Tag Archives: dementia

The Destructive Search for an Elixir of Life

For 3,500 or more years, mankind has been searching for the mythological elixir of life, the Fountain of Youth, the philosopher’s stone, pool of nectar, etc. that will defeat aging and extend life, if not achieve immortality.

According to Wiki, “The elixir of life, also known as the elixir of immortality and sometimes equated with the philosopher’s stone, is a mythical potion that, when drunk from a certain cup at a certain time, supposedly grants the drinker eternal life and/or eternal youth.”

All around the globe from 400 BC on, alchemists from India to China to Europe were seeking the elixir of life. Many thought gold was an essential ingredient.

The Fountain of Youth, also known as the water of life, was part of the search for the elixir of life. That search was in full throttle during the crusades and was carried to the New World by Spanish explorers, the most famous of whom was Ponce de Leon in the 1500s. Even the Mayans had legends about waters of eternal youth.

The search for the elixir of life didn’t end there.

In the 19th century in the U.S., many believed that bathing in special springs had healing powers. During that era, people flocked to eureka springs, hot springs, healing springs and many, many more. So-called healing spas are still very popular today.

“Snake oil” salesmen were peddling various cure-alls into the 20th century. A search on the Internet will reveal a large number of “promising” balms and salves, some of which actually worked for minor scrapes and burns.

If you’re over 60 or so, you may recall Carter’s Little Liver Pills. They were advertised to treat biliousness and other ailments. The FTC made the company drop the word “liver” from the name. Carter’s Little Pills are still sold, but as a laxative.

If you watched the Lawrence Welk show, you saw ads for Serutan, which is “natures” spelled backward. It’s a “vegetable hydrogel.”

Today, the search for an elixir of life, by various names, is still in high gear, and salesmen abound.

People still pursue the same goal of longer and healthier lives through a mix of vitamins, supplements, wellness, incentives, education, exams, tests, etc. that will push the time of their death out a few years.

But, alas, the human body and its organs simply wear out over time. No insurance plan, wellness plan, patient education program or prevention combination can defeat the inevitable. As we age, our bodies just wear out. For example, the reason brain aneurysms and strokes occur in the elderly is that blood vessels get thinner and more fragile with age. The same applies to other vascular diseases. Joint diseases are common as we age. Why? Joints just wear out over time. Dementia is usually related to aging. The list goes on and on.

According to NIH data, all cancer rates begin to skyrocket at about age 65. That is partially the effect of age-related diminishing immune systems. Our immune systems wear out as we age.

Companies are paying huge dollars to elixir of life promoters today, when all the facts show the elixirs just doesn’t work as advertised. Such companies’ intentions are good, even noble, but doomed to fail. Lesson: Whatever you seek, someone will find a way to sell it to you.

We are all going to have a mortal illness someday unless we die sooner from something like an auto accident. My grandfather died at age 99. Every organ in his body was failing. His kidneys were failing, as were his vascular system, his brain and his liver. Why? He simply outlived his body. I’ve known a number of good people who died a miserable death after years in nursing homes. I wouldn’t wish that on my worst enemy.

Another factor driving up costs in the U.S. has been the creation of the emergency phone number system — dialing 911 and having a life-saving trained team show up at your door in a few minutes. The 911 system saves live, no doubt, but there have been unintended health cost consequences.

If one survives a heart attack, the average cost is about $250,000. Because of the 911 phone system, some 80-year-olds are surviving three heart attacks in nine months just to die from the fourth one, adding $750,000 of cost to their last 12 months. Now, healthcare providers are even putting ventricular assist devices in people like that to keep them alive for one more day. The cost for that procedure alone is $900,000.

I’m not making a comment on the morality of deferring an elderly person’s death for nine months at a cost of $750,000 to $2 million. But we need to have an adult conversation in America about how we are going to pay for all this. By any measurement, Medicare and Social Security are both totally unsustainable unless huge changes are made that will affect everyone. Beware of proposed changes that promote intergenerational rivalries.

This chart shows death rates by age). When people hit about age 50, the death and sickness rates begin to skyrocket.

This chart shows leading causes of death. See the strong correlation to aging and heart disease. People are simply outliving their hearts and blood vessels. In 1900, people rarely died of heart disease because they didn’t live long enough to develop chronic conditions. Most of the chronic diseases we worry about are simply a consequence of aging. They are irreversible. As with the Hydra of Greek mythology, if you defeat one chronic condition, three others will pop up.

