Vanity of Age: The "Meno-Belly"

Tripe (stomach). Istanbul market, Turkey. July 2012. Credit: Mzuriana.

This "meno-belly" (aka "meno-pot") business has only just come to my attention. 

When I arrived at my healthy body weight (overall, a 150-pound weight loss over the course of some years), I had what they call an "apron," which is loose skin that hangs down a bit from the abdomen. 

But more recently, I have acquired the proverbial spare tire around my middle. "Recently" meaning: In the last two years, maybe a bit longer. 

I blamed it on these two things, in chronological order: 

1. Moved from a dance-intensive area to an area where there is not much of a dance community, so I lost that good workout; and
2. COVID, of course 

I had gotten a little loosey-goosey on my caloric intake, too, not much, but over time, enough sloppiness to spill over into some weight gain. 

So I've tightened up the daily caloric envelope to see what happens. 

You'd think an esteemed institution such as the Cleveland Clinic would have something insightful to offer here, but it doesn't. Just the usual stuff: Weight, exercise, diet, blah, blah, blah. I can get that in a so-called "women's" magazine. Or The Enquirer. The Mayo Clinic isn't much better. 

However, there is a possible tiny hint of what might have contributed to my meno-belly - which by the way - did not emerge until well after I'd passed through menopause: 

1. A reference to sleep apnea in the Cleveland Clinic's article; and
2. A reference to breathing problems in the Mayo Clinic's article. 

Because "breathing problems" are a function of sleep apnea, it's possible that as the treatment of my sleep apnea progresses, my meno-belly might contract. 

I wonder about this possibility because I noticed a change in my sleep patterns after I moved to Tucson. And it was during my Tucson sojourn that I began to notice the belly change. 

We'll see. 

Lessons From My Elders: New & Improved Is Not Always Better

Cars on a table. Missouri. January 2006. Credit: Mzuriana.

 

My mother bought a new car when she was in her mid-80s. 

Her old car didn't have a back-up camera.

It made sense for her to buy a car with a back-up camera, yes? Safer for her! Safer for the people around her when she backed up! Right? 

Well, maybe not.

A back-up camera can make backing out of a space more treacherous unless you master the new quirks the camera requires of the driver. While you're looking down and to the right at the back-up video screen on or below your dashboard, you are not looking at what's coming at you just out of view of the back-up camera:

• A shopper who is about to walk directly behind you
• A car in the parking lot lane approaching your egress path. 

We've still got to look up and into our rearview mirror, over our shoulders to the rear, over to the right to the passenger side mirror, over to the left at our side mirror, turning to look in the rear window. All of these movements we are accustomed to do. 

Adding a new visual point to see what's in the camera screen in front of us - adds a complication in both the passage of chronological time and mental processing time.  

The lesson for me, as I peer into my aging future, is this: Sure, try the new thing out before I get rid of my old thing. Maybe newer will be better, but maybe the ease and comfort of the old will actually be safer, or if safety isn't a factor, maybe more satisfying. 

Lessons From My Elders: Exercise Bands

 

Resistance bands. Credit: Mzuriana.

When my mother, "Joanne," was in her late 80s, there was a day when she had what I can only call a system crash. Joanne acquired some sort of infection that, like a malware program, brought her down both physically and cognitively. It was scary, and after doing some hospital time, she passed additional time in a rehab center. 

It's my mother's experience at the rehab center that taught me two lessons that I have onboarded for myself: 

1. Get a set of stretchy exercise bands for strength-building at home, the same bands that the rehab center's physical therapist had Joanne use
2. Actually use them

I did buy a set of bands.

I do actually use them. Almost every day. 

I can get some benefits of a gym without having to go to a gym. The bands are inexpensive and they take up virtually no space. 

I can build and maintain strength and muscle. I'm going to need both as I continue to grow old. 

Literature: The Fountain of Age

 

"Half old chicken" at Asian market. Toronto, Canada. June 2016. Credit: Mzuriana.

Betty Friedan is best known for The Feminine Mystique (1963), published when she was 42 years old.

