Columns

Maybe it's true that life begins at 50... but everything else starts to wear out, fall out, or spread out. That’s according to Phyllis Diller. She was ninety-five years old when she died last year, a devotee of cosmetic surgery, and a strong woman.  

A lot of fallen senior and mid-life citizens no longer laugh at the old saw about the shortest time span, said to be between the traffic light turning green and the driver behind you honking. The shortest time span is between falling and landing hard on the cement! Some (myself included) have found the time between tripping and landing to be the longest time span. One is thinking “Oh, no” and sometimes, “Oh, no. Not again.” Taint funny, McGee.  

The real risk and potential complications of falls can be exceeded by the morbid fear associated with going to the ground. And it’s a circular problem — studies have shown the fear of falling actually increases the risk of falling. 

Sex and the City’s fictional columnist Carrie Bradshaw observed that “When you're young, your whole life is about the pursuit of fun. Then, you grow up and learn to be cautious. You could break a bone or a heart. You look before you leap and sometimes you don't leap at all because there's not always someone there to catch you. And in life, there's no safety net. When did it stop being fun and start being scary?”  

That older people take more time to cross the street is a fact. A Centers for Disease Control and Prevention study showed the risk of pedestrian death increasing slowly through life and peaking with people over age 75; they are more than twice as likely to be killed by a car than are people overall. Better safety generally would make walking safer for older people. Better crosswalks, raised medians, enforcement of speed limits and pedestrian right-of-way, and car-free zones. Crossing signals need to be altered so that people -- seniors are people -- have sufficient time to cross the street. Why men were found to be twice as likely as women to be killed as pedestrians may be due to men walking more often than women, as well as alcohol consumption.  

Falls are one of the top 10 causes of injury reported by California Hospitals’ Emergency Department 2011 data. This month an American Association for the Advancement of Science study reported an increase in fall-related traumatic brain injuries among elderly men and women. In Australia, where four times as many elderly die from falls, falls by the elderly are proving costly for hospital. 

Falls, osteoporosis, fractures, balance and hearing, joints and knees are often associated.  

Total knee arthroplasty (TKA -- knee replacement) is one of the most costly surgical procedures performed in the United States. It “is a common and safe procedure typically performed for relief of symptoms in patients with severe knee arthritis. Available data suggest that approximately 600,000 TKA procedures are performed annually in the United States at a cost of approximately $15,000 per procedure…” Medscape’s 2013 Physician Compensation Report is online: physicians are doing well and income is on the rise overall. About one third of the specialties surveyed each earned a mean of over $300,000 annually. This year's 3 top-earning specialties -- orthopedics, cardiology, and radiology -- were the same as in the 2012 Compensation Report. 

The increase in total knee arthroplasty procedures over the past 20 years has been driven by increases both in the number of Medicare enrollees and in per capita utilization, and by an aging population and an increasing prevalence of certain conditions that predispose patients to osteoarthritis, most notably obesity. While there has been a decrease in hospital length of stay for TKA -- the notorious three-day hospital stay -- there have been increased hospital readmission rates and increased rates of infectious complications. 

A senior citizen who resorts to a TKA has usually applied all the ‘simple reminders…’ that may help prevent fractures. Knee braces from the drugstore can, it is said, 'significantly' reduce pain of kneecap osteoarthritis for a while. Glucosamine chondroitin is in vogue. Pool exercise may build strength, reduce falls. 'Mobility shoes' take a load off for knee osteoarthritis sufferers. Physical therapy may delay surgery.  

A new study by researchers at the Hospital for Special Surgery reports spinal -- or epidural -- anesthesia, improves outcomes in patients undergoing hip or knee replacement. It was found that neuraxial anesthesia, a type of regional anesthesia, reduced morbidity, mortality, length of hospital stay and costs when compared with general anesthesia. [May 2013 Anesthesiology journal] Wasn’t this well known? 

It is essential that the total knee arthroplasty (TKA -- knee replacement) patient take command of her/his situation long before surgery. Try the delay tactics first. Then into the hospital. Here’s my seniorcitizenwithoutfamily-relevant checklist:  

Before hospitalization, discuss with the orthopedic surgeon your wish/need for: a morphine drip, no catheters, at least a week’s hospital stay, and thence to a “rehab,” i.e. not a nursing home. Ask her/him to write each into your hospital chart. Whether s/he will comply with your requests or even discuss them is another matter. 

Ask the anesthesiologist for spinal anesthetic and to make you unconscious during the procedure.  

Stay at least 2 weeks in the “rehab.”  

Follow up with a month’s physical therapy visits. 

“Dreamer!,” you respond, and several aspects may indeed be beyond the patient control. They shouldn’t be. Your primary care physician may be willing and able to intervene in your behalf.  

According to the American Association for the Advancement of Science, 98% of total knee replacement patients return to life and work following surgery.  

NEWS 

May 8, 2013 headline: Older New Yorkers Advocate for an Age Equality Budget. More than 350 older New Yorkers from senior centers descended on City Hall to advocate for $26 million in restorations to services funded through the Department for the Aging. These services directly impact the lives and those of their families, friends and neighbors.  

Senior citizen delegations, led by the Council of Senior Centers and Services (CSCS,) met with 45 of the 51 Councilmembers. CSCS Executive Director Igal Jellinek stated, “The community-based aging services network were first responders during and after Hurricane Sandy making 20,000 calls to homebound older adults, delivering meals-on-wheels and keeping senior centers operating and used as community warming centers. These services are more important than ever.” 

On May 13, 2013, the Vermont legislature passed the Patient Choice and Control at End of Life Act – a tremendous advance for citizens of the state and the entire movement. The bill is similar to Oregon’s law, but reduces requirements for patients after three years, when Vermont physicians may practice aid in dying under professional practice standards instead of procedures adopted by the legislature. This makes Vermont: the first legislature in the nation to approve death with dignity; the first state in the East and fourth in the nation affirmatively to permit aid in dying; and the first state to pass a bill that transitions to less government involvement. 

OWL (The Voice of Midlife and Older Women) reports that median income for older women is only $15,000 a year. Underemployment is much higher among older women -- 20.5%, than men - 7.2%. Seventy percent older Americans living in poverty are women.