Falls and fractures.

As an undergrad, I was a nutritional sciences major, which, believe it or not, was insanely tough. We memorized vitamins and recommended daily allowances as well as things like the Krebs Cycle and the structures of the different amino acids. All to understand how the different parts of the body and what we put into it interact. This morning, I came across this article on NPR that looks at a study between vitamin D and bone. The study administered very high doses of vitamin D in the autumn to elderly women at high risk for fractures and falls, and found that the women with the high doses were actually having more falls and fractures!

I was kind of shocked when I read this article, because every class I took in undergrad emphasized that high super-doses of any vitamin was dangerous and low doses over long periods of time were both safer and more effective. On one hand, I'm glad that these researchers have found that to be true, but on the other hand, it shocks me that they didn't already know this.

Huge Vitamin D Doses Appear to Hurt More Than Help

by DEBORAH FRANKLIN

Students of the "if-a-little-is-good-a-lot-must-be-better" school might want to look hard at the latest vitamin D study in this week's JAMA.

iStockphoto.com

Taking huge amounts of vitamin D might not be the greatest idea.

Researchers at the University of Melbourne found that giving annual megadoses of vitamin D to elderly women with brittle bones may have actually increased the women's rate of falls and bone fractures, instead of reducing their risk as the researchers had hoped.

Now, these were very big doses of the sunshine vitamin — 500,000 IU spread across ten days, once a year for four years. That's more than 600 times the daily dose of 700 to 800 that's been shown in earlier studies to decrease fracture risk by up to 25 percent.

Why, you might ask, would doctors even think about giving patients such huge vitamin doses?

As Dr. Bess Dawson-Hughes, a long-time bone researcher at Tufts University who wrote an editorial about the work in the same issue of JAMA, says it's quite common for doctors to kickstart their patients who are low on vitamin D with 50,000 IU twice a week for six to eight weeks.

The University of Melbourne's Kerrie Sanders and colleagues say they were motivated to try even bigger doses because it's hard to get people to stick with with a daily regimen of pills. They also knew from other work that fat-soluble vitamin D is stored in the body for long periods, and released a little at a time.

Giving a megadose in autumn, they figured, would help boost the women's blood levels to a good range throughout the dark days of winter when vitamin D levels typically dip. And there was no reason, they say, to think it would hurt — the women's blood levels, even at the peak was much lower than toxic levels.

But after several years, women in high-dose vitamin D group had 15 percent more falls, and 26 percent more fractures than women who swallowed dummy pills instead.

Why that would happen is still far from clear, but at least one other similar study has shown the same result. Both Sanders and Dawson-Hughes are still optimistic that vitamin D, given in lower daily doses, can help build bones. But the effect of very high doses, Sanders says, warrants further study.

You're Only Old Once

You're Only Old Once

By Dr. Seuss

One day you will read in the National Geographic of a faraway land with no smelly bad traffic.

In those green-pastured mountains of Fotta-fa-Zee everybody feels fine at a hundred and three 'cause the air that they breath is potassium-free and because they chew nuts from a Tutt-a-Tutt Tree. This gives strength to their teeth, it gives length to their hair, and they live without doctors, with nary a care.

And you'll find yourself wishing that you were out there in Fotta-fa-Zee and not here in this chair in the Golden Years Clinic on Century Square for Spleen Readjustment and Muffler Repair.

Just why are you here? You're not feeling your best ... you've come in for an Eyesight and Solvency Test.

And if you're the type that gets finicky-finick, at this point you'll try to get out of that clinic. But they will out wit you as quick as a wink! The Quiz-Docs will catch you! They'll start questionnairing!
They will ask you point blank, how your parts are all fairing.

And your grandfather's parts. And Please try to recall if your grandma hurt most in spring or fall. Did your cousins have dreadful wild nightmares at night? Did they suffer such ailments as Bus Driver's Blight, Chimney Sweep's Stupor, or Prune Picker's Plight? And describe the main cause of your uncle's collapse. Too much alphabet soup? Or martinis. perhaps?

And the next thing to know, when you've finished that test, is somehow you've lost both your necktie and vest and an Ogler is ogling your stomach and chest.

