Slow Medicine

OPINION:
GUEST COLUMNIST OPINION:
Martha Bauman
Slow Medicine
A friend recently suggested that I write
about slow medicine. Slow medicine? I
want my health problems fixed as soon
as possible. Doesn’t everyone? But with
further conversation, reading and
thinking, I revised my view.
Slow medicine is grounded in research at
the Dartmouth Medical School.
Physicians are encouraged to think twice
about the high risks and limited rewards
of aggressive treatment for
persons who are near the end
of life or whose health is
already compromised. Patients
and families are also
encouraged to consider
carefully the risks and rewards
of treatment.
Slow medicine is not the same as the end
of life choices that we make in our living
wills. A living will states preferences for
the time when one is near death and
unable to communicate one’s choice
about life support measures. Slow
medicine allows a patient to decide that
he or she does not want to experience the
impact of a possible procedure or course
of treatment. This decision does not
mean that treatment for other conditions
will also be withheld.
Nor is slow medicine a variety of
hospice care, though there are
similarities. Palliative care, to ease the
symptoms of the condition is a critical
component of slow medicine. Much has
been learned from the experience of the
hospice movement.
The practice of slow medicine can be
seen at work among residents of Kendal,
a senior community in Hanover. An
article in the New York Times (May 5,
2008) gave an example, provided by
resident Edie Gieg, age 85. Her husband,
Charlie, 86 at the time, was suffering
from a heart problem, an intestinal
disorder and was in the early stages of
Alzheimer’s disease, when doctors
suspected that he also had throat cancer.
A specialist outlined what he was
facing: “biopsies, anesthesia, surgery,
radiation or chemotherapy.” His ability
to tolerate these diagnostic and treatment
procedures was of concern to both Mr.
and Mrs. Gieg. They feared that a period
of decline and dependence would follow.
There was concern about the
risk of anesthesia, which could
accelerate the dementia. They
decided to forego further
diagnosis and treatment for the
suspected cancer.
This is not a decision made
lightly, even with the support of
Kendal’s on-site medical staff. People
who live at home may feel less secure in
deciding to forego possible treatment.
For one who does not have good family
support, this would surely be a lonely
time. Who will be there to help the
patient with daily life, if need be? The
support of nurses and physicians who
understand this approach is critical. If
possible, family and/or close friends
should be involved in making the
decision and should plan to support the
patient throughout the months to follow.
The idea of refusing treatment is
startling. We live in an age of
possibilities for medical treatment that
sometimes seems miraculous. Doctors
want to make people well, at almost any
cost. Specialists want to use and perfect
new techniques for diagnosis and
treatment. The prevailing mind-set of
June 2009
Volume 4, Issue 6
EngAGING NH NEWS
EngAGING NH
9 Eagle Drive
Bedford, NH
The idea of
refusing
treatment is
startling.
June 2009
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2
ENH welcomes all points of
view and invites your
submissions. Send articles to:
lcamst38@peoplepc.com
both the medical community and
the public is “Do all you can.”
Martha Bauman enjoys growing
older in the Monadnock Region.
She writes a weekly column on
senior issues for the Keene
Sentinel and Senior Life articles
for New Hampshire Magazine.
She serves on the Advisory
Council of the Endowment for
Health and is involved in Cheshire
Hospital's Vision 20/20 project.
END OF LIFE VIEWS:
HAVE YOU AND YOUR
FAMILY HAD THE TALK?
Be sure to let your family know
your wishes.
• 97% Having family “listen to
them” is support they expect to
need;
• 96% Having family “know what
they want when they die” is
support they expect to need;
• 86% Think total physical
dependency on others would be
worse than death;
• 75% Think being unable to
communicate their wishes or
needs would be worse than
death;
• 84 % Agreed that dying is an
important part of life;
• 71% Feel it is very important to
be off machines that extend life;
• 72 % Think it is very important
to have family relationships
settled.
Source: MA Commission on End of Life
Survey 2005
FINANCES:
IDENTITY THEFT
Think it can’t happen to you? You
might want to think again! There
has been a rash of thefts in the
Concord Area with people being
targeted in local stores and
parking lots. Such rings operate in
several states and they look for
easy targets.
What is an easy target? A purse
left in a grocery cart, credit cards
or wallets left in cars, a purse
hanging off the back of or under a
chair while someone reads, uses a
laptop or goes to pick up coffee.
Not only can your cards be used,
by your identity can be stolen to
apply for new cards, create false
documents including driver’s
licenses, and to purchase gift cards
which can be used long after you
shut your credit card accounts
down. If you have debit cards or
online banking, those accounts are
vulnerable too.
Prevention and Protection
• Always use a zipped bag and
make sure it is closed.
• Make a copy of everything in
your wallet and keep it on file.
• Sign your credit cards— and
add "check ID".
• Only carry with you what you
will need for each specific trip.
Don’t treat your wallet like a
filing cabinet!
• Create a file with your credit
card information including the
full number and expiration
date. Add the fraud call-in
numbers to it--And don’t
forget to update as needed.
If It Happens:
® Call your credit card
companies immediately and
report the problem
® Call the police and provide
the credit card companies with
the police report number
® Request a fraud alert from
the Fraud Department at the
three major credit bureaus:

