In Sickness and In Health, Part 1: The Heart of the Matter

My mother died from congestive heart failure in January 2014, as discussed in this post on awakening to grief. That was when her organs finally shut down and the medical establishment was able to “pronounce” death.

In reality, after unsuccessful heart valve surgery in early December, it was only a matter of time. I’d intuited the end was near months before, since I believed she was too weak even to withstand the surgery. But with a lack of straightforward information from the doctors, other family members interpolated a sliver of hope and were determined to fight to the bitter end. And bitter it was.

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The Role of Comfort Care

Extreme interventions at the end of life may be authorized from love, but for the person whose life is concluding, these invasive procedures are likely to prolong suffering.

In fact, painkillers can actually shorten the life they seek to extend, by causing breathing complications, drug interactions, and more serious side effects, such as stroke.

Former First Lady Barbara Bush chose another route, and in so doing, shone a valuable light on the role of comfort care at the end of life. Like my mother, Mrs. Bush had had congestive heart failure for many years. But rather than being placed on the “conveyor belt” of costly medical interventions aimed at prolonging life, she made the courageous decision not to seek further treatment.

This is the purpose of hospice: to ease pain and provide attentive, loving support as someone prepares to depart earthly life. It takes courage to choose this route; to say, “I have lived a good life, and am at peace with what comes next.”

Barbara Bush’s Parting Gift

bush-careJust two days after deciding not to pursue further medical treatment, Mrs. Bush passed away, surrounded by her loved ones. The same might have been true for my mom; instead, she endured seven weeks of machine-supported existence, dying in the sterile, institutional healthcare environment so pervasive in modern America.

We’ve touched upon alternative endings a few times, such as this story about one LO’s mother-in-law’s decision to choose hospice care, and how you might broach the topic with HECM clients. Resources such as The Conversation and the National Institute on Aging’s End of Life guide are also useful tools.

“We’ve lost the rich wisdom of normal human dying,” writes British palliative care specialist and author Dr. Kathryn Mannix. Death is natural, but the systemic breakdowns that often lead up to it can be wrenching. As someone long in the public eye, Barbara Bush gifted us one final time with her choice to acknowledge her time was near, and to pass peacefully.

While death discussions are rarely easy, and not necessarily in your purview as a reverse mortgage professional, it’s important to be cognizant of the options available, and the choices others make that could prove relevant to your clients’ family members.

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Heart disease warning signs

Since heart disease is the number one cause of death for both men and women in the U.S., it’s helpful to be aware of these unusual warning signs many people might overlook:

  • Creased earlobes: More than 40 studies have shown a correlation between a diagonal crease on the earlobe and an increased risk of atherosclerosis (hardening of the arteries).
  • Fatty bumps on the elbows, knees, buttocks or eyelids: These benign bumps can signify high cholesterol.
  • Clubbed fingernails: Fingernails that become thicker and wider indicate oxygenated blood isn’t reaching the fingers properly. It’s one of the oldest known medical symptoms, sometimes referred to as “Hippocratic fingers“, named for Hippocrates, the father of medicine.
  • Iris halo: A ring around the iris of the eye is also a sign of fat deposits. About 70 percent of people over age 60 have it.
  • Rotten gums and loose teeth: Oral health is a predictor of the state of overall physical health. Dental decay allows bacteria to enter the bloodstream and create inflammation, which can lead to cardiovascular disease and a host of other illnesses.
  • Blue lips: Unless you’ve been swimming in frigid waters, blue lips are not normal, and can signify heart problems due to a lack of oxygenated blood in the tissues.

Of course, each of these symptoms can also be benign. The best course of action is for seniors (and people of every other life stage) to know their body, and seek the services of a competent health professional when they notice a change. The more information we have about health and well being, the better prepared we will be to make potentially life-altering decisions when the time comes.

Older Americans Month: Celebrating Ageless Perennials



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For most of human history, “aging” wasn’t a hot topic. In the Iron Age, people didn’t live past their twenties. By 1900, the average lifespan was still under 50 in the United States. When President Kennedy designated May as “Senior Citizens Month” in 1963, only 17 million living Americans had reached their 65th birthday, and there were few programs to meet their needs.  

Two years later, President Johnson signed the Older Americans Act (OAA) into law. Under the auspices of the Administration on Aging, the OAA helps promote the well being of older adults by providing community-based services and opportunities to help people live healthy, independent lives. It was a game-changer in every way, from health and wellness programs, to long-term care support, to elder rights protection, and other social services.

