Officially Old

I once had the job of maintaining refrigeration equipment. Part of my job entailed noticing when something quit working in order to save the food before it got warm. Then I’d call Walt to fix it. I wanted to know when I was throwing good money after bad; when it was time to buy a new compressor rather than keep fixing the old ones. I would ask Walt for an opinion and his response was invariably, “How high is up?” And he would patch it together again.

This leads to the question of “How old is old?” Those compressors were old. I’d gotten them free from other stores that had gone out of business. (Some of them had been sitting out in a field at a dairy for years.)

My mom delivered Meals on Wheels. She referred to this as “delivering meals to the seniors”. She was in her late 70s at the time. She did not think of herself as old.

My daughter once asked if I were old. (I was 43 at the time of their birth.) I said, “You can call me old when you can beat me one-on-one in soccer.” By that standard I’m not yet old.

In the United States, one can begin to draw Social Security at age 62 (for most people). The amount you collect on a monthly basis continues to increase the longer you wait to begin collecting. At age 70, it’s about 40% more than if you start at 65. When you start to collect involves gambling against the house. How long are you going to live? When do you stop working? When do you need the money? Those are all questions to answer and I’m not here to answer them for you. Nothing in this post should be construed as financial advice.

In my case I decided I hoped to live for a long time and work past the “standard” retirement age. By waiting until monthly payments were at their maximum I hoped to win the bet. I calculated how long I’d have to live for the bet to pay off in terms of total dollars collected. (On a monthly income basis, it is paying off immediately, of course.)

I reached the age at which waiting served no purpose. I was at the maximum. That, I decided, made me “officially old” by one standard (though not the soccer standard). Social Security told me to apply in advance to get approved. It took them four months from the time I applied until they told me that I was eligible. Then they let me know that I would actually get my first payment two weeks after the month ended. One is not eligible to collect benefits for the month in which one dies so, to avoid taking chances, they don’t actually pay until the next month. That’s like telling your landlord you won’t pay your January rent until February 15 because you want to be sure your apartment isn’t destroyed by fire sometime during January, and you want two extra weeks just to be sure.

So the first Social Security payment has arrived. According to the US Government, I am old. I thought I would work right up until that date (at one point I thought I would work several years past that date) but a little bike trip changed that plan.

Social Security is known as an entitlement program. We’ve been trained to think that feeling entitled is a bad thing. The relevant definition of entitlement is “the right to guaranteed benefits”. Why am I entitled to this benefit? Because it is my money. I have been saving it for over 50 years – actually, the government has been saving it for me (since 1969) so I wouldn’t blow it on things like rent and food. So the next time you read the word “entitlement” in regard to Social Security, remember it is not referring to a “sense of entitlement”, meaning “the world owes me something because I’m special”, it means “I have a right to this money because it is mine”. If you put money in a bank savings account, would it be okay for the bank to decide not to give it back? Neither is it okay for the government to decide not to give back your own money that they’ve held onto for 50 years with the promise that it would be yours in retirement.

Had I kept working, I would now get my first raise in years. I was once represented by a union. (Wisconsin Act 10 changed that.) Each time we came into contract negotiations, management would tell us that their “market research” revealed that we were overpaid. They considered that research proprietary so they wouldn’t share it, or any evidence that it actually existed. One year they offered a 0% raise to occupational therapists (since we were overpaid but they decided it would be impolitic to cut our pay) and a fractional raise to physical therapists. Though our schooling and training were almost identical, they always made more than we did; and they were never overpaid. Through bargaining we all got a modest raise that year.

Our pay was based on a grid. PTs were a couple of steps higher on the grid than we were. Each grade had a range. Once you reached the top of the range for your pay grade, you never got a raise unless they changed the ranges. I worked my last several years at a flat (falling in real dollars) wage.

I had lunch with a former co-worker after retirement and learned that management had done some new market research and found that we were underpaid by two pay grades. (And apparently PTs were not underpaid as badly as OTs…surprise, surprise.) How much that means in dollars I don’t know and I think I don’t want to find out. If I were still working I would be getting my first raise in years about now. If I wanted to be working, I’d be bitter. Instead I’ll just go ride my bike. Retirement wins.

Phil Ochs – “When I’m Gone”

Not to be overly morbid but, when you write about aging, death is looking over your shoulder to make sure you get it right. On a recent indoor bike ride, I watched the movie “Phil Ochs: There But For Fortune” (available via the Kanopy streaming service at your local library). Have I mentioned that the public library may be the pinnacle of civilization? No offense to the folks who put up Little Free Libraries, but these big libraries are also free.