The third chart shows health spending by age; again, disease correlates to aging. That will always be the case until someone comes up with a way to prevent aging or finds an “elixir of life.” That chart also illustrates the massive, wasteful spending on end-of-life care in the U.S. compared with peer countries.

People born in the U.S. today can expect to die along a bell curve centering on age 80. If we all do everything we can possibly do to be healthier for all of our lives, there will be slightly fewer deaths around ages 78 or 79. (A great source of information on this topic is Nortin Hadler’s The Last Well Person: How to Stay Well Despite the Health-Care System.)

In any case, if you are able to add a year to your life it will, obviously, be added to the end. For most people, that will mean another year in a nursing home, in assisted living or as an invalid at home. (For a Washington Post article on just how nasty nursing homes can be, click here. Again, I would not wish that on my worst enemy.) People sometimes tell me about someone who was more or less healthy and independent at age 90. For every person like that there are a hundred in nursing homes or dementia units.

Most people retiring today don’t have enough in savings to support themselves for more than a few years, let alone enough to pay for assisted living or nursing homes when they are elderly and frail. Medicaid nursing home budgets are likewise unsustainable. Don’t count on that. For many people, living a year or two longer will simply mean being a burden to your children for another year or two, both financially and emotionally.

What about your children’s lives? Do you really want them to have to look after you well into their 60s? At that age, they should be concentrating on their own welfare.

As people age into their 80s and 90s, many become demanding in an irrational way. Some people aged 55 and up are relieved when their elderly parents pass away, but often with feelings of guilt. Most people have witnessed this in their own families.

Someday, researchers may discover a way to delay the effects of aging. Personally, I believe such is the province of science fiction. If aging is ever reversed, God help us. That would be very destructive to mankind.

Imagine our world populated by a billion or more centenarians. Imagine a nation with an average age of 65. Imagine yourself at age 90 with a 120-year-old parent or two. Who will look after whom? Will 70-year-old children or their 45-year-old children be able to look after and support such parents, grandparents and great-grandparents? The news from Asia is that many young people are no longer willing to support their centenarian parents or grandparents today, let alone great-grandparents.

What should we all do then? Simple. Spend less time wringing your hands over which illness will get you in the end; rather, make the most of the time you have. Worry will never add a day to your life.

The Romans had a blessing: May you live well and die suddenly.

How End of Life Is the Real Healthcare Crisis

To contend with ever-escalating healthcare costs, Americans will need to come to grips with the cost of end-of-life care. Right now, it’s my reality. I am seeing, first hand, rampant and seemingly uncontrollable costs of sustaining life in a system that lacks any semblance of common sense.

My mother is 90 years old and, other than some spending on five healthy sons, has expended very limited healthcare dollars in her lifetime. That is, until now. Suffering mild dementia, she is a resident in a very pleasant assisted-living facility on Long Island. The facility takes good care of her creature comforts, but, medically, she appears to be a case study in why we are all facing a cost crisis. Two of my brothers are medical professionals, and we have a concerned, knowledgeable, family that oversees her care, but we are not with her all the time to manage treatment, and that’s where things break down.

At the first sign of an issue, the facility phones an ambulance and ships her off to the nearest emergency room — three times in the past few months. The first was because of the flu. She weathered the illness but, because of scarcity of resources, was bedridden for a week. As a result, she needed more than a month of inpatient rehabilitation to restore her ambulatory skills. I am guessing that this episode cost in excess of $50,000. The doctor believes that the next two episodes – which occurred in the past 10 days – relate to an allergic reaction, and he has been trying to rule out possible culprits. He took her off Prilosec, and soon thereafter she complained of chest pains, which turned out to be indigestion. So the hospital sent her home. She burned through about $3,000 in costs to figure that one out. Then, after some tinkering with her medication, her blood pressure spiked to 200/113. This has resulted in another in-patient stay. We are planning to keep her moving to avoid another costly rehabilitation; so, for this one, Medicare and her supplemental insurance will probably spend less than $20,000.

The medical expenses she has experienced could have easily been reduced. The problem is that our Medicare system pays for services rendered and not for care management. Care management would have resulted in a much better outcome for my mother, for our family and for U.S. taxpayers.

I am convinced that the Affordable Care Act is not the answer to solve the healthcare crisis, which can only be fixed if we change the way we deliver care at the end of life. And those who lobby for Medicare for all can consider my mother’s experiences. That’s certainly not the answer.

How to Live Longer? Drink More Coffee

This idea is taken from The Doctor Weighs In post by Dov Michaeli.

As the article says, “Coffee drinkers have a reduced risk of dying prematurely from all causes, and consequently live longer.” Coffee is a “vice” that is most worthy, and one to be embraced.