Equifax 800-525-9285,
www.equifax.com, to order a
report 800-685-111

Experian 800-397-3742,
www.experian.com to order
a report 800-397-3742

Trans Union 800-916-8800,
www.tuc.com , to order a
report 800-916-8800
® Notify your bank and credit
union. Ask you bank about
their policies for changing
account information. (Look for
banks that require a secure
face to face transaction.)
® Notify the NH Department of
Motor Vehicles, to request a
duplicate license ($10) if
necessary.
® Notify the Social Security
Administration 800-269-
0271, email:
oig.hotline.ssa.gov
® Contact the Federal Trade
Commission Consumer
Response Center 877-438-
4338 or
www.consumer.gov/idtheft
News You Can Use
June 2009
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Grandmothers
have an
extraordinary
power
® Contact your US Postal
Inspection Services
www.usps.gov/websites/depart
/inspect
® Contact the NH State
Attorney General’s Office.
BANKING CHANGES
Like credit card companies, banks
are making small changes to the
way services are provided and the
fees charged. Some of the changes
you may see include:
• Allowing overdrafts on debit
cards and charging a fee or
increasing fees on this feature,
if you have it in place;
• Charging or increasing fees for
using ATMs out of network;
• Increasing or changing the
way late fees are calculated.
If you have a good reputation you
may be able to negotiate and you
don’t need to go to a supervisor, as
most personnel have been
authorized to make changes.
Resource: www.mint.com
GRANDMOTHERS CAN
REALLY MAKE A
DIFFERENCE
In an effort to preserve the
knowledge and skills of
grandparents, famous Irish chef
Darina Allen launched Slow Food
International Grandmother’s Day
to be celebrated every April 25.
Is Grandmother’s Day just a ploy
to persuade people to buy
grandmothers presents every
year?
“No, the goal is to create a
fraternity of grandmothers right
around the globe. The idea is that
grandmothers gather their
grandchildren and pass on the
abilities these elders have within.
Many of these are forgotten skills:
how to garden, how
to cook, how to fish.
The idea is for
grandmothers to
exchange knowledge
and strengthen bonds
with their
grandchildren.”
How did you think up the idea?
“My friend Alice Waters [a
famous Chez Panisse chef] and I
came up with the idea together.
She’s a wannabe grandmother and
I’m a grandmother six times over.
I realized how important it is for
us to pass on our cooking and
growing skills.”
What do grandmothers know that
others don’t?
“A whole generation has never
seen their mothers cook in the
kitchen because nowadays, in
most households, both partners
work, and many schools no longer
teach cooking or home economics.
Most grandmothers still have these
important life skills. They still
know how to cook, sew, sow
seeds, keep chickens.”
Do you think kids will listen to
their grandmothers about this kind
of stuff?
“Grandmothers have an
extraordinary power and influence
over kids, and so we can really
make a difference. Of course, it
depends how close the relationship
is, but kids absolutely love to
cook, peel, mix, grate, chop—
anything from pancakes to apple
pies. In my experience, children
who are involved in sowing seeds
and growing vegetables will eat
absolutely everything they grow,
even if they shivered at the
thought before.”
What exactly will change if
grandmothers pass on
their knowledge?
“There is a drastic
deterioration in the quality
of food people eat these
days. When you know
how to cook, you can whip up a
meal for family and friends at a
moment’s notice using fresh,
seasonal ingredients. It’s less
expensive, more nutritious, more
delicious. Grandmothers can also
teach the joy of sitting down
around the kitchen table again.”
And what about the grandfathers?
“We want grandfathers to
participate and especially teach
grandchildren how to fish and
garden.
Source: Ode Magazine
May 2009
HOME ENERGY COSTS
Unitil announces an online home
energy calculator: www.unitil.com
RETIREMENT INSECURITY
At the Long Term Care (LTC)
Legislative Caucus’ June 22
meeting, the NH Women’s Policy
Institute (www.nhwpi.org)
provided a presentation on issues
NH women face in retirement.
Retirement Insecurity covered
facts that are well known: women
earn less than men, are more likely
to take a leave of absence for care
giving, and often give part or all of
their savings to children and
Legislative Update
June 2009
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The average
Social Security
benefit for an
older woman is
$800 per month
grandchildren. These factors erode
the base amount on which
retirement benefits are calculated.
NH women, over age 65 who live
alone, have the lowest incomes
among the state’s older
population. Sixty-two percent
(approximately 28, 000 women)
have incomes that do NOT cover
their basic cost of living.
Based on the 2006 Livable Wage
Study, the Institute estimates that
an older woman living alone needs
about $20,000 a year to cover her
basic cost of living. The primary
source of retirement income for
most of these women is Social
Security. Yet the average benefit
for a woman age 65 and over is
about $800 a month!
Given these facts, we
can assume that older,
poorer women will
become significantly
dependent upon NH’s
public assistance
programs. For example, by the
year 2020, Medicaid can
anticipate a 46% increase in
spending to care for elder women.
That’s a cost of $351 million!
As the Caucus examines the
variety of issues coming under the
umbrella of long term care and
supports, it is critical that such
issues be considered. So often,
LTC is oversimplified to mean
medical services/care and the
related costs.
But in reality, LTC means creating
environments that support the
needs of a changing population as
it ages. The more successful we
are at creating livable and
responsive communities, and the
more we create policies that
address tangential issues, the more
we will reduce the dependency on
public assistance.