Half a century hence, with the Boomer wave graying the globe, OAA funding failed to keep pace with inflation, prompting the Older Americans Act Reauthorization Act in 2016, which focuses on:

  • Modernizing multipurpose senior centers
  • Addressing economic needs
  • Stronger elder justice and legal services
  • Chronic disease self-management and falls prevention. 

Clearly, “Older Americans Month” is every month, now. And, appropriately, the 2017 theme is, “Age Out Loud.”

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Doris Day

Brands get it: they’re embracing seniors, aka “Perennials,” in lieu of “overrated” Millennials. Explains trend curator and author Rohit Bhargava, “We should each be described not by the generation we fit into, but based on our interests, passions, and who we are as people.

“Netflix doesn’t target shows or recommendations based on age — they do it based on what they know we like to watch. While not a new idea for any brand that uses psychographics, the term is an elegant way to describe the simple idea that if we are going to be categorized for anything, it should be on what we believe and love instead of what year we happened to be born.” He sounds like a great HECM spokesperson.

Engage, Entertain, Exercise 

Another site that understands the concept of aging out loud is Passport for Wellness, a physical, mental and social program created for “21st century seniors” who are aging in place, or living in an assisted living community.

The virtual travel site streams scenery and sounds of exciting destinations from all over the world, so “travelers” feel like they’re touring while they exercise.

Led by an on-screen host, travelers explore the world through physical movement, memory recall, and trivia questions. Each “episode” incorporates entertaining story lines and interesting experiences from around the world and throughout history. The creative storytelling allows traditional exercises to become an integral part of the immersive, movement-filled activity, providing seniors with a full sensory workout.

Stepping Out of the “Age Discussion”

One creative way mature adults can celebrate Older Americans Month is to simply say, “I’m ageless”. Women’s health expert and author Christiane Northrup, M.D., says there’s actual science behind our culture of ageism — and we can change it.

“We co-author each other’s biology,” Northrup explains. “Our idea of what an age ‘should’ look like programs our biology in a profound way that has been studied. It’s robust research. When you spend time with people who don’t think about their age, all the parameters of health improve: cardiac output, vital capacity with lung function, blood pressure…all of it. Because our body doesn’t know an age.”

Northrup also distinguishes between chronologic age (the age on our driver’s license) and biologic age (the actual age of our cells) — which we have much more control over than we think. Northrup’s mother, now in her 90s, has always been a fitness powerhouse; in her sixties, she had a biologic age of 35.

Northrup’s advice: don’t celebrate milestone birthdays (e.g., 40, 50, 60) because we tend to measure ourselves by some invisible yardstick in terms of health or accomplishments.

Of course, this caveat may be less critical for nonagenarians like Doris Day, who didn’t know her chronological age all her life, until now. “I’ve always said that age is just a number and I have never paid much attention to birthdays, but it’s great to finally know how old I really am!” Day said on the eve of her 95th birthday.

Or, like Ernestine Stollberg, perhaps a mature adult who’s stepped out of the age discussion will discover 95 is the best age to become a model.

The only age an older adult really needs to know, of course, is 62, when they become eligible to apply for a reverse mortgage. Beyond that, you’re as old (or young) as you decide to be.

The Song Remains the Same



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The He(art) of Elder (Eng)agement

In November we featured “Oldchella,” the humorously nicknamed, star-studded ensemble that rocked southern California for two consecutive weekends, featuring musical legends who defined an era: the Rolling Stones, Bob Dylan, Paul McCartney, Neil Young, The Who. Besides their iconic status, the participants in Desert Trip had one other trait in common: each was at least 70 years old.

Yet the joke is on those who minimize the importance and impact that mature voices can have on those who sing — and on those who hear them sing.

Young@Heart Chorus requires members be in their 70s — 73, to be exact. One hopeful’s interest was piqued when he was a mere 72, so he was politely asked to reapply in a year. Now 80 and a six-year Young@Heart Chorus veteran, John Reinhart has soloed Michael Jackson’s “Man in the Mirror,” and says he’s never been happier. “When I retired, I told my wife we’d better get a casket; I’ll be gone in six months. The Young@Heart Chorus came along at the right time for me.”