Ochs was one of the greatest singer/songwriters who ever lived. Imagine if Bob Dylan had continued to write topical songs and had the voice of an angel. Dylan famously denigrated Ochs by telling him he wasn’t a folksinger, but a journalist; but his satire was too powerful to call it journalism. (Ochs also didn’t consider “journalist” an insult.) “Love Me, I’m a Liberal” and “War is Over” are way beyond journalism. In introducing “Love Me”, he said a liberal is someone who is 10 degrees left of center, but when it’s personal, he’s 10 degrees right of center. “War is Over” imagines simply declaring war to be over. He held a march in NYC declaring the end of the war in Viet Nam as a piece of political/street theatre, to see how people would react. In “Small Circle of Friends” he looked at the phenomenon of people “not wanting to get involved”. The impetus was the murder of Kitty Genovese in New York, with the news reporting that people heard her screams but didn’t call the police because they “didn’t want to get involved”. Ochs puts that story and others to music with banjo, honky tonk piano, and snare drum – a vicious satire juxtaposing good-time music with a chilling message.

I saw him near the end of his life. (Concerts Wiki tells me it was February 1, 1974 in a benefit for The Wounded Knee Defense Fund. He died in April of 1976.) He had broken his hand – he said he had punched a wall the night before – so playing the guitar was a challenge (at least it was his right hand). Nonetheless, he played through his pain and it was an evening to remember.

Ochs was already contemplating his own mortality with this song. It is not about dying as much as it is an exhortation to not waste our lives but to live them fully while we’re here.

In that spirit I will ride the Horribly Hilly Hundreds this spring. I have to admit, 70 sounds old – much older than 65 sounded.

I just collected another 2 liters of sap. That may be it for a while. The temperature is dropping as the day progresses (colder at noon than it was at 6 AM) and a snowstorm (possible blizzard with 35 mph winds and up to 10 inches of snow) is on the way.

A Modest Proposal

…and I don’t mean that in the Swiftian sense. About 30 years ago, I had an idea. I talked with a few people about it and it didn’t go anywhere. I was a bit busy, having just moved halfway across the country, having a new baby, starting school to embark on a new career, and being broke from trying to live on worker’s comp and then short-term disability after a spate of on the job injuries and illness. The specific opportunity is long gone – the two parcels of land I had in mind have become an apartment complex and a city park.

But I still stand by the general idea and two books I read this month brought it back to the foreground. The books were “Every Deep-drawn Breath” by Dr Wes Ely, and “David Couper: Beyond the Badge” by Rob Zaleski.

Ely is a pulmonologist (lung doctor) with a degree in public health. His specialty is critical care and, more specifically, the delirium that arises from how we treat people in intensive care units. He has found life-long cognitive disability arising from what we used to call “ICU psychosis” and which we used to think was normal and temporary. We didn’t really think about or look at the life people were left with – the focus was on keeping them alive at all costs. The unmeasured costs included unemployment and suicide. Families scrambled to care for loved ones who could no longer care for themselves. One of the reasons I became a therapist and not a doctor is that I got to spend time with my patients. Dr. Ely seems to have found a way to spend time with his patients and stay involved in their lives after discharge.

David Couper was a cop. He was chief of police in my hometown for many years, and an early proponent of community policing. He retired from the force to become an Episcopal priest. While at first blush those two professions seem to have nothing in common, he is a man who believes in a life of service and he saw those as two branches along that path. As chief he had posters of Martin Luther King, Jr and Mohandas Gandhi on his office wall. The book is a wide-ranging discussion about his life and thoughts and, like any talk with someone who is old and has been touched by death, alights on the question of how we choose to spend our last days. (In the final interview, he suggests his epitaph might be “Maybe he wasn’t such an asshole after all.”)

Many people, if asked, would say they never want to end up in a “nursing home”. Many of those have difficulty distinguishing between a short-term rehab facility and a long-term care facility. Most of us don’t know the terminology nor the options until life sneaks up on us and leaves us no choice but to talk about it. Getting old, getting sick, dying…those are things we like to ignore for as long as possible – especially if we are the sort that reads bicycling or other fitness blogs.

Care of our youngest and oldest are among the more poorly-paid fields in the United States. (The mean annual income for child care workers was $27,680 per the Bureau of Labor Statistics in May of 2021. For “Personal Care and Service Workers” it is about the same.) We want good child and elder care but we don’t want to pay for it. We’d much rather pay for B-21 bombers (at ~$700 million/each) and F-35 fighters (>$100 million each). Lifetime costs are estimated at $1.3 trillion for the F-35. (Figures from armscontrolcenter.org and airandspaceforces.com). That’s a lot of caregivers.

I came of age personally and professionally in the world of co-operatives – businesses owned jointly by the people who use them. I worked in and managed a grocery co-operative that was owned by and served thousands. I lived in a house jointly owned by half-a-dozen of us who lived there (plus those who had lived there previously and still had shares). I later managed a housing co-operative jointly owned by 79 families. As a limited-equity co-op, owners were guaranteed a modest return on investment when they left, and the cost to buy into the co-op for a new member was kept affordable. Monthly costs were about ⅓ of market rate.

