfulfilled, because of the onset of dementia or the meddling of siblings. Or property was conveyed too early, and then the older person would be at the mercy of a child who no longer “cared” — or who could not deal with the work of care.

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