Some health attributes of coffee include reduced risks of death from:

  • Cardiac arrhythmia
  • Type 2 diabetes
  • Dementia
  • Pneumonia
  • Lung disease
  • Accidents
  • Strokes

That’s quite a list. The good news is that a 50-cent cup of coffee works as well as a five-dollar cup. Any amount of coffee is better than none. According to results of a study by the National Institutes of Health (NIH), “Compared with people who drank no coffee at all, men and women who drank six or more cups per day were 10% and 15% less likely, respectively, to die during the study.”

Don’t tell wellness true believers about this. They may want to start charging coffee-free employees a higher health payroll deduction.

There Are No Rules For Dealing With Those Who Suffer From Some Type Of Dementia

Let me begin by saying: There are no rules for dealing with this. That is, there is no firm set of steps to take, no one size fits all plan.

Sometime over the last few years, the baby boomers started to retire. This has created a complex double-edged sword for professionals. While these people are typically in need of legal and financial help, they are also more likely to suffer from some type of dementia. This problem is compounded by the fact that people typically wait until later in their life to perform complex transactions.

As an attorney who practices in the area of asset protection, captive insurance and estate planning, it’s a situation I run into with more and more regularity. In addition, I have a parent who has Alzheimer’s, so I’m familiar with this situation from the other side of the equation.

Below are some tips for dealing with this situation. In my next piece, I’ll discuss my situation in general to give you an idea of the solution that has worked for my family.

Let me begin by saying: There are no rules for dealing with this. That is, there is no firm set of steps to take, no one size fits all plan. For all of us, this is a matter of figuring it out as we go; every fact pattern is a different situation. So, if you’ve run into this situation and you’re looking for a plan, realize there isn’t one.

All professionals who deal with older clients are struggling with this just as much as you are. I realize this offers little comfort, but that’s more or less where we are.

That being said, consider these points:

Don’t be willfully blind.

The older people get, the more likely they are to suffer from some type of dementia. When you meet someone who is 60 years or older, be vigilant.

Assume there’s a problem.

And look for reason to prove there isn’t a problem. Look for the following signs:

  • repetition of conversation topics
  • inability to understand simple concepts
  • reaching for words they should know
  • overall general confusion

You don’t have to be a doctor to let common sense inform your observations on these points. If it seems like there is something wrong, there probably is.

Meet older clients multiple times.

People who suffer from Alzheimer’s and dementia can have good and bad days. On a good day, everything may seem fine over a short period of time, but problems will present themselves over a longer period of time. On bad days, they have pronounced problems.

Commit to see older prospects at least three times and for longer than a few minutes — meet with them for at least an hour.

In addition, meet with them at different times throughout the day. There is a condition called sundowning, meaning that as the day progresses, people get worse. Meeting someone later in the day can highlight a developing problem.

The older the client, the more conservative the recommendation.

There are a number of cases involving family limited partnerships that were sold to the deceased within years — if not weeks — of death. The various courts overturned the deductions claimed because the partnerships were obviously formed purely for tax reasons. In short, none of these plans should have been sold to the parties in the first place.

The same is true in all fields, be it legal, accounting or financial. Put more directly, don’t sell Grammy junk bonds.

Document everything.

For an older existing client, have an agenda for each meeting and send it to them beforehand, asking them to add their own topics of discussion. Document the meeting as soon as they leave. For prospects, develop a set of detailed questions that not only allow you to comply with “know your customer” rules, but also help to gain some insight into their respective mental condition.

It’s important to ask prospects for an explanation of their previous service providers.

For example, if a 65 year old who is financially well off comes into your office and says, “I want to create an estate plan,” begin by asking them if they already have a will written. The point is, a prosperous older person probably has existing relationships with various professionals. Why are they looking to change?

And again, keep the above points to look out for in mind: repetition, confusion, reaching for words etc…

Don’t be afraid to turn away business.

Here’s a real life example from my practice. An older gentleman (roughly late 60s) wanted to write a new estate plan. We met for lunch and toward the end of the meal, he just seemed a little “off.” I scheduled another meeting about one week later in the late afternoon (4 pm) and he was definitely worse off. More importantly, he already had an estate plan drawn by another attorney (who’s very good).

After the meeting, I sent him a letter thanking him for considering me, but stating I didn’t think he would benefit from my services. My suspicions (completely unproven by the facts) were that he and the other attorney had an argument or falling out and that I’d be walking into a powder keg if I took him on as a client.

Please share your own ideas, experiences and observations in the comments section below so that others may benefit from your experience.