Three decades later, at age 72, she birthed another pivotal book: The Fountain of Age. She proposed that we replace the view of aging as a process of decline with a view that aging "opens the way to a further dimension of 'personhood.'" 

p. 20

"In the months that followed my sixtieth birthday, I grimly forced myself to study age, head on. .... I took a fellowship at Harvard ... I would immerse myself in state-of-the-aging art: medical, clinical, physiological, psychological, social policy. .... 

"Looking around the paneled room at my first Harvard meeting on 'Ethical Issues in the Care of the Aged,' I realized that, aside from my own, there was only one white head of hair. It belonged to a man who was a pioneer in the study of age and was about to retire (it seemed gerontologists must also retire at age sixty-five). These bright young turks of the new aging field were mostly men who maybe started out in psychiatry, doing post-docs in 'geropsychiatry' ..., and a few women staking out new turf as legal-medical 'ethicists.'" ....

 

"I grimly forced myself to study age, head on ..." 

Well, I feel neither grim nor forced, but otherwise, I'm with Betty on an exploration of the Land of Age. 

It's my big new country of residence, after all, and I want to see what's what. 

On Mortality: The Trench

 

In the Trenches, World War I Museum. Kansas City, Missouri. January 2010. Credit: Mzuriana. 

My mortality. 

I've been thinking of this, of late. 

Neal Stephenson, in Fall (or Dodge in Hell), described the process of such thoughts for some of us.  

"He saw life as a trench in the First World War sense of that term, dug very deep at one end but becoming more shallow as you marched along, gradually ramping up to surface level. 

Early in your life you were so deep down in it that you didn't even know that shells were bursting and bullets zipping over its top. 

As time went on these became noticeable but not directly relevant. 

At a certain point you began to see people around you getting injured or even killed by stray bits of shrapnel, but even if they were good friends of yours, you knew, in your grief and shock, that they were statistical aberrations. 

The more you kept marching, however, the more difficult it became to ignore the fact that you were drawing closer to the surface. 

People in front of you died singly, then in clusters, then in swathes. 

Eventually, when you were something like a hundred years old, you emerged from the trench onto open ground, where your life span was measured in minutes. 

Richard still had decades to go before it was like that, but he'd seen a few people around him buy the farm, and looking up that trench he could see in the great distance - but still close enough to see it - the brink above which the bullets flew in blazing streams. 

Or maybe it was just the music in his headphones making him think thus."

With both of my parents now dead, I'm at the head of the line. A sobering thought. 

Until very recently, my goal was simply to enjoy a good quality of life for as long as possible, and as independently as possible, without placing an unrealistic burden on my descendants. 

But a few days ago, I thought to put a number on it. 

If I look at the longevity of both my maternal and paternal parents, grandparents, and blood-related aunts and uncles - plus my generation's better nutrition, access to health care, advances in health treatments, etc. - I had a vague assumption that my early 90s would not be unrealistic. 

Some of that is magical thinking, to some extent, because my father died in his mid-70s and his mother died in her 50s. 

I thought to put a number on it because I wondered: How many years do I have left, really? 

And if I put a number on how many years I have left, how will that guide my allocation of time and other resources to: 

• Achievements I still want to accomplish? 
• Experiences I want to have? 
• Relationships I want to nurture?
• Relationships I need to let go?
• New relationships I want to find? 
• For my descendants, leave a legacy of love, a current and past family history, connectedness, memories, and investments in their and their descendants' futures, whether tangible or intangible. 

So I've applied the WAG method to come up with a concrete number for myself. 

86 

So if I make that 20 years from today, that's June 13, 2042. 

42. 

 Oh my gosh. 

42. 

The answer to the question in Hitchhiker's Guide to the Galaxy: 

What is the meaning of life? 

42. 

It is poetic. 

Inshallah. 

Elder Barriers: Non-Adherence vs. Non-Compliance

 

User-friendly toilet instructions. Antigua, Guatemala. April 2016. Photo credit: Mzuriana.

Definitions: Adherence versus compliance

From a 2019 article in Medscape: 

"Noncompliance Versus Nonadherence

".... there is a difference between the two terms. ....

"Generally, 'noncompliance' describes patients who deliberately refuse to follow a treatment plan.