Your escape plans have melted! You haven't a chance, for the next thing you know, both your socks and your pants and your drawers and your shoes have been lost for the day. The Oglers have blossomed like roses in May! And silently, grimly, the ogle away.

What those Oglers have learned they're not ready to tell Clinicians don't spout their opinions pell-mell. So you're back with the vestibule fish for a spell. Norval won't bring you comfort, you know. But he's quite sympathetic as Clinic Fish go.

There you'll sit several hours, growing tenser each second, fearing your fate will be worse than you reckoned, till finally Miss Becker, your beckoner beckons...

... to a booth where the WOrld-Reowned Ear Man, Von Crandell, has perfected a teast know as Bellows and Candle. If wind from the bellow can't blow out the flame, you failed! And you're going to be sorry you came.

You'll be told that your hearing's so murky and muddy, your case calls for special intensified study. They'll test you with noises from far and from near and you'll bet a black mark for the ones you can't hear. Then they will say, "My dear fellow, you're deafer than most. But there's still hope, since you're not quite as deaf as a post. We'll study your symptoms. We'll give you a call. In the meantime, go back and sit down in the hall."

So you'll find yourself talking to Norval once more. And Norval will think you're a bit of a bore because Norval has heard the same stories before.

To this fish you'll become a plain pain in the neck while you wait, once again, for Miss Becker to beck.

But Miss Becker won't come. With great swish and great swank a wheelchair will come! You've gained status and rank! And Whelden the Wheeler will say with great pride: "You have qualified, sir. You are now certified as a VIP Case. You're entitled to ride! Through thin and through thick I'll be at your back side."

Dear Whelden will show you great sights as you go: Right now you are riding down Stethoscope Row. And I know that, like all our top patients, you're hoping to get yourself stethed with some fine first class scoping. So I'm sure you'll be simply delighted to hear that in the Internal Organs Olympics last year Doctors Schmidt, Smoot, Sinatra, Sylvester, and Fonz won fifteen gold medals, nine silvers, six bronze! For the moment, however, we'll by-pass this bunch. There is plenty of time to see them after lunch.

You must see Dr. Pollen, our Allergy Whiz, who knows every sniffle and itch there is. Dr. Pollen will find, as he works on your case, if the face powder's wrong on your stepsister's face. He will check your reactions to thumb tacks and glue, catcher's mitts, leaf mold, and cardigans, too, nasturtiums and marble cake, white and blue chalks, anthracite coal and the feathers of hawks. Also corn on the cob. Also buffalo grease and how you react when you're stared at by geese. He'll take copious notes. Then I'll hazard a guess that he'll send you downstairs to see Dr. Van Ness.

Van Ness has enjoyed a high rate of success in his pioneer work in the Study of Stress. So, you can be sure, he will stress you a trifle, then he'll send you around to see Dr. Van Eiffel.

Dietician Von Eiffel controls the Wuff-Whiffer our Diet-Devising Computerized Sniffer on which you just simply lie down in repose and sniff at a good food as it goes past your nose. Fromcaviar souffle to caribou roast, from pemmican patties to terrapin toast, he'll find out by Sniff-Scan the foods you like most.

And when that guy finds out what you like, you can bet it won't be on your diet. From here on, forget it!

Then, into the New Wing! We'll see Dr. Spreckles, who does the Three F's-Footsies, Fungus, and Freckles. And nextly we'll drop in on young Dr. Ginns, our A and S Man who does Antrums and Shins, and of course he'll refer us to Doctors McGrew, McGruire, and McPherson and Blinn and Ballew and Timpkins, and Tompkins and Diller and Drew, Fitzsimmons, Fitzgerald, and Fitzpatrick, too, all of whom will prescribe a prescription for you.

For your Pill Drill you'll go to Room Six Sixty-three, where a voice will instruct you, "Repeat after me... This small white pill is what I munch at breakfast and right after lunch. I take the pill that's kelly green before each meal and in between. These loganberry-colored pills I take for early morning chills. I take the pill with the zebra stripes to cure my early evening gripes. These orange-tinted ones, of course, I take to cure my charley horse."

