I have tried to think of ways to begin talking about this topic without being too heavy handed or too flippant. The topic is suicide. I know that most of the people reading this will stop now and see what Bruce has to say about financial planning or Tamara about cars. Still, it is so essentially an older adult issue that I can’t let too much time pass without addressing it here.
An older adult completes suicide every 100 minutes in the US. Notice I don’t say he is successful. It is not a success. A completed suicide is a failure of the people and the environment around the person to hear and respond to the signals he’s given that he is at risk. A vast majority of older adults who die by their own hand have visited their doctor in the last month. Very few older adults will not tell someone, in some way, that they are thinking about killing themselves. Sometimes they start to give everything away, make arrangements for pets, and cancel services like meals on wheels or cable TV. Nearly all will admit this is their plan if asked directly.
Some groups are at more risk than others. African-American women seem to be protected by an unknown factor, White men, Asian women, and some other older ethnic/gender groups are more often at risk for suicidal behaviors.
There is basic information that everyone who knows older people should have.
If you ask someone about suicide, they won’t be more likely to do it. You can’t talk someone who is not suicidal into being at risk.
If someone talks about suicide they are at risk. It is a myth that people who talk about it never try it.
Alcohol is less often a factor for older adults and suicide than for younger folks.
Multiple changes, especially losses, will often be related to thoughts of suicide.
If someone you know tells you that they are thinking about suicide you or they can call 1(800) 273-8225 to get help. I’ll write something funny next week.

The Medicare Hotline established by the social security administration reports diminished satisfaction ratings with users who call for help with questions about benefits. I wonder how much of that dissatisfaction is from problems with the way you get information and how much is dissatisfaction with the news you get when you call.
I have seen a number of reports and cases from older adults who have reached the “donut” in Part D benefits- the new drug coverage has a surprise for many people who depend on their insurance to cover medication. When you get to a certain level of expense, they stop paying. The coverage resumes when you reach a new threshold. From about $2400 covered at 75% to $3000 you pay all the drug cost. For some users, accustomed to paying one quarter of the cost of their medication, they suddenly have to pay all of it. That part, the donut, lasts until the drug cost reaches $3051.25 then lowers again. So there is this time bomb of six hundred dollars you didn’t budget. The RAND Corporation reported last month that the real cost isn’t the six bills; it’s that about half of seniors don’t pay it. They miss the medication for as long as ninety days. For hypertension, cardiac and diabetes drugs, there is a higher cost at the point where those conditions cause functional impairment. That point is hastened by “drug holidays”. The difference between what the government expected and what was spent adds up to a rebate from the Part D insurers of … $4 billion! That’s a lot of pills folks didn’t get.
Help doesn’t seem to be available from the Medicare folks but there is a group called The Center for Health Care Rights that can coach you through some of this. If you are a Medicare enrollee living in Los Angeles County and have questions about Medicare or need help resolving Medicare or health insurance-related problems, you can call the Health Insurance Counseling and Advocacy Program at 1-800-824-0780. And the Medicare hotline isn’t just giving bad news. Of more than two hundred people trying to get through the automated answering system, only five got the information they needed. Please press 1 now to exit.

“I yam what I yam and that’s all that I yam, Right Olive?” It looks like the very first super-powered comic character in history may have been on the right track. Popeye got his strength from eating spinach. A recent study published in The Archives of Opthamology reports that spinach and other dark leafy vegetables prevent age related macular degeneration. Other eye problems are also reduced but AMD is the leading cause of blindness in folks between 60 and 80.
In an oddly related story, it seems that poor dentition and dementia have an unexplained relationship as well. A study in England noted that cognitive impairment and tooth loss have a high correlation. (They go together but cause and effect aren’t clear.) There could be inflammation or nutrition factors that create both conditions.
Last week I went on kind of a tirade about hand washing but never said this: Flu is probably carried to your upper respiratory tract by your hands, not from breathing in someone’s sneeze or cough. Advice: don’t touch your face unless you wash your hands first. That is tied for the best way to prevent flu with this: get a flu shot. If your Doctor isn’t giving flu shots, pay the pharmacy students at the corner drug store to give you one. It’s worth it.
So, let me review. Wash your hands. Eat your vegetables. Brush your teeth. Get your shots.
Now lest you mistake me for your mother, Eat chocolate, have a beer or glass of wine now and then and get plenty of physical intimacy. That’s advice every senior can put to use.

I enjoy writing about the lighter side of aging and anyone looking for chocolate after last weeks column should find a soccer player who is raising funds this week. However, my good friend Jeanine Yonashiro is a graduate student in gerontology at USC and reminded me recently that I am in a position to advocate against elder abuse in this space.
She reminds me of the recent news that caregivers for Alzheimer’s sufferers that receive counseling are healthier than those who are unsupported. Since the majority of abusers are family members and caregivers, keeping those people healthy is going to directly reduce the number of abuse cases that occur. Caregiver stress is a superhuman burden and I absolutely encourage those of you who care for a family member or client to seek out help, either from a mental health professional or a peer support group like Leeza’s Place in Sherman Oaks or from a church or religious group in your own community. The important factors are having someone to talk to who won’t try to tell you it’s like when their kids act up, but know what you are dealing with, and won’t be shocked when you tell them how very bad you feel sometimes toward the person who has multiple physical, cognitive and behavior problems.
Dr. Tony Kuo of the L.A.County Public Health tells me that the death rate for dementia is increasing and we don’t have the tools to track it and tell us why. A condition that is still poorly understood in many ways, often managed in isolation and silence, and now increasingly dangerous. How can a caregiver not approach burn-out?
My best advice is to use every resource offered. If the Alzheimer’s Association will pay for respite, take it. If the local hospital gives a support group, go! If your church starts an elder day care, use it. Make a selfish choice now and then. Now I think I need a piece of chocolate.

Once you get a cold, you will never get that cold again. If the virus changes to a new strain, it can then come back and infect you again.
The changes in strain, and the harbingers of where they will move are the factors used to predict what flu shots will be used in the coming year. It is a lot of science and a bit of guesswork that usually does a good job covering most people for a season. Older Adults are a priority population because of reduced tolerance of illness.
I teach a class called Field Safety with a Sheriff’s Sergeant for mental health workers seeing patients at home. My first question is always “what is the most important thing you can do to keep from being physically compromised and harmed working in the field?” Filling your gas tank, having a charged cell phone, parking safely are common guesses. The answer is, of course, “wash your hands.”
There is another factor involved, and one that is disturbing to medicine watchers. When the guys who do this kind of science call people at home and ask “do you wash your hands after visiting the toilet?” 92 percent says, “Yes!”
If you stand around public rest rooms and count the number of people that do wash their hands, you get a different number. 88 percent of women, only 66 per cent of men wash their hands after exiting the stall. Some places are worse than others. A baseball filed in Atlanta yielded the lowest rate for men (57%) but the highest for women (95%) Bless those Southern Ladies!
By the way, those gels they sell now to sanitize your hands are said to actually work better than soap and water to remove germs. But 20 seconds of soap, water and friction are still the greatest advancement in health in the history of mankind. Use it!