Healthcare and You
by Marvin Ackerman, MD
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Respect for the Elderly: A Tradition of the Past Gets New Fuel for Thought
If it could happen in China, I suppose it could happen anywhere. These days old folks don't have much of a chance any longer. Today's culture exhorts youth and denigrates the aged. The elderly are mugged, robbed, scammed, derided, refused work or retired and replaced by younger employees, made to pay exorbitant premiums for insurance policies, and have become the target of tyrannical dictator vindictiveness, as we are all well aware, in the not too distant past. The conclusions of an article in the Archives of Internal Medicine for January 28, 2002 may be pushing the envelope just a bit further. One doctor from the Stanford Sleep Epidemiology Research Center, and one from the Laboratoire d'Exploration Fonctionelle in Paris coordinated their efforts to produce a paper called "Daytime Sleepiness and Cognitive Impairment in the Elderly Population." Their conclusion: "A complaint of excessive daytime sleepiness is an important risk factor for cognitive impairment." In other words, if an old person sleeps too much during the day then look out, maybe there's something wrong with the way that they think or learn about things. Before you older readers jump to any vehement conclusions of your own about all of this, why don't we look into the manner in which this study was run, and then see if we can reach some of our own "more mature" conclusions.
Elderly in this paper was defined as anyone over 60 years of age. This is already a point of controversy. All individuals who were screened live in the metropolitan area of Paris, which is indeed a rather strong limiting factor, bound to raise objections about the ability of results to be extrapolated to the rest of the world population. After locating 1269 households having at least 1 resident 60 years or older by calling 11,650 telephone numbers, the interviewers were able to pin down 1026 old folks who were willing to cooperate. It's hard to say whether being willing to cooperate means that the individual is too gullible or too spaced out to know any better, or on the other hand, is more likely to possess better cognitive capabilities. They did attempt to rule out such things as illness, deafness, speech impairment, and poor French. I wonder though, how they were able to rule out unwillingness to admit illness, and mild or moderate deafness, perhaps even unknown to the interviewee, which rendered that individual unable to properly comprehend a question. As a matter of fact, I'm not so sure about the interviewers themselves. They were all university students with no experience in psychiatric assessment. True, they were trained to use the Sleep-EVAL system used in the study and were monitored daily by one supervisor. However, I think I would have preferred the interviewers to be fully experienced and much closer in age to the "elderly" study population.
Although I am certainly no psychiatric assessor myself, I did go over the rather involved concepts employed in the Sleep-EVAL system and found them to be rather inclusive. We will have to assume that better-informed "cognition" was the basis for developing this protocol. The authors also defend their use of the telephone by stating, "the literature suggests that telephone interviews in general are appropriate and yield results comparable to those of other strategies." They did, however, acknowledge the fact that the most impaired individuals, and those with speech or hearing defects were not reached. They further admit, "that we did not have objective data on cognitive difficulties and daytime sleepiness." There's a great deal more to be considered here but I'm certain that by now you have the idea. Overall, I must admit that the investigators made a Herculean attempt to do the thing the right way. I'm just not so sure that there really is a "right way."
Now that a study has been done to see whether old people, with little else to do but sleep during the day because they can't find work or anything else interesting to do, develop cognitive deficiencies, perhaps we should apply the same sort of approach to evaluate the cognitive capabilities of young people trapped in today's morass of mounting pressures and rapidly moving changes in environmental living. I must presume that if you have actually reached this part of my treatise then you more than likely belong to that small fraction of society, which has not been affected by its excesses.
Where did I go wrong?
Somehow I seem to have gotten old.
How come I never noticed?
I admit though, I'm always cold.
When did the steps get so high?
The house doesn't look any taller.
How come my wife rarely answers?
No matter how often I call her.
So what if I sleep after lunch.
After all I'm awake all night long.
So what if I've forgotten your name.
I can still sing that "old time song."
Don't count me out just yet.
There must be some life in these bones.
Just remember who put you through school,
And I haven't forgotten those loans.
Copyright © Marvin Ackerman, M.D.
Copyright © Marvin Ackerman, M.D.
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Copyright © 2005 by Marvin Ackerman, M.D.