inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #26 of 99: Cindy Smith (clsmith) Wed 13 Nov 13 11:49
    <scribbled by clsmith Wed 13 Nov 13 12:08>
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #27 of 99: lies straight from the Pit of Hell (crow) Wed 13 Nov 13 15:39
    
I didn't like the essay. I'm also one of the ones who thinks Mrs. Klass can
and should make more of an effort. I'm also very glad I'm not related to
her.

She reminded me some of my MIL who is disabled from a stroke in her 30s and
finds it hard to accept help. To the extent that she would try to pick up a
heavy pan from the stove - "I've got it, I don't need help!" - and then drop
it, because she really couldn't do it. There were plenty of things she could
do an everyone respected her for those; it seemed weird that she couldn't
accept help for things she couldn't do, like lift heavy things with two
hands.

She's living further away now and I don't see her so often so I don't get so
annoyed.

My mom, who is much older, is very flexible about being helped, and I
appreciate that a lot.
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #28 of 99: Pamela McCorduck (pamela) Wed 13 Nov 13 18:37
    
I didn't say Mrs. Klass should be "grateful." I said "gracious." A
difference. (I personally would be grateful, but obviously, I'm not
her.)

The hearing loss is a tremendous issue, and thanks, <brady>, for
bringing it up. As my mother got older, we really began to think she
was losing her marbles--her responses to conversation were so
inappropriate. No, turned out she was just getting deaf, and wouldn't
concede. Even when we finally coaxed her into getting hearing aids, she
hated them and would seldom wear them.

I hope to God the technology is improving, because it's genetic, and I
realize my own hearing isn't what it used to be.
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #29 of 99: Lisa Harris (lrph) Wed 13 Nov 13 18:43
    
My grandmother decided to wear the hearing aids when she realized she
was missing conversations with her daughter and grandchildren.  It
pained her to miss even a moment of time with us. I am grateful she was
willing to go out on that limb.  It was hard to give up on the little
bit of vanity. 

Recently I have learned about otosclerosis and the related surgery
(stapectomy) which can be done to replace the stape with a titanium or
plastic or metal prosthetic stape. 
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #30 of 99: Paula Span (pspan) Wed 13 Nov 13 19:43
    
The technology IS getting better, but what's maddening is that Medicare will
pay for a cochlear implant, which costs tens of thousands of dollars, but
won't pay for hearing aids.  And a good digital aid can cost -- well, brady,
you probably know better than me -- a few thousand bucks, right?  And a lot
of folks need two.  Simply out of reach for most older people on Medicare.

But the implants are recommended for people who already have hearing aids
and whose hearing loss has progressed to the point where the aids don't do
the job anymore.

I kind of wonder if we'll be more apt to use this technology than our parent
s have been or were.  Maybe people willing to wear Google glass or whatever
follows won't be all vain about wearing a hearing aid or the external
equipment for an implant≥

Hearing loss is so major. Worse, in that it shuts down communication, even
than loss of sight, in my book.  And the research is mounting that shows a
connection with dementia.
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #31 of 99: Jane Hirshfield (jh) Wed 13 Nov 13 22:44
    
paula, have you ever written about smell and palate in old age? I know
I've seen some articles suggesting that diminished olfaction is a
marker for dementia, and have never heard of any equivalent to eye
glasses or hearing aids when it comes to smell and taste. What if, as
with hearing, it might be partly correctable, and aid the brain if it
were?
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #32 of 99: Gary Greenberg (gberg) Thu 14 Nov 13 08:31
    
I've been anosmic (no sense of smell) for the last 25 years or so. No
idea why, although I do know, courtesy of a brain MRI, that I don't
have a brain tumor (or didn't then), and I can tell you that there is
no equivalent to sight or hearing aids for the noseblind, probably
because we hav enowhere near the level of understanding of the
olfactory system as we do of the visual or auditory. Whether ansomia a
marker for dementia isn't clear, although there is suggestive evidence,
as there also is for depression (although in this case it may just be
a reaction to not being able to smell, which, let me assure you, is
really dispiriting if you think about it, although it does make you a
champion diaper changer, dog deskunker, and chicken house shoveler.)
I've experienced plenty  depression, but I suppose dementia is one of
those things I'd be the last to know about. 
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #33 of 99: Pamela McCorduck (pamela) Thu 14 Nov 13 17:12
    
A friend of mine turned anosmic from a fall when he hit his head. It
was horrible for him. Food was suddenly uninteresting, and other more
subtle effects. It has come back a little bit for him, but it's still a
major loss.
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #34 of 99: Pamela McCorduck (pamela) Thu 14 Nov 13 17:30
    
So, to the socially assistive robots talk today, and it was
interesting, both for what the lecturer (a scientist at USC) said, and
what she didn't say. These are socially assistive robots--they don't
clean the house or walk the dog.