I saw a model of elder care (for those who can afford it) that provided a continuum of care. My mom lived in one of those. She lived in her own 2 bedroom apartment and initially did her own cooking and cleaning. She had the option of meals in a restaurant on site. When she went into a hospital, she could discharge to a rehab center on site until she was ready to return to her apartment. If she couldn’t care for herself in her apartment she could move into assisted living, where she would have her own room and bathroom, with meals and housekeeping services provided. If she needed a higher level of care, she could move into the long-term care facility with round-the-clock care. This all came, of course, with significant cost. To get in you signed a “life lease” for hundreds of thousands of dollars. When you died, your heirs would get a fraction of that and the person taking your place would pay a multiple of that. And then there were the monthly fees. The more services you used, the more you paid.

I envisioned a co-operative model. Lots of us had grown up with the grocery co-op I helped start when I was 21. Lots of us were still in the neighborhood 20 years later when the idea came to me. Most of us still didn’t want to think about getting old. I was weird – I had proposed a pension plan at the co-op in my 20s, when no one else could imagine working there into their 30s or 40s.

I saw this vacant land within easy walking distance of the grocery co-op. What if we bought that land for a co-op? We could build accessible housing (since I’d moved from the co-ops to the building trades to occupational therapy, this was right up my alley). We could build in a continuum of care; or rough out the buildings and develop them as we aged if we couldn’t afford the whole project at once, starting with independent apartments in a co-housing model. We could walk to get our groceries. We could own this jointly and eliminate the profit-motivated middleman.

I talked to a few people who either saw it as a pipe dream or thought it was fine if I could pull it together. The folks who were in a position to pull it together weren’t interested and I wasn’t in a position to pull it together. Now we’re old. Some of my friends pooled their funds for a co-housing community. It seems to be a nice, inter-generational place but has no real services for aging-in-place as far as I know.

So I’m tossing this idea out there to the world at large. When I teach my course in trauma care I toss out several ideas for studies I’d like to see done but am not in a position to do. I offer the ideas to anyone who might want to pursue a doctorate and needs a topic for a dissertation. To the best of my knowledge, no one has done them yet. In that same spirit I offer this to anyone who wants to build a co-operative, continuum-of-care senior housing community. Just let me know if you do it so I can come and visit.

If you can remember this

you’re old.

• sprocket boards at the bike shop, so you could build a custom freewheel
• “corn cob” or “straight block” freewheels (14-15-16-17-18)
• “alpine” gearing (14-28)
• “Half-step” gearing (in which each shift between chainrings is ½ of each shift between cogs) or the “half-step plus granny” touring variant
• downtube shifters
• pre-Hyperglide cogs, which you could flip over when worn and they’d be like new again.
• Zeus (the Campagnolo clone company)
• Jack Taylor, Ron Cooper, 3Rensho, Cinelli, Ciocc, and other framebuilders
• Framesets hanging from ceiling hooks in the bikeshop – you ordered parts to have them built up custom.
• Suntour, Stronglight, Atom, Regina, Normandy, Simplex, Weinmann, Dia-Compe, and other component manufacturers
• center-pull brakes
• No braze-ons – all accessories clamped onto frame tubes
• Braze-on pump pegs
• When Cannondale made bags (panniers, handlebar bags), not bikes
• Tire savers
• Tubular (“sew up”) tires

How old is old?

• “40 is the new 30.” (Douglas Coupland, author of “Generation X”)
• “50 is the new 30…and delusion is the new self-esteem.” (Steve Kelley snd Jeff Parker – from the comic strip “Dustin”)
• “Don’t trust anybody over 30.” (Jack Weinberg of the UC-Berkeley Free Speech Movement)
• “14 or Fight.” (Christopher Jones, fictional character from the movie “Wild in the Streets”)
• “Your old road is rapidly agin’/Please get out of the new one/If you can’t lend your hand/For the times they are a-changin’.” (Bob Dylan)
• I saw a sign advertising Senior Apartments the other day. This is old to them:

I discovered the lifespan of a Campagnolo Super Record cassette is 3 chains. I placed my fourth chain on the Wilier last week and took it out for a test ride. Fine around the block, so we headed into the countryside. Soon, one cog began skipping under load. Fine, I thought, I can get by without that gear for today. I’ll change before the next ride. Then another and another began skipping. I realized I could not get up the infamous Mounds Park Road missing 3 of my lower gears, so I cut the ride short. I still got to see (and climb) this:

Actually, Campagnolo 11 speeds come with two groups of 3 and 5 loose sprockets, so individual parts could be replaced, if one could buy them that way – or if one chose to take some of the parts out of the box and leave others behind.

