Aging

My treating older people have been dotted with experiences of ageism which, years later, will recount to me something I regret. So common is ageism, and so natural is it to those of us who have received little training in geriatrics, that functional decline becomes the sine qua non of old age.  

Recently, I read about the origin of the term "ageism," coined in 1968 by an American gerontologist Dr. Robert Butler. Known for his decades-long passion to challenge the deep-seated age-based discrimination in healthcare, Butler called for sweeping policy reforms when older patients were often neglected and simply shrugged off. 

We've all been there. I've lost track of the number of times I said something like "You know that she's very old. She can't tolerate more treatment. You are asking too much. She will soon be no more."

I have learned more about special needs of old people by looking after my dad than any lecture in geriatrics medicine. It's challenging, but I must agree with Butler that many of the ailments of the old are possibly preventable, probably rewardable, and most certainly treatable.

Pineapple

We tend to look inside of ourselves to explain the norms and outside of ourselves to call something deviant.

The debut novel of Jenny Jackson, Pineapple Street, is a good example of such conflict. Think about the chaos when a middle-class New England girl married into a family of much higher social class. Characters in the novel are our witnesses to opposite values. Millennials, who only bought things from Instagram ads, stand in contrast to Generation X who still sift through catalogs from mailbox. Daughters who prefer texting to talking on the phone are decidedly different from their mum who pronounced wi-fi as "whiffy."

The difference between apple and orange, when we come to think about it, can be up to our interpretation. All we need to remember is never compare one with another. Apple is apple. Orange is orange. Pineapple isn't apple, either. 

Back on Feet

Wealth or health (or lack thereof) is the catalyst for tension in almost everyone – though we can often decide which of them is the priority.

My dad has suffered from a stroke and repeated falls recently. Is that an high stakes situation? Absolutely. After everything that had happened last week, and pondering everything that could happen later, our family found comfort in tackling the mess one by one. 

It's like the tangles in our hair. We can't settle unless we start from the bottom and gently work our way up. We must take our time and can't tug or pull.

Be a patient, and be patient.

Medication

In September 2015, a drug company's CEO Martin Shkreli ordered a price hike of pyrimethamine from 13.5 to 750 dollars per pill, after his purchasing exclusive rights to distribution.

Pyrimethamine is a medicine to treat life-threatening parasitic infection in disadvantaged AIDS patients. The reason for lofty profits from jacking up the price is nothing other than greed. There were no development costs because this drug has existed for over 60 years. To prohibit manufacturers from "price gouging" on essential off-patent or generic drugs, the court had ordered Shkreli to repay the profits, and  barred him from the industry for life.

I didn't know this shameful story until my friend recommended me Elisabeth Rosenthal's book An American Sickness. I couldn't agree more with Elisabeth Rosenthal that doctors in training are generally taught little to nothing about the cost of medicine. We have been taught how to prescribe medicine, but knew little about the market. 

Neither doctors nor patients could have heard the story how a drug company intentionally moved its acne medicine from one form to another three times in order to keep its costly brand-name drug status. We knew nothing about the tactic of developing a "new" version (that could be chewed, or broken up and sprinkled on applesauce) to eke out time with patent protection. We didn't know that drugmakers can gain extra months of protection by filing a lawsuit to stymie or delay the launch of a generic.

Now I know.

Lie

You know the feeling: you have a hard time recalling the name of someone you know – in many case, an old acquaintance.

You appear to have recalled someone's face or voice, but not the name. You have to admit having a lousy retrieval system for name. The older you grow, the worse the system will be.

One way to train myself is reading novels with more characters. I don't know your manageable number of characters without the need of a cast spreadsheet. I recently read a novel, First Lie Wins, in which the central character operates under multiple aliases. That gives me the challenging experience of not mixing up Lucca Marino, Evie Porter, Izzy Williams, Regina Hale, Wendy Wallace, and Mia Bianchi. Those are simply different names of one protagonist. 

If I wish to tell you a lie, I would pretend that I didn't get confused with these names.

Muscle

If you have been told about your age-related muscle mass loss, join the club. 

About half of adults older than 80, like my parents, are having sarcopenia or low relative muscle mass, often defined as skeletal muscle mass being two standard deviations below the mean of a young reference group.

I must admit that I don't visit my parents frequently enough. I hardly ever, if ever, look into the fridge of them. We checked today upon visiting them. I saw an empty freezer and plenty of space after opening the lower door. My wife leaned over and shook her head. Chances are high that my parents aren't taking enough proteins. We don't even need to check with a dietitian. 

Before teaching them squat exercise or body resistance training, we knew the quickest way to reverse the downhill sarcopenia course is to fill up their fridge and stomach. Our home visit then turned into a grocery errand. A fulfilling one.

Technology

In November 2022, the release of ChatGPT became a viral hit within two months. By then, the milestone of reaching 100 million daily active users (within two months, let me repeat here) was a testament not only to the explosion of artificial intelligence, but also to a new era of technology. This year, a powerful model DeepSeek emerged in China and shunned the world.  

Fifty years ago few of us were familiar with VCR, let alone computers. Now that we get problem comprehending TYVM and ICYMI texts from our children, we will get further behind if we don't prepare ourselves with mainstream real-world AI skills.

To get myself less outdated, I borrowed the book Teaching with AI written by two educators, José Antonio Bowen and C. Edward Watson. They cautioned that AI will eliminate some jobs, but it is going to change every job: those who can work with AI will replace those who can't. Rather than banning AI, they clarified the need for teachers to help students move above and beyond what AI produced for them. A few good examples of writing assignments would be asking students to grade a paper produced by AI, and to write a better paper or improve the AI-generated essay (and include tracked changes and comments).

Another way of understanding the new changes is to look at the history of calculators. Think about the days when we were busy with learning multiplication tables, doing long division, or adding long columns of numbers. Then came the technology of calculators. The calculator did not really eliminate the need for human math, but changed which math skills we needed. By the same token, AI won't eliminate the need to write well and with ease, clarity and voice. Trust me, never ask AI to write your wedding vow, or your Valentine's Day love letter.