"I take three blues at half past eight to slow my exhalation rate. On alternate nights at nine pm I swallow pinkies. Four of them. The reds, which make my eyebrows strong, l eat like popcorn all day long. The speckled browns are what l keep beside my bed to help me sleep. This long last one is what l take is l should die before l wake."

When at last we are sure you've been properly pilled, then a few paper forms, must be filled so that you and your heirs may be properly billed.

Whereupon ... if you are smart, there's a very good chance that you'll meet soon again with your socks, coat, and pants.

And you'll know, once your necktie's back under your chin and Norval has waved you Godspeed with his fin, you're in pretty good shape for the shape you are in!

Retirement

I've recently been reading some studies that emphasize the positive effects that volunteering has on the retired population. One study I found especially interesting noted the relationship between volunteering and depression. Kim and Pai, in their article "Volunteering and Trajectories of Depression" published in the Journal of Aging and Health, found that "volunteering affects the decline of depression for individuals above the age of 65." Now, I didn't have to read this article to know this because Grammy's been telling me that forever!
Maybe Grammy is just over-zealous, but she is a perfect example of how volunteering can improve a life. If there was an award for the Best Volunteer of the Century, I think my grammy would probably receive it. And, consequently, Papa would also receive it because whatever Grammy volunteers for, Papa also gets to do. He pretends like he doesn't like it, but I know he secretly does...And so does Jim Bevier. In the spirit of retirement, Grammy got me a subscription to Reader's Digest and amongst articles about shark attacks and saving money, I found this inspirational article:

Best of America: He Delivers to the Blind

In his spare time, this former FedEx pilot helps distribute cures for blindness around the globe.

By Peter Guglielmetti

From Reader's Digest

You might think Jim Bevier—newly retired and finally kicking back after a harrowing hurricane season—would be content on his Mississippi horse ranch, teaching his grandkids to ride. But this 62-year-old former FedEx pilot has another passion. Bevier is a volunteer pilot for Orbis, a nonprofit that has fought blindness in developing countries for more than 25 years (orbis.org).

One of its weapons is the Flying Eye Hospital, a converted DC-10 aircraft that houses a state-of-the-art surgical and teaching facility. Bevier's mission is to land this giant sight-saving bird (as patients have described it) on runways that are most definitely not designed for it.

Photographed by Wyatt McSpadden

Jim Bevier pilots the Flying Eye Hospital.

"It's not like flying for FedEx," says Bevier. "We have to make sure the runway is long enough, get diplomatic clearances, figure out the fuel load, and find the safest place to park in case of a political coup."

Once he gets the hospital to its destination, it becomes a place for local doctors to get ophthalmologic training so they can treat conditions like glaucoma and cataracts and prevent blindness for thousands of people.

The plane stays on location for weeks, and while Bevier is free to return home, he likes to stay and meet those who arrive for screenings. Many walk on dirt roads for miles; many are blind children.

"I've seen them get on the airplane and come out the next day and they can see," Bevier says. The volunteer doctors can't handle all the patients. A Vietnamese boy who had made Bevier a paper airplane was turned away. "A pilot's job involves hours and hours of boredom and the occasional few seconds of stark terror. So you learn to keep your emotions in check. But when he didn't get picked, I broke down," he admits.

Challenging as the gig may be, Bevier isn't looking to retire anytime soon. "I don't golf, I don't have a recliner, and I tell my kids not to ever buy me those Velcro tennis shoes," he says. "You beat your body up getting there and back," he says of the Orbis flights, which can span 30 hours. "But I think of my grandchildren back home, and all I want is for those kids to be able to see their own grandparents for the first time."

Spring Break.

Last year for spring break, I drove my grandparents to Florida to visit Papa's sister. It was epic, to say the least.

Happy Spring Break!

Wii

I came across this article in a magazine I get called Paste and thought it was just wonderful! I feel like oftentimes with aging comes a loss of ability, whether it be driving, body movement, energy or anything else and I'm thrilled to see that the Wii is doing more than just making me better at fake-skiing. It is so important to feel like you are of worth and to feel connected with other people and I think that Willa Mae sums it up well when she says:

“It was about us. We wanted to do better, so we came together as a team. And by doing that, we were better, whether or not we won. That’s something special. There’s a real value and dignity to that.”