Encapsulated, turns out s.a. robots--they don't have to be very smart,
or even very humanoid--can be very effective in working with stroke
victims, Alzheimer's patients, and autistic children (three of the
places where this team has worked). The care gap is
enormous--worldwide, in the billions of people who need help. No way
humans are going to be able to step in and help other humans this way. 

The lecturer made the point that these s.a. robots are intended to
enhance the care humans give, not replace it. 

With the elderly, they function as coaches and assistants. They keep
the elderly motivated in what are generally dull, depressing tasks,
such as exercising a limb that has been affected by a stroke, or
keeping an Alzheimer patient exercising and amused. 

Humans are eager to ascribe agency to almost anything ("my dog
understands every word I say") so they willingly ascribe agency to the
simplest of robots. (This was particularly interesting to me because
I'd spent yesterday watching quite humanoid robots in tasks that didn't
require social interaction, but required subtle motor skills, so that
they could work in places like Fukushima.)

Very important to humans is an embodied presence in their companion
(as opposed to an on-screen companion). It doesn't have to look human;
but it needs to be in the real world in three dimensions and its
embodiment has a measurably strong behavioral influence on the client.

Well, on and on. It was an interesting hour and a half.
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #35 of 99: Lena M. Diethelm (lendie) Thu 14 Nov 13 18:07
    <scribbled by lendie Thu 14 Nov 13 18:08>
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #36 of 99: Lena M. Diethelm (lendie) Thu 14 Nov 13 18:09
    

Marty Spergel appeared via robot at the Reunion of the Homebrew Computer
Club this past Monday.  Googling should get you a pic or two of "him".
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #37 of 99: With catlike tread (sumac) Thu 14 Nov 13 22:06
    
The discussion of hearing aids makes me think I would like to read a
diatribe against them. I'm NOT against them, but I would love to
understand why so many people with hearing difficultis hate them, won't
use them, don't turn them on, etc. I'd like to read a screed from someone
who feels that way. (In a line with the cantankerous individual discussed
above -- which I understand much better than the hearing aid thing.)
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #38 of 99: Eric Rawlins (woodman) Fri 15 Nov 13 07:21
    
I've always wondered about that too. There seems to be a shame element
to having poor hearing that doesn't apply to poor vision, broken
bones, back trouble, etc.
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #39 of 99: Paula Span (pspan) Fri 15 Nov 13 09:41
    
It's a communications disorder, as opposed to a purely physical one, so
people feel stupid/pitied/judged when they can't understand what people say.
THey withdraw socially, which is isolating and dangerous in itself.

And it's true, given how much technology has supposedly improved hearing
aids, that lots of people either hate them or are incensed that they cost
thousands of dollars and aren't covered by Medicare.  Which is perfectly
happy to reimburse for cochlear implant surgery which costs 10 times more
and might work for people whose hearing aids no longer help them hear.  Now
if we could just do something about that intervening 20 years or so.
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #40 of 99: Paula Span (pspan) Fri 15 Nov 13 09:45
    
Pamela, I'm wondering how these robots keep people with dementia amused and
"exercised." They have voices, I imagine, but how do they provide
motivation?  Do they escort people with iffy balance and stamina?

Smell and taste -- I've really read very little about this in the geriatric
literature.  Both decline with age, and I could see where their loss would
contribute to unwanted weight loss which, in turn, is associated with
frailty. And eating is one of the final pleasures for some very old or
ailing people, so being unable to taste and smell would be a major bummer.
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #41 of 99: Nancy Montgomery (nan) Fri 15 Nov 13 14:21
    
There was a contestant on Project Runway who had been deaf most of his
life until he had an implant and a subsequent hearing aid. On the
show, he noted that lots of voices could be irritating, and he
sometimes turned his hearing aid off to get some relief. And though he
was very happy to be able to hear, he appreciated those times when he
turned it off, too.

I can see where it might be unsettling to be surrounded by so  much
noise after being used to quiet. 
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #42 of 99: With catlike tread (sumac) Fri 15 Nov 13 15:03
    
Some of the above factors (like shame) prevent people from getting
hearing aids.

But why do people who get them -- either willingly or because pressured
by relatives -- not wear them? Or wear them but NOT TURN THEM ON?