We note that Sen. Jean Shaheen
is sponsoring a bill to create case
management services for elder
persons discharged from hospital
care. The RN case managers
would monitor the post
discharge routine to insure that
the appropriate treatments were
in place. Massachusetts hospitals
have already adopted such a
policy and have had a decrease
in recidivism and inappropriate
use to emergency
rooms, saving
hospitals a great
deal of money.
Given that the nation
has a shortage of
nurses, we hope that
the use of a nurse and Social
Worker team will be considered.
Good case management is the
backbone of successful, noninstitutional
care. Social
Workers play a critical role in
education, involving families,
developing resources and
insuring that non medical
supports are also in place.

The most recent discussion
around health are reform have
begun to include LTC issues.
Most notably are the talks of
eliminating the Medicare
Advantage Plans (Medicare Part
C) and shifting the savings to
Prescription Drugs.

Another critical issue for
Medicare Prescription Drugs is
the ability to negotiate costs.
Following is a local comparison
made by an ENH Board
member.
Medication: METFORMIN

Walmart –3 months: $10 all
strengths

Costco: 100 – 500 mg. $6.99

CAREMARK 3 months
[including $4 co-pay: $37.97

TARGET--$10 all strengths
Medication: PRAVASTATIN

Walmart: 10-40 mg. $10

Costco: 100, 20-mg: $10.83

100, 40 mg: 43.44

TARGET $10

CAREMARK: $154.80
Medication: SIMVASTATIN
Walmart: N/A

Costco: 100 tabs-more than 90
day supply: $10.83

TARGET: N/A

CAREMARK: $79.34
The June 22, 2009 Boston Globe
featured an interesting article
entitled, “The Purposeful Life”.
(Are they on our mailing list?)
Based on research conducted by
Patricia A. Boyle and a team from
Rush University Medical Center in
Chicago, reported in the June 15th
issue of Psychosomatic Medicine,
older people who find meaning in
their lives have a lower risk of
dying than adults who felt their
lives had little direction. The study
Purposeful Living
Health Care Updates
June 2009
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also supported that having a sense
that life has meaning also makes
for a more positive outlook.
Perhaps the most significant
finding is that the results did not
change when depressive
symptoms, neuroticism, disability,
the number of medical conditions
and income were factored in!
“Positive factors such as having a
sense of purpose in life may
provide a buffer against negative
health outcomes, particularly in
old age,” the authors wrote.
A sense of purpose does not
necessarily mean grandiose goals,
altruistic projects, or even
volunteering. It can be simple
things like caring for a pet.
How to make a difference in your
own life?

Create a phone tree and check in
daily with older friends who live
alone,

Spend time with a grandchild or
neighborhood children,

Read to someone who is home
bound, even if it’s over the
phone.
The ways to bring a sense of
meaning into life are as varied as
we are. But it begins with the
choice to assume responsibility for
asking what needs to be done.
Happy New Year! July 1, 2009
marks the beginning of the State’s
biennium budget cycle.
Many of those involved in the
process grimace while they justify