Getting Their Groove On

Making music, whether with one’s voice or another instrument, has repeatedly been demonstrated to be beneficial for mental health. In a recent controlled trial of 200 British adults over 60, those who participated in weekly singing groups for three months had improved mental health (decreased anxiety and depression) compared with those who didn’t sing. These health effects were sustained over a period of at least three months after the weekly singing ended.

By contrast, the benefits of playing a musical instrument did not tend to endure once the playing ceased — unless the participants had played over an extended period of their lives, which may explain why lifelong musicians such as the septuagenarian stars in Oldchella are still jamming with the same gusto as performers a third their age.

Singing the Dying Across the Threshold 

Singing can also be highly beneficial for those who are preparing to transition out of this life. At the turn of the millennium, Kate Munger, who had sung to a dear friend as he lay dying a decade earlier, was inspired to create Threshold Choir to bring comfort to the dying. Hearing is the last sense to go, so even someone in a comatose state may receive benefit. Today, there are more than 150 Threshold Choirs throughout the US, Canada, Europe and Australia.

Each choir is composed of a small group of singers (primarily women, though the choirs are open to all) from the local community, who gather at a person’s bedside and sing in calm, a cappella voices for about twenty minutes. These committed volunteers rehearse weekly for the privilege of singing to the dying; most have been Threshold Choir members for many years, and are often well past midlife themselves.

Art for the Heart

Have you ever noticed that the word “heart” contains “art”? That may not be a coincidence, as a research-focused arts blog surveyed the literature and found “the most compelling evidence of the value of the arts revolves around reverse mortgage newsimproving the lives of older adults.” Confirming the data already discussed, the evidence for (eng)aging with the arts benefits elders in the following ways:

  • Singing improves mental health and subjective wellbeing (i.e., perceived quality of life)
  • Playing a musical instrument has myriad positive effects, including dementia risk reduction
  • Dance classes bolster cognition and motor skills, and lessen the likelihood of developing dementia
  • Visual arts practice generates increases in social engagement, psychological health and self-esteem.

To Be of Use

Finally, art serves the deeper purpose of keeping seniors (eng)aged. And what that looks like may be very different from the more conventional arts just described. Retired social worker Lynn Rayburn, 91, is “convinced her mind would have long ago floated ‘into outer space’ if not for the mental stimulation and social interaction” of Senior Center Without Walls, a Bay Area-based non-profit that aims to ameliorate elder loneliness and social isolation. For Rayburn, who lives alone and is confined to a wheelchair, the telephone classes, such as Sing-Along Broadway, are a lifeline. Rayburn “participates in classes daily, and facilitates five classes as a volunteer, including a session that encourages callers to talk about things they’re grateful for and another that allows them to participate in philosophical debates.” She refers to Senior Center Without Walls as her “art form” and avows, “I couldn’t handle life without being needed.”

As noted last week, January 31st is National Inspire Your Heart with Art Day, a superb moment to encourage the elders in your HECM sphere to (eng)age with whatever form of the arts calls to them for expression, even (especially) if it’s something beyond what we typically think of or refer to as “art”. Creativity in all its forms is ageless, and like wine, can improve over time..

Elder Cool is Red Hot!



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Last month we discussed how grandparenthood is shifting radically from “the old days”. Maybe age really is just a number…

sc4Could the following elders be the next level of “whither grandparenthood”?

• Dame Judi Dench got her first tattoo at 81. It was a birthday present from her 43-year-old daughter. The actress had her favorite saying, “Carpe diem”, inked onto her wrist — although her costars, carping, you might say, on her eccentricity, insisted the tattoo said, “Fish of the day.” But even her creative achievement pales in comparison with this British great-grandfather, who got his first tattoo at 104!
• Indefatigable Betty White, 94, honored female rapper Queen Latifah by giving a dramatic reading of the latter’s hip-hop lyrics. Listening to White recite these words with such conviction is not only inspiring — it galvanizes respect.
• Norman Lear, the creator of some of the most successful sitcoms of all time, is still producing television shows at 94. Like Dench and White, he possesses a wonderful sense of humor. He says, “Often I’ll get undressed and look at myself, dissatisfied but amused — and I’ll sing and dance alone, in front of a full-length mirror. And I have wondered, for a great many years, how do we know that’s not the secret to longevity?” In this engaging 9-minute video, Lear auditions senior actors for “Guess Who Died?”, a show about the elderly that, he avers, “Nobody wants.”