Wii are the Champions

By Michael Saba

Willa Mae Graham grips the Wii controller at her side, coolly eyeing the bowling lane on the LCD screen in front of her. “Come on, now,” she says as she waves the remote in a forward arc. Her virtual avatar swings and releases its ball in tandem, and a camera follows it to the end of the lane where it demolishes all 10 pins. “Nice strike!” the game’s robotic announcer chirps. Graham turns around, cracks a smile and walks back to her team to hand the controller to the next bowler.

At 81 years old, Graham—a former church-league bowling champ—has, in her own way, stepped out of retirement. Her Wii bowling chops have earned her the captainship of the Langston-Brown Senior Center’s LB-1 team in Arlington, Va. Today, her team is competing in the National Senior League’s inaugural Wii bowling tournament, a nationwide contest between senior-center squads for the “National Wii Bowl” championship. This first season is a test-run; organizers hope the tournament will eventually involve whole communities, akin to other intramural sports.

High expectations, but not unrealistic. The NSL’s tournament has quite literally changed some players’ lives, offering them a new way to enjoy the dizzying highs and lows of competition, forge friendships and discover unexpected reserves of spirit.

It’s a sunny, bracingly cold day in the suburbs of Northern Virginia. In the Langston-Brown multipurpose room, seniors gather under fluorescent lights to play dominos and assemble puzzles while “The Cha Cha Slide” pulses on a boombox. The center’s two Wii bowling teams are assembled in one corner of the room, donning tie-dyed team shirts before they play. “For luck,” explains Margaret Richardson, captain of Langston-Brown’s LB-2 team.

They can’t see their opponents, the Clark-Lindsey Village Guttergals from Urbana, Ill. (the scores are posted online after each game to determine who wins), but the competitive tension is still palpable. And yet Willa Graham’s serene demeanor never changes; in her church-league days, back in high school, she took home trophies, scoring as high as 290 one game. Her best Wii score is only slightly less impressive: 246.

The bowlers’ pre-game confab carries an air of warmth and mutual respect. Center director Eva Cano-Mayor thrills at how the game has inspired such camaraderie: “Wii bowling is definitely the most popular here, and I believe it’s because everyone is moving around a lot more and, most importantly, having more fun.” Cano-Mayor was born in Peru and speaks with a thick accent, but her voice has a forceful clarity and conviction when discussing the benefits of Wii bowling. “The spirit of friendly competition—it’s great,” she says. “Even the seniors who never play watch and cheer along. I would definitely say that everyone here has become a lot closer since they started.”

Richardson shares that sentiment. “Young people do things. It’s the seniors who sit around and do nothing. If we’ve got something that can get us up and moving around, and get us together, well, let’s do it,” she says with a laugh. “My grandkids still won’t play me though, I think they’re a little scared that their grandma would win.”

The National Senior League’s very existence is testament to the Wii’s incredible success. Since the console’s release in September 2007, Nintendo has sold more than 20 million Wiis in the U.S. and 50 million worldwide, far surpassing sales of Sony and Microsoft’s competing video-game systems. The Wii’s budget-friendly price and motion-sensitive control scheme have made Nintendo’s brand synonymous with a new generation of casual gamers, erasing the decades-long borderlines of age and gender that made gaming the stigmatized hobby of teenaged basement-dwellers and twentysomething men with too much free time. Gaming may be a wildly lucrative industry, but only very recently has the video-games-as-art argument been taken seriously.

The paradigm shift was long overdue. Steven Johnson’s 2005 book of low-culture apologetics, Everything Bad is Good or You, makes a neuroscientific argument that the strawman of gaming as a mind-numbing waste of time is undeserved; video games actually enhance the brain’s cognitive functions. Dennis Berkholtz, the founder of theNSL, champions Wii bowling for the very same reasons.