"'Nonadherence' is the behavior in which a patient unintentionally fails to follow a plan.

"Although the resulting behavior might be the same (e.g., unfilled prescriptions, missed appointments), the causes can be very different.

A noncompliant patient could ignore a plan for several reasons, whereas a nonadherent patient might intend to follow physician orders, but be unable to do so. ..."

It is self-serving for providers to default to patient "noncompliance"

It's expedient for healthcare suppliers and insurers** to blame their patients or end users for not following their prescriptions/instructions for:

• Medication 
• Equipment 
• Exercise routines
• Diet

**Includes researchers, pharma/device developers and designers, process developers and technical writers, administrative and regulatory bodies that oversee approval of products, those who prescribe the meds, equipment, processes, etc. - In short, every entity in the chain that leads to the end user. 

In the case of Medicare, patients are financially penalized for not following instructions for things such as CPAP machines and their accoutrement, as Medicare will not pay for the equipment cost unless there is documentation showing the patient is using same. 

On the surface, Medicare's punishment follows a logical "if this, then that" algorithm. 

But the blame-the-patient model ignores certain realities of working with a cohort of patients who are in the Third or Fourth Ages. 

As groups, each of these two Ages is much more likely to live with a constellation of common compliance barriers, including those related to memory or cognition, than patients who are under age 65. 

So, for the nonadherence definition, I would change it thusly: 

"Nonadherence is the behavior in which a patient unintentionally fails to follow a plan or is unable to consistently follow a plan because adherence requires a certain level of:

1. Visual acuity (e.g. to read instructions, liquid measurement levels); 
2. Motor strength (e.g. to handle or carry DME or the parts thereof); 
3. Finger and hand dexterity (e.g. to apply eye drops, open latches and lids); 
4. Time management or impulse control (e.g. to prioritize the timing of doses over the calls of hunger/thirst, such as for meds that must be taken 30 minutes before or after eating);  
5. Financial resources to implement the plan; or
6. The ease and speed with which they can access technical support to answer questions or troubleshoot problems ... 

.... you get the idea. 

Some thoughts on adherence and compliance in these articles: 

• 2018: Medication Adherence: The Elephant in the Room (Source: US Pharmacist)
• Circa 2014 or later: Understanding Factors Influencing Patient Compliance (Source: Care Excellence Management)

But even these articles focus almost all of their attention on how to influence the user. 

It is time for the healthcare suppliers and insurers to feel the spotlight's heat

There seems to be scant attention on those who: 

1. Develop the products, 
2. Design the products and their packaging, 
3. Develop the usage protocols and treatment processes, etc. 

If low adherence to a treatment is common, then a spotlight should shine on the provider (developer, designer, manufacturer, supplier or prescriber) first, and not the patient. 

Note: By "products," I mean: 

• Equipment
• Medications and delivery methods of same (e.g. eye drops, ointments, special timing of medication consumption)
• Prescribed actions, such as exercises designed for strength-building, range of motion, motor skills, etc. 

The USAID story

The focus on the end users instead of the product providers (et al) reminds me of a story that an Ethiopian university instructor told me in the mid-80s:  

In Ethiopia, as land was handed down to sons by their fathers, their descendants - subsistence farmers - owned smaller and smaller pieces of land as it was divvied up with their brothers. The plots of land were becoming too small to support cattle, the traditional livestock of choice. 

Some smart people from the US, perhaps with USAID, had a great idea: 

Encourage the subsistence farmers to switch from cows to goats. The goats provide meat and milk like cows, but take up less space and consume fewer resources.

Upon hearing this story, I said, "Hey, that is a great idea. Creative!"

The Ethiopian professor said: 

"No, it's forcing the farmers to do all the changing. 

The oligarchy doesn't have to change anything. 

They keep their wealth and vast properties. 

What needs to happen is land reform."

What needs to happen is ..... 

.... pressure to remove adherence barriers at the front- and back-ends instead of more pressure at the user end. 

 

User-friendly toilet instructions. Antigua, Guatemala. April 2016. Photo credit: Mzuriana.

 

Elder Barriers: UI and UX Generalized

Red berries in winter. December 2006. Credit: Mzuriana.