Yet death itself is apparently becoming cool. Thanks to the Internet, obituaries now have an afterlife. We’ve discussed what happens to someone’s digital assets when they die — but the obits are going viral.

The weekend after legendary boxer Muhammad Ali died, Legacy.com published a 600-word obituary. However, nearly a million obituaries on the site received hits from the curious. The Legacy.com stories read like lifestyle blog posts and include pictures, which help draw readers in. The departed live on, in digital perpetuity.

The Second Half May Be the Best

Granville Stanley Hall, who essentially invented adolescence at the beginning of the 20th century with a landmark book by that title — when he himself was 60 — subsequently created the concept of senescence as well, publishing Senescence: The Last Half of Life at age 76. Even a century ago, Hall viewed later life with the same sense of renewal and possibility as Dench, White and Lear. He wrote,

“Modern man was not meant to do his best work before forty but is by nature, and is becoming more and more so, an afternoon and evening worker.” (And he’s not referring to shift work!)

“Not only with many personal questions but with most of the harder and more complex problems that affect humanity we rarely come to anything like a masterly grip till the shadows begin to slant eastward, and for a season, which varies greatly with individuals, our powers increase as the shadows lengthen.” Indeed, Hall’s greatest creativity and achievement came after age 50.

Hall’s words will be heartening for reverse mortgage professionals and the seniors they serve. Clearly, with the right perspective, we can use our gifts fully right to the very end (Hall published Senescence just two years before he died.)

Oh — and if you or an elder you know is considering getting that first tattoo, be sure you get the spelling right. Carpe diem!

Aging in Community: With A Little Help from Our Friends

With a little help from our friends…


A year ago we explored some new models for seasoned adult living, beyond assisted living or standard retirement communities. In With A Little Help from Our Friends, aging expert and journalist Beth Baker takes us on a journey through expanded innovation that elders themselves are co-creating.reverse mortgage news

Aging in place is only as good as the place you’re aging in, writes Baker. Today’s mature adults are less likely to swim in the river of denial and more apt to be proactive, taking charge of their current and future independence by focusing on interdependence, the watchword of successful aging in place. And reverse mortgage can play a valuable role in enabling this to happen.

Some of the creative community options reverse mortgage professionals need to be aware of as Boomers become clients:

    1. Villages. Launched with Beacon Hill (a Boston suburb) in 2002, Villages are not actual structures, but neighbor-to-neighbor support systems designed to enable older adults to remain at home as they age. They’re volunteer run, usually with one or two paid staff, and provide everything from a ride to the doctor, to help changing a lightbulb, to grocery shopping — or “just” a friendly ear. Members (the seniors who receive assistance) pay an affordable annual fee, and are encouraged to volunteer to the extent they are able and willing. Villages also organize social events and outings, exercise classes or computer training; whatever the members want. The model is growing rapidly, with nearly 200 Villages now open nationwide and another 150 in development. The Village to Village Network helps communities establish and maintain their own Villages.
    2. Cohousing. The brainchild of a Danish architect, cohousing emerged in the U.S. in the 1980s, and like Villages, is mushrooming. The model enables each household to own (or in some cases, to rent) their own house or condominium, while sharing common space, weekly meals, and other social and lifestyle needs (e.g., cars and lawnmowers). Cohousing is collaborative, non-hierarchical, and can be multigenerational or dedicated to those 55+. Moving to a cohousing community can be an excellent way for seniors to downsize, perhaps with a HECM for Purchase, while creating a wider support network of neighbors and friends for their later years.
      Some cohousing models are designed for a specific elder niche, such as the Babayagas’ House that opened in a Paris suburb in 2012, an affordable urban site for women 50+ whose residents pledge to perform ten hours of weekly chores, and to care for one another with no professional staff. The model has caught fire in Canada, with Baba Yaga Place launching in Toronto.

      For those who become ill while living in cohousing, it may also be a way to live one’s final months without needing to resort to a nursing home. Baker relates the story of one single, childless 60-year-old man living in an intergenerational cohousing community, who developed colon cancer. His neighbors accompanied him to medical appointments, delivered meals, etc., enabling him to live nearly twice as long as his prognosis and to die peacefully at home, surrounded by friends and loved ones who sang to him in his final hours. This is an aspirational vision for both how to live and how to die.

