Rory Cohen | January 17, 2012 |
thing one would notice about Lulu is her smile. “Hello, dear, when is your
party?” Lucille “Lulu” Weinstein beams at me. “I need to decide what to
wear. What are you going to wear to the party? A blue dress or a pink one?”
effervescent and undeniably sweet personality easily charms. She’s the kind
of lady who wants to have a nice time and look good doing it. The 87 year
old who likes to put on lipstick and pull back her hair into a neat twist
suffers from Alzheimer’s. It’s a chronic disease marked by bouts of
confusion and a rather frightening sense of losing one’s identity.
leads Lulu to jump from asking about the weather to discussing a party she’s
made up in her head. Lulu, a patient at Carmel Board and Care, California,
is lucky. She’s cheerful and gentle, and has been placed by her loving
family in a top nursing facility whose employees care for all of her basic
needs as well as her emotional ones. She has a constant stream of visitors
and is generally happy.
Americans, those who cannot afford first-rate private care, are not so
65 years or older were numbered at 39.6 million in 2009, making up 12.9
percent of the U.S. population or about one in every eight Americans. That
number will increase, according to the U.S. Department of Health and Human
Services. It is estimated that about 72.1 million older persons will make up
the 65 plus age bracket by 2030. With a rising aging population comes a
growing demand for special care facilities. Living longer means that
diseases become long-term and chronic, and services are more expensive as
people spend more time in facilities, and not everyone will be able to
afford private care and will eventually come to rely on social welfare—but
can governmental services, city and federal alike, cope with demands?
has had to navigate tricky geriatrics services for an elderly loved one,
they don’t usually consider the ramifications of getting older. Los Angeles,
after all, is often perceived as the land of perpetual youth, both by
California residents and tourists. The Sunset Strip is filled with aspiring
models and actors, some beyond their prime, perfectly coiffed, with sprayed
on tans and a disconcerting, overabundance of face-lifts. There is an
understandable sense of trepidation people feel about aging, so it’s hardly
surprising so many of us try to delay it as long as possible. But there is
no way to ignore, however, that the Baby Boomers have begun to collect
benefits while taking advantage of already economically strained health and
seems to be a sort of fear, if you will, of aging,” said Valentine Villa, a
California State Los Angeles Social Work professor and the director of the
Applied Gerontology Institute. “In aggregate we are doing better in terms of
health, in terms of socioeconomic status. We’ve been living longer.”
that surround aging are complicated. For example, there are shortcomings as
certain demographics have a higher likelihood of age-related problems
evident in Los Angeles.
disparities, racial disparities, among African-American women in particular
and among African-American and Latino children,” said Karen Lincoln,
associate director of the USC Roybal Institute.
ailments are both genetic and linked to culture or socioeconomic situations,
such as food culture and the realities of poverty. They can lead to higher
instances of problems ranging from diabetes to obesity—ailments that are
more prevalent among ethnic communities in Los Angeles. As people live
longer, many more are now becoming old enough to suffer from chronic
illnesses like Alzheimer’s.
African Americans, some Asian and Native Americans don’t do as well as
non-Hispanic whites,” said Villa.
demographic concerns exists challenges that health care providers will face
as aging populations experience more long-term, debilitating illnesses that
will require around-the-clock care.
“A lot of
those people who would have died of heart attacks are now [suffering from]
Alzheimer’s that they would never have got because they would have died
early,” said Kelvin Davies, professor at the USC Davis School of Gerontology
and an expert in Alzheimer’s. “We used to have more coronary care units…
that was the shining star of hospitals twenty years ago.”
Davies’ research looks at why people age, focusing on Alzheimer’s and other
age-related ailments. His latest study published in August in the Journals
of Gerontology found that Lon protease, an enzyme, or a substance that
increases the rate of a reaction is mobilized less frequently as a cell
protease isn’t called on as frequently, cells are less protected from
oxidative damage, such as peroxides and free radicals, which cause damage to
his research team exposed cells to various oxidative stresses, such as
ozone, hydrogen peroxide, pesticides and herbicides and other toxins. In
experiments, some of which used human lung cells, Lon production increased
to fight oxidation. The process can be likened to rusting or food spoiling.
that if you give cells the right opportunity, cells adapt,” said Kelvin
Davies, professor at the USC Davis School of Gerontology. “They adapt by
changing their gene expression which means that they start making more of
some proteins and less of others.”