The inspiration for a nationwide video-game tournament for seniors came to Berkholtz after a visit to his parents’ retirement community in Cape Coral, Fla. “It bothered me that there weren’t any programs to engage the senior residents, programs that encouraged what I’d call a good community or active minds,” he says. “A year later, I played Wii bowling for the first time. A light immediately went on in my head: This is the perfect game to keep them sharp! So I worked out a business plan, and I discovered that many senior communities were already playing Wii sports. All I had to do was bring them together with a national championship.”

Berkholtz, 64, played handball for the U.S. team in the 1972 Summer Olympics, and he swears by the merits of organized competition as a panacea for the many ailments and illnesses that accompany aging. “It’s a fun way to keep them physically and mentally engaged, which is so important when you get older.” His steely voice trips for a split-second: “That’s why I started this, to help raise money for Alzheimer’s, as a way of honoring my father who died with dementia.”

Berkholtz quit his job last June to manage the NSL full time. Encouraged by the positive response to last fall’s trial season (which boasted more than 186 teams from 24 states), he’s already planning to expand the program to include a webcam league, and possibly a multi-sport Wii Olympics to coincide with September’s international Active Aging Week. “Right now, we’re also looking at expanding into public housing, which traditionally has big senior communities, and also into the Veteran’s hospital system,” he says. “After that? International!”

Rusted-over bridges and abandoned factories line the approach to Charleroi, a sleepy exurb on the banks of the Monongahela River in the hills south of Pittsburgh. A sign on the outskirts of town featuring hollow-eyed businessmen informs you that you’re entering “The Magic City.” There’s a peculiar homogeneity to the vast stretches of farmland and post-industrial towns in Pennsylvania that makes Bruce Springsteen seem like America’s most accurate regional historian.

The NSL’s championship game is going down at the Riverside Place senior center across the railroad tracks from the town’s main drag. Riverside Silver will play two games against the SAS Strikers of Boca Raton, with victory going to the team with the highest point aggregate. The players can watch their rivals on a TV hooked up to Skype, giving the competition all the drama and immediacy of live sports.

Bedecked in black-and-white bowling shirts emblazoned with “Wii are Riverside Silver,” the competitors are stationed in front of two TVs, right next to a pair of unpluggedDance Dance Revolution pads that are used in the center’s “DanceTown” program. Kathy Cochran, a wheelchair-bound bowler, maneuvers over to the playing area and grins.

Her teammate Larry Maraldo, a former Pittsburgh police officer and weightlifter, crosses his arms over his barrel chest and peers at the screens from underneath bushy eyebrows: “We were seeded 16th and came up from the very bottom. Talk about your dark horses.”

They edge out the SAS Strikers by 26 pins in the first round, thanks largely to a perfect 300 from Maraldo, each strike bringing thunderous cheers from the dozens of onlookers. “I’m still alright,” he deadpans after his final throw. “I bowl perfect games in Wii all the time,” he explains as they ready for the second of two games. “When I bowled in a league I averaged about 260. But I had two open-heart surgeries, carotid surgeries, back problems and marital problems. I can’t do real bowling any more, but with this I still feel like a champion.”

Despite another perfect game from Maraldo, Riverside falls 46 pins short in the second match, losing the championship to Boca Raton by just 20 pins. And though the bowlers are in mild disbelief about the loss at first, a sense of pride quickly replaces their disappointment. “This is a wonderful thing,” Maraldo says. “It brings us together, and it brings good friendships. This isn’t just a video game, it’s something better.” Cochran, silent for most of the postgame, suddenly speaks up: “I like to think I’m not afraid of anything, but I’d probably be scared if I tried to bowl in real life. I’m legally blind and in a wheelchair. This lets me do something I’ve never been able to do.”

Though they’re hundreds of miles away in Arlington, the Langston-Brown bowlers are treading the same emotional ground as Riverside Silver. Both Langston-Brown teams made it to the playoffs and were defeated in close games. And maybe it’s a certain perspective that only comes with age and experience, but they don’t really care about victories and losses, point and rankings.

“It was never about winning,” Graham says as she prepares for a postseason exhibition match between LB-1 and LB-2. “It was about us. We wanted to do better, so we came together as a team. And by doing that, we were better, whether or not we won. That’s something special. There’s a real value and dignity to that.”