    3. Cooperatives. Similar to cohousing in terms of community focus, housing cooperatives have a distinct legal and financial structure. Autonomy and affordability are two bywords, along with democratic member control and concern for the wider community. While most housing coops are multigenerational, senior housing coops are growing. Community relationships that support elders as they age are one of the strongest reasons seniors cite for choosing this form of retirement living.
    4. Housesharing. While creating community with friends or strangers may seem the purview of college students and twenty-somethings, housesharing is also an economical and creative way for elders to find companionship and reduce expenses in their later years. Some people opt to live among peers; others are comfortable with an intergenerational arrangement, and some just want to rent a room to defray costs — though they may find the tenant becomes a friend. The National Shared Housing Resource Center can help seniors find a shared housing organization in their community.


Affording the Future

In the third section of her book, Baker dives into “getting from here to there,” including accepting help (even if that means a robot assistant or smart home technology), advocating for direct care workers (another term for caregivers) and examining the ways seniors can plan for the unknown.

In lieu of pricey long-term care insurance, Baker suggests that reverse mortgage might be a viable way for mature adults to turn their home equity into cash to use as needed. She writes, “Many of us will likely turn to the value in our home to help pay for care.” With a combination of home healthtech, direct care workers, community support, and available home equity, the next wave of retirees may be able to remain at home until the very end.

App-solutely Easy: Visionary Elder Tech

New Technology Making Senior’s Lives Easier

As we explored last year in Caring for the Caregivers, technology can make aging easier on both sides of the care equation. Here are some exciting new ways technology is fueling a positive aging experience:

  1. Doc-in-a-Box. The days of house calls have vanished along with corded landline phones, but technology is returning doctor visits to the home — via Skype and similar videoconference service providers. Just as seniors have embraced technology in droves, video visits will replace (or at least supplement) in-person office visits, with their typical long waits.reverse mortgage news
  2. Share and share alike. Complementing video doctor visits is an exponential rise in online medical records sharing. While privacy and information pirating are also growing concerns, an inappropriate medical record release isn’t likely to prove fatal, whereas lack of access to vital information in an emergency could mean the difference between life and death.
  3. Alfred, the Robo-butler. A tech-savvy reverse mortgage client might visit her doctor online, order groceries from the local market via their website, and Facebook regularly with grandkids. But wouldn’t it be nice to have someone like a trusted butler to handle all of a senior’s household needs, including setting appointments, or reminding them when to buy more milk? A real-life Alfred (like a personal assistant you never see) will handle all the particulars in the background of someone’s life — if they live in New York City or Boston. For everyone else, a virtual version, Hello Alfred, functions as an on-demand one-stop service portal. Because, as today’s seniors are proving by their behavior, rocking out means a concert, not a porch chair.
  4. Lights, camera, action: No matter how healthy an older person may be, certain faculties tend to decline with age — particularly hearing and vision. Fortunately, merchants everywhere are recognizing that if a senior can read what’s on offer, they’ll be that much more likely to buy. LED lights have begun showing up in unexpected places, such as on restaurant menus. Fashion designer Ralph Lauren, who at 75 understands this demographic, has gone one better: designing a tote bag with LED lights on the inside, to help a mature woman find the pen to sign her credit card receipt.
  5. Can you smell that? One company has developed an “electronic nose” based on nanotechnology that will interface with any smartphone. Creator Samuel M. Khamis explains how, with just a whiff, the e-nose will be able to provide information about a person’s metabolic state and the number of calories being burned, in real time. This data can help people lose weight — or warn users well in advance of a potential asthma attack. As his company refines the technology, it will be useful for many additional health care applications based around breath analysis.

What’s certain is that the number of elder apps will continue to flourish, helping seniors to track illnesses, along with medications and potential side effects. My Recovery, designed by a surgeon, helps patients prepare for their operation, understand what to expect during and after the hospital stay, and even guides them through rehabilitation exercises. The Flowy app uses games to help people manage panic attacks — and a pilot study has already demonstrated a significant decline in symptoms.

So while tomorrow’s tech-savvy seniors may have to contend with a bit less personal privacy than in the past, the flip side is the promise of greater independence in the home, for longer — possibly even to the end of their lives.

Looking for more reverse mortgage news, commentary and technology? Visit ReverseFocus.com today.