I guess it's that last that I really wonder about. Is it simply and
only denial? Or are they unpleasant in a way I don't understand?
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #43 of 99: lies straight from the Pit of Hell (crow) Fri 15 Nov 13 15:22
    
They don't work very well. It's not enough to just make things louder,
because that's not the way we hear. If you imagine a party where it's loud
but a person with normal hearing can have a conversation with one person -
people with hearing loss have a hard time with that, and aids don't fix it
very well. Or a person has lost sounds in one range but not another so they
can hear some sounds well but not others. again, hearing aids don't do well.
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #44 of 99: Paula Span (pspan) Fri 15 Nov 13 15:42
    

I don't actually know why, but a few possibilities:

The kind that fit in your ear, which are less noticeable, are quite small
and people with reduced manual dexterity or arthritis may have trouble
placing them or removing them. (Plus, have you SEEN the size of hearing aid
batteries, which have to be replaced every other week or so?  TINY.)

They may, as Elizabeth says, just amplify sound but don't allow users to
distinguish sounds from backgrounds.  The better digital ones apparently do
a better job of that, but they're pricey.

They're associated with age and debility, which lots of people don't want to
cop to.  They're a visible sign of decline.  Like walkers and canes, which a
lot of older people also acquire but don't use.
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #45 of 99: Renshin Bunce (renshin) Fri 15 Nov 13 17:55
    
I visit lots of people in facilities who have/need hearing aids.  Once
dementia has set in, it's hard for patients to deal with them without
help.  And it's my observation that staff in facilities are careless
with hearing aids.  They'll put them on patients and ignore the fact
that the batteries need replacing.  The aids themselves get lost, and
family members can get pretty impatient with replacing them multiple
times.
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #46 of 99: Pamela McCorduck (pamela) Fri 15 Nov 13 17:56
    
Paula, I don't know the answer to your questions about keeping the
Alzheimer's patients amused. What I saw were videos of the robot doing
a kind of Simon-Says exercise routine with an Alzheimer's patient.
Alzheimer's patients (according to the speaker) would say,"I can't get
my hair done tomorrow; my buddy is coming." Nobody in this facility got
their hair done; nobody left the front door, but the robot was
considered a "buddy," and anticipated.

The hearing aid problem. Of course you'd like it small and
inconspicuous, but then how do you handle it? Hearing is probably like
vision; 2/3s of it is in the brain, not the hearing system.
Supplemented by other sensory systems, e.g., vision. ("I can't hear you
until I put on my glasses.")
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #47 of 99: Cindy Smith (clsmith) Fri 15 Nov 13 18:36
    
My dad, who uses hearing aids, has the following complaints:  they
don't work well in noisy environments, like restaurants or shopping
malls because all the sound, including background sound, is amped. This
is aggravating to him because it means in many social environments, he
might as well not bother.   They work OK on some telephones, but not
others for reasons he cannot determine.  And, once in a while, he just
gets tired of wearing them. They become uncomfortable and he has to
take them out for a while.
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #48 of 99: Cindy Smith (clsmith) Fri 15 Nov 13 18:37
    
And his hearing aids are not cheap.
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #49 of 99: Eric Rawlins (woodman) Sat 16 Nov 13 07:22
    
Modern hearing aids don't just amplify the sound; they are heavily
EQ'd toward the high end, and the EQ pattern is tunable to suit the
needs of each user. I've heard (heh) good things from the people I know
who have them, though I have no first-hand experience myself.
  
inkwell.vue.470 : Paula Span's New Old Age Blog for the NY Times: Let's discuss!
permalink #50 of 99: Brady Lea (brady) Sat 16 Nov 13 11:35
    

Yes, what Woodman said.

David got two in the last few months. They were about $3500 each. They are
digital and they are pretty  much invisible, esp. since he wears glasses.

He has several settings that can continue to be adjusted by the audiologist.
For certain settings  you want the full spectrum of sound, for others, they
can play around so that you'll hear the range of the voices of the people
who are near you, with less background noise.

Even so, just a couple years before he was told he was not a good candidate
for hearing aids because of the particular quality of his hearing loss. Not
only could he not hear, he couldn't make out specific syllables.

While he says the aids are a big improvement and have made some social
things more possible again, they aren't perfect. But we've been given
homework that we haven't done very well at completing. I am supposed to read
to him, for example. And that will give him something to focus on and he can
practice making out all the elements of words again.

Because a big part of his hearing loss included tinnitus, he has spent a lot
of the last few years trying to ignore everything he heard, because it
included a lot of annoying sounds. So, now that he can hear stuff again, he
needs to relearn how to sort out which are the important sounds.

(Being unable to do this is one of the issues with cochlear implants in
young people or people who have never had close to normal hearing. They
haven't lived their life sorting out voices from a truck going by and the
wind in the trees.)

I was surprised that someone who had pretty good hearing for most of his
life could lose this ability, but it can happen.
  

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