the underfunding or elimination of
services and programs that will
have a profound impact on all of
us. NH has always been frugal,
often overestimating revenues and
underestimating expenses.
But this time, things are different.
We are not an island, but part of a
global economic restructuring.
Government officials talk about
the need to reinvent departments,
be more efficient, eliminate
duplication and waste; the bottom
line is that even if we do all those
things, it might not be enough.
We still base our budgets and our
plans as if the level of federal
funding will remain constant. In
fact the Government Accounting
Office has twice pointed out that
the Medicaid Reimbursement
formula should be revised to
reduce the differences among
states for medical care coverage of
the poor, to distribute the burden
more fairly. NH was named in
both reports as a state that should
have its rate lowered.
But this is not just about health
care; Medicaid reimbursement is
also important funding for our
schools. We need to start
planning, broadly at all levels of
government for an increased need
for supports and lower levels of
public assistance.
One approach that the ENH Board
supports is focusing on livable
communities. And we are not
alone. Several organizations are
looking at long term care reform
and what is needed to create
services and supports in a
changing world.
• Seniors Count Making Seniors
Visible: Policy and Advocacy.
(livable communities issue) 603-
644-2240, Report available at
www.seniorscountnh.org
• AARP Long Term
Independence. 1-866-542-8168.
www.aarp.org/health/longtermcare
• Home Health Care Association.
Help US Choose Home is a new
public information campaign.
800-639-1949,
www.homecarenh.org.
Know of others? Please let us
know!
It is time for us to also look at
differences in access to services
and supports in NH, and how
fairly the burden is distributed.
Can we take the frugal NH way
and create models that work for all
of us?
We encourage you to become
EngAGED. Get informed. Share
what you know!
Board Notes
June 2009
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© 2008 EngAGING NH,
All Rights Reserved
EngAGING NH Newsletter
articles may be copied for
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copyright and credit to
EngAGING NH must appear on
all copies made.
This permission does not apply
to reproduction for advertising,
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commercial purposes.
Easy, cheap, good food
EGGS GOLDENROD
2 slices TOAST
2 hard boiled EGGS
White Sauce:
Heat 1 tbs. butter; add 1 tbs. flour
Add 1 cup of milk to thicken.
Add salt, pepper, onions, garlic, Worcestershire to taste
Chop egg whites and add to sauce.
Pour over toast, and crumble yolks over it all. Add left over
vegetables, or crumbled cheese as desired.
Clip & SAVE
When times are tight, you can still eat well. We are sharing a favorite
Depression era recipe from ENH board member Maida Sengupta. Do
you remember a favorite dish or comfort food? Consider sharing your
recipe with us so we can publish it.
MAKE A DIFFERENCE!
PLEASE--share this
newsletter with family,
friends, neighbors and others
in your community.
EngAGING NH
9 Eagle Drive
Bedford, NH 03110
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