Note that we are moving on from the trees blooming to the trees leafing out. This is a few miles down the road from our adopted highway, and a few seconds before I came upon a rider with a broken derailleur hanger – which kind of ends one’s ride. I didn’t feel so bad about cutting ten mostly uphill miles from my ride.

With a new cassette in place I headed out again on Sunday, riding into a strong headwind for 25 miles. It was 45 degrees (7 C), so I tucked a bag between my jersey and my jacket for the first several miles to add insulation and wind-proofing. My luck held and the wind was still blowing for the tailwind part of the day when the temperature soared to 55 (13 C).

I was thinking that the bike is almost ready to go (more so than I), but that it needs new shoes (tires and tubes) before the trip, which brought this to mind:

The wind had me singing wind songs – the mind brings up what it brings up.

(2)

Forgetting where your keys are, or forgetting what your keys are?

One of the definitions of Alzheimer’s Disease is that it is normal to forget where you put your keys. It is not normal to find your keys and not know what they’re for.

My father died of Alzheimer’s Disease (AD, also known as SDAT – Senile Dementia of the Alzheimer’s Type) at age 78. He recognized no one around him. My mom, on the other hand, died at age 93. She not only knew who I was, but knew that, since it was Monday, it was my day off and that was why I could be with her all day. The fact that she was dying went unsaid. She died just as it got dark that evening.

How does one die of Alzheimer’s Disease? Forgetfulness goes beyond just “what are these things for?” to forgetting how to chew and swallow. The immediate cause may be dehydration or malnutrition but the ultimate cause is the disease. My father’s autopsy report mentioned cardiac arrest and multiple organ system failure…duh. He died when his heart stopped beating, not really because it stopped beating. He could have remained alive longer with IV fluids and a feeding tube, but to what end? He had made that decision long before, as have I. If you have not done it yet, write an Advance Directive – a document that specifies what care you want (and don’t want) in the event of a terminal condition. I know – you don’t want to think about that. Death happens to other people. Guess what? It happens to all of us. But you’re not old. Guess what? Not everyone dies of “old age”. Ultimately, there is one terminal condition in life – it is birth.

Alzheimer’s is only definitively diagnosed after death, from examining the brain. In his case, they even left that out until we demanded an addendum to the report. They had examined his brain but neglected to include those findings in the report. With research, we may be able to diagnose the disease short of death; maybe even treat, cure, or prevent it.

An aside: you may notice that “cure” is a rarity in medical science. We tend to “treat” disease by administering medications to control symptoms – medications that often must be taken for life and at great cost. We don’t “cure” a whole lot of diseases. The cynical among us may say that there is little profit in cure and a lot of profit in lifelong treatment.

Prevention of SDAT may well hinge on a lot of the same factors as many diseases – eat well, sleep well, stay physically active, control blood pressure (and have the right genes).

The PBS series Nova produced a documentary on the WRAP (Wisconsin Registry for Alzheimer’s Prevention) study. It is an hour well worth your time. There were damp cheeks in the program, on both sides of the screen.

The project enrolls the children of people diagnosed with AD (and a control group of people without a familial history) and follows them longitudinally. Every few years, participants complete a lengthy questionnaire (with another completed about them by someone who knows them well) and complete a lengthy battery of neurocognitive tests. Additional optional studies include MRI, functional MRI, and PET scans; lumbar punctures; and treadmill testing.

As a test subject, some of this is difficult, as it involves testing to failure. How long a digit span can you recite backward after hearing it once? You get longer and longer spans until you fail. How steeply can you walk up a treadmill at a set speed? You go until you can’t.

Can we see changes in brain structure and function before one develops symptoms of the disease? Does cardiorespiratory fitness delay or prevent onset of disease? Can we see biomarkers of disease in the brain or the cerebrospinal fluid prior to recognizable disease onset? If so, can we address those markers and influence the disease path? These are a few of the questions the study aims to answer.

What’s it to you? Research shows the children of those with AD are more likely to contract it themselves. My father, his brother, sister, and mother all died of AD. On my maternal side, I have questions about a couple of aunts. But you’re not me. According to the Alzheimer’s Association, “1 in 3 seniors dies with Alzheimer’s or another dementia. It kills more than breast cancer and prostate cancer combined.” The longer you live, the greater are your chances of developing Alzheimer’s Disease. If you are a woman or person of color, your risk may be higher than if you are a white male. Per 2022 Alzheimer’s Disease Facts and Figures “Structural racism pervades many aspects of life that may directly or indirectly alter dementia risk.”

Maybe a coast-to-coast bike ride will help prevent Alzheimer’s Disease. That would be icing on the cake. For today, I’ll ride my bike through the snow to the library.

It is snowing. It is the day that US taxes are due. Does that have anything to do with why I am writing this today? It was in 1716 that Christopher Bullock wrote “Tis impossible to be sure of any thing but Death and Taxes” (though for the uber-wealthy, even taxes are not a sure thing).