believe Lon protease protects mitochondria, organelles that transform oxygen
to energy. With the decrease of Lon production, mitochondria function starts
to deteriorate. Older cells don’t have that same ability to adapt to
environments that cause damage, however, so they ultimately die.
think is going on is that this is part of a normal, adaptive response that
all cells have,” explained Davies.
research shows that as people age they are less able to cope with stresses
ranging from physical, such as chronic illness, to psychological, such as
Alzheimer’s the process of Lon protease can be compared to soldiers in a
war. Oxidants are warded off or endured because of the mobilized Lon. Older
cells, however, take longer to produce Lon in experiments. The longer it
takes cells to mobilize Lon, the more a cell has to cope with oxidation
which eventually kills it.
disable Lon protease, if you genetically modify [Lon protease] or if you
decrease the rate of a cells’ production of Lon protease, the cells are
particularly sensitive to oxidation stress and typically die,” said Davies.
findings can help scientists to better understand the aging process and in
the future could direct medicine to new diets and drugs that improve the
quality of life. Researchers could potentially find treatments that would
increase the productivity and function of Lon protease. No current
treatment, including much-advertised, over-the-counter supplements that
contain enzymes, is capable of increasing Lon productivity, according to
He is also
cautious about exaggerating the research.
understand very little about the aging process,” said Davies. Scientists
first need to understand better what changes in aging and what contributes
to the aging process, and understand that current research is not going to
provide an immediate remedy for chronic, age-related diseases.
current treatments aren’t promising and notes that the future for
Alzheimer’s patients looks bleak.
somebody comes up with something for Alzheimer’s then we’re going to need an
awful lot of care facilities because people are just not able to cope in
their own homes all the way through the disease,” said Davies.
dollars will go to these new facilities for chronic care where a patient may
sometimes spend years. And, for those who rely on programs like Medicaid,
care and equipment winds up being an expensive taxpayer burden.
their fault, but we need to do something about coping with that,” argued
Organizations like the Department of Aging are concerned about rising
numbers of chronic illnesses, especially in light of the U.S. Census
Bureau’s newly released numbers which show a record 46.2 million Americans—1
out of every 6 people—are living in poverty today. “The only word for it is
grim,” said Robert Greenstein, president of the Center on Budget and Policy
Priorities, in a September report.
Angeles’ Department of Aging is particularly focused on “low income,
socially isolated” senior citizens who require more assistance, according to
Laura Trejo, general manager of the Los Angeles Department of Aging.
keeping a watchful eye so people are not falling through the cracks,” said
Trejo. The organization provides support to senior citizens and disabled
individuals that include transportation, especially for disabled citizens,
and a daily nutritious meal for senior citizens who are disadvantaged.
people find themselves out of work and facing poverty, the City of Los
Angeles could see an increase in residents who seek public services of which
plenty have been cut due to budget woes. Los Angeles’ Department of
Recreation and Parks which provides senior citizens with centers has lost
two sites, said Carolyn James, principal recreation supervisor. Park
services for the elderly keep individuals, especially more independent
seniors, engaged. They give seniors a place to gather and hold events—to
socialize. In Los Angeles and throughout the state, budget cuts have
threatened public programs such as these.
Department of Aging has fared better, but they, too, “have been impacted in
loss of city resources,” according to Trejo. The organization’s budget is
made up of federal and state grant funding from the Older Americans Act, the
Older Californians Act, and the Medi-Cal program.
For the first time since WWII, nearly 1 in 5 young adults are at risk for
living in poverty. This number is the highest jobless rate for young adults
also have larger implications as people move back in with their parents or
grandparents suddenly find themselves contributing to their children and
grandchildren’s households. According to experts these seniors often
contribute their social security and pensions to their children and
services already stretched to the limit, the private sector sometimes offers
a better alternative in terms of quality.
private sector has managed to help,” said Phoebe Liebig, associate professor
of Gerontology at the USC Davis School of Gerontology. Liebig notes private
services, financed and run by businesses or religious groups, which include
care facilities and programs for senior citizens.
Medical, a company that supplies several for-profit facilities with adult
diapers and nutrition formulas for elderly patients, has had to navigate
governmental bureaucracy that pervades the Medi-Cal program.
does Medi-Cal not pay providers but they do not provide patients with
adequate services,” said Ofer Elkayam, president of MCL Medical. “They use
subpar adult diapers, for example, which often lead to bed sores when they
aren’t changed frequently enough.”
worked with senior citizens in some capacity for more than two decades.
ever forget that you are dealing with people,” he said. “It could be our
parents, it could be us there.”