Healthcare: Care vs. Money

In an audio story segment of All Things Considered on NPR, Robert Siegel interviews one family dealing with costs associated with nursing homes and the Medicare that helps this family pay for it. Last year while living in an older community, it was apparrent that no one ever wanted to have to go into the nursing home. I remember one visit my grandpa took to see his friend who had just had a stroke and died a few days later. He came home and was quiet the rest of the night, aside from saying that the nursing home was too sad and depressing and he can't go back there. For Papa, I feel like his visit brought the reality of sickness and death into sight. Grammy on the other hand has a different view of nursing homes. She goes to visit her friends there at least once a week and, instead of coming home upset, she comes home to tell us how everyone is happy and holding on. Maybe she's just good at looking on the bright side and maybe Papa isn't, but there is definitely a stigma attached to nursing homes.

Studies, like the one performed by Achterberg et al, looking at the prevalence of depression in nursing homes and others focusing on elder abuse further stigmatize nursing homes, but bring up important health issues that elderly moving into nursing homes may face. The NPR interview brings up points about both quaility of care and Medicare, and shows how the federally funded Medicare has helped Gracie, the focus of the story. I think that Lela Peterson, Gracie's daughter, sums the healthcare "problem" up well when she states:

"Mom worked in an era when health care was what it was called. It was called care. Kindness and care. In today's world, health care is money," said Petersen.

Rural America.

Living with my grandparents last year showed me a whole new side to growing up, and more specifically, to growing up in a rural area. One of the biggest changes to my "city-life" was the need to drive anywhere I needed to go. I drove 30 minutes to work, at least 10 minutes to any restaurants, and 1-2 hours to any hospitals, shopping centers or cities. Now, I'm not really a fan of driving because it mentally wears me out. Which leads me to wonder how people can live their entire lives driving!

Further, it is amazing how strongly people can be emotionally tied to a place. My mom and I are constantly trying to get my grandparents to consider moving to a larger area, so they wouldn't have to drive numerous hours to get healthcare, go out to eat, go shopping, or basically do anything that isn't in their small town (which is almost everything). I even tried to get them to move back to college with me when I moved out last year to start my master's degree so that we could still be roomies, but my grandpa just laughed and told me to learn lots at school and spend my money wisely.

An article in the New York Times describes just how much harder things are, physically and mentally, for elderly people growing up in rural areas as opposed to urban areas. Though I always thought this was true, it was somewhat disheartening to read this article that confirmed my suspicions. Living alone in isolated areas, injuries and accidents can become much more life-threatening and even for people living "in-town" and around other people, there is often a lapse in time between the injury and the length of an ambulance or car ride to any hospital.

Like I stated earlier, driving is essential to life in rural areas, which means that the elderly growing up in rural towns must drive or get rides in order to do anything. Like one of the men highlighted in the article, many elderly people worry about getting their license renewed; if they don't pass their test, they not only lose their independence, but lose ability to provide for themselves. Along with this loss of transportation often comes isolation and loneliness. According to research, there are links between isolation/loneliness and disease outcomes and health, that state. And according to my grandma, old people who are alone too much start to lose their mental capacity and ability to relate and converse with other people. Sure, that's not a published fact, but if I learned anything from my elderly friends last year is that they know more than me.

Interestingly, the concept of "loneliness" is not dependent on isolation, but rather, is "the more subjective feeling state of being alone, separated, or apart from others" (Tomaka et al), meaning that a feeling of loneliness is different for everyone. For some, a connection to their home and environment is enough to diminish the solitude, as is the case for Ms. Clark in the NY Times article. Ms. Clark says that she sits and stares out over the landscape where memories of her deceased husband and raising her daughters fill her mind. To Ms. Clark, she is not lonely, but another person may feel incredibly isolated and alone in her same situation.

The question then comes down to, when should people worry about isolated elders? Or should we at all? Is it our place to decide if someone is happy or content, even if they live in complete solitude? Back to the issue of driving; do we have the right to take away someone's mode of transportation and independence without providing them with an alternate way to get around?