Heheheheheh, "elder barriers" ......... "elderberries."  I like that. 

Perhaps I will some day self-identify as an "elderberry." Hopefully, that's not too close to dingleberry. 

But I digress. 

What are UI and UX? 

UI and UX refer to the "look and feel" of a website, application, or device (such as a cell phone, tablet, or laptop) for the person who uses it. 

UI = User Interface. UI refers to the:

1. Buttons,
2. Toggles,
3. Icons, and other visual elements 
4. That you interact with when using a website, app, or other electronic device.

UX = User eXperience. UX refers to the entire interaction you have with a product, including how you feel about the interaction.

UI and UX generalized

We can apply the terms UI and UX to almost everything around us. 

About UI: 

• Is a store or community center or park or health care facility visually appealing? Does it draw me in or does it repel me? Does it create a vibe? Does the design give me information about its target users? 
• Does the appearance or presentation of a product or service seem friendly to use or does it seem daunting to use? 
• Is there good signage that tells me where to go and where I am? 

About UX: 

Is it relatively simple to access the facility, product, or service? Can I afford it? If there are barriers, are they relatively easy to work around? Is there help available when I experience problems? 

UI and UX and elders

As I age, my abilities will change. I'll be somewhere on a spectrum of typical changes in:

1. Abilities, 
2. Disabilities, and perhaps
3. Inabilities

I want products and services and processes with a UI and a UX that respect the most common ability changes that occur as we age. 

The Americans with Disabilities Act (ADA) and its associated entities (Department of Justice, Access Board, ADA Network) already have laws, regs, guides, technical support, training, and enforcement remedies in place to ensure access to products and services provided by: 

• Health care providers
• Health care facilities
• Assisted living, rehab, and skilled nursing care facilities
• Website designers
• Software applications
• Durable medical equipment operations, cleaning, and maintenance
• Drug packaging designers
• Pharmaceutical delivery systems (times of day, frequency, before/during/after eating)
• Eye drops
• Cell phone designers

There's also the World Wide Web Consortium (W3C) Web Accessibility Initiative (WAI) - with accessibility standards since 2000. It's now in its 3rd draft. 

But the execution of all of these wonderful UI and UX measures? 

Not so great, I'm thinking. 

In the meantime, I need to check my own website for accessibility. 

My Inspirations: Long Journeys

 

Old Mines Trail, Big Bend National Park, Texas. September 2017. Credit: Mzuriana.

In addition to saving the world (ahem), I've dreamed all my life of taking a long trek. Usually by hiking. Well, walking. There was a time when I devised a plan to walk from the Arctic Circle to the southernmost tip of Tierra del Fuego, in Chile, when I turned 50.  That plan evaporated when I read the story of the hiker who, unbeknownst to him, had a bear tracking behind him. A driver who passed by alerted the hiker. 

Ernie Andrus is the oldest person to have run across America. It took him three years. He was age 90 at the start and 93 at the finish. 

Nimblewill Nomad,' 83, is the oldest to hike the Appalachian Trail

Nan Resinger is the oldest woman to hike the Appalachian Trail, doing so at age 74. And, hey, her hike partner, also a woman, was no yowwen at age 67. 

Emma Gatewood, at age 67, was the first woman ever to complete the entire Appalachian Trail alone in one season (and this was back in 1955). (Do note that her trail name was Grandma Gatewood, tying her to her uterus, versus the character-rich trail name of "Nimblewill Nomad" in a link above. 

From the Amazon page of the book, Grandma Gatewood's Walk: The Inspiring Story of the Woman Who Saved the Appalachian Trail: 

"[Emma] Gatewood not only hiked the trail alone, she was the first person—man or woman—to walk it twice and three times. At age seventy-one, she hiked the 2,000-mile Oregon Trail."

 80-year-old Yuichiro Miura claims new Everest record. Mr. Miura is also the oldest person to ski (and, er, tumble part of the way) down Mount Everest - at age 70. There's even a movie about his descent: The Man Who Skied Down Everest: 

Note: "[S]ix Sherpa members were killed during the expedition, as well as a Japanese member who died of a heart attack." Source: Wikipedia  What is recreation for a few is a means to support one's families for others.