Board and Care Elkayam’s wife, Edva, oversees eight privately run health
facilities in the San Fernando Valley, each house boasting three full-time
caregivers for every six patients.
of our patients want peace of mind and we give it to them,” said Edva
Elkayam. “Always you let your patients feel that you understand them.”
facilities under the Carmel umbrella offer a private trainer specialized for
the elderly, gourmet-style meals and regular activities designed to keep
patients engaged. Unlike most facilities, Carmel doesn’t keep to a visiting
hours schedule but instead implements an open-door policy so family members
can visit loved ones at any reasonable hour.
like Lulu are happy here and are loved by the staff.
meet my Lulu?” Florence Ormilla, a house manager for one of Carmel’s homes
in Woodland Hills, asked me.
responsible for everything from administering medication to making sure
patients, who she likens to her grandparents, aren’t bored.
“I left the
Philippines…but found my inner peace and contentment that I’m doing my
part,” said Ormilla. “I am their granddaughter now, I take care of them.”
facilities are filled with many well-intentioned individuals, but many lack
these same resources. Whereas Lulu has constant engagement, those
individuals living in poorer quality facilities—including some public
nursing centers—face poorer care and less one-on-one interaction.
is impossible to know how bad it is, several reports document that at least
one in ten patients have reportedly been abused in nursing institutions.
Most crimes go undetected, according to the national Center on Elder Abuse.
Mistreatment of elders can range from physical and sexual abuse to
psychological harm and abandonment.
In 2008 a
five star rating system was adopted by President George W. Bush to help
evaluate cost of treatment as well as to bring scrutiny to failing
everyone has saved for retirement or is able to afford best treatment. And
many who have paid into individual retirement arrangements have also lost
funds with the recent market downturn.
experts say current programs, like Social Security and MediCare, will have
to play a big part in the solution even though they may need some reform.
will be shortfalls,” said Villa, “but we can do things to change this.”
Others are less
optimistic about the future of social security. When social security was
introduced by FDR there were 163 people working for every one person
receiving it. By 1950 there were about 15.3 people working for every
recipient. Within the next 15 years there will be two people working for
every recipient. In 1940, when the average life expectancy was 60 years of
age, the retirement age was set at 65. Today the average life expectancy is
about 82 and the retirement age is still 65. The current system is not
larger population that is going to have to rely on social security with
fewer people paying into that system,” said Lincoln. “You’re going to have
this huge population of people who are receiving the benefits and fewer
people paying into it,” said Lincoln. “That’s just a recipe for disaster.
I’m not sure how we can sustain this system.”
just the poor who rely on social security because people from all segments
of society collect their benefits—but with a limited pool the funds are not
sure what we can do for those who are retiring now, but certainly we need to
begin to think about how to prepare people for retirement,” explained
could combine social security with other types of funds, while at the same
time educating people about retirement. Experts agree social security just
won’t be enough, especially with more people taking advantage of the
choice most people—understandably—prefer to age in their own homes.
Eventually, however, the best intentioned of families may need to place a
mother, father or grandparent in care. It isn’t an easy decision either
emotionally or financially. The care, after all, is costly—in excess of
$3,500 a month at the best of facilities. Insurance typically only covers a
portion of that. It’s unclear how our society will cope with changing aging
demographics, especially in light of current economic turmoil the nation
faces. What is clear is that conversations about aging need to take place so
that people are aware of the limitations of social security and city
services. Reports indicate that Americans save less and spend
more—ultimately it will be this that will create a perfect storm as people
live even longer and find that they need to rely on flawed, untenable
the Author: Reut
R. Cohen is a journalist with a special interest in gerontology and public
health. Her work has been published with several publications and
organizations, including Annenberg Digital News, CAMERA, KCET, the Middle
East Forum, and Pajamas Media. Her broadcasts have appeared on PJTV.com.
Reut graduated from the University of California, Irvine with distinguished
honors, earning a Bachelor of Arts in English. Presently she is pursuing a
Master's degree at USC Annenberg School for Communication & Journalism in
the field of Broadcast Journalism. Her Twitter handle is @ReutRCohen. You
can also visit her website atwww.reutrcohen.com.