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RWJ: Aging Healthfully

A geriatrician explains the importance of care geared towards older patients
Geriatrician Sara Ali, MD.

About 15 percent of Americans are currently age 65 and older, according to the U.S. Census. By 2060, that number is expected to jump to about 25 percent. So there’s a pressing need for geriatricians — physicians who care for older adults. Here, Sara I. Ali, MD, a geriatrician at Robert Wood Johnson University Hospital (RWJUH) Hamilton, explains how patients benefit from these physicians.

How are geriatricians different from primary care physicians?

We treat chronic conditions that affect patients of all ages, such as high blood pressure, heart disease, and diabetes. But we also treat health problems that tend to affect the elderly, including dementia, movement disorders like Parkinson’s disease, and frequent falls. We spend more time with patients during office visits than primary care physicians are able to — 30 to 45 minutes instead of 15 minutes.

What health problems do you see most often in older patients?

“Polypharmacy” is a huge problem. This occurs when patients are prescribed too many medications by different doctors. Not only can this cause drug interactions, which can lead to side effects like falls and confusion, but patients become frustrated and sometimes want to stop taking their medications. I help them understand which medications are most important and which ones they can stop. Other common conditions include memory problems, mood disorders like depression — which, in a geriatric population, often stems from a lack of socialization — and frailty.

How do geriatricians fit in with the hospital’s Better Health program?

Better Health, which provides education, social activities, support groups, exercise classes and membership benefits for those ages 55 and older, is part of a larger initiative to build a comprehensive geriatrics program to improve seniors’ quality of life. Better Health is part of our outpatient geriatrics practice. Health coaches educate patients about their screening and treatment options through lectures and seminars.

Join Better health and discover the benefits of membership. Call 609-584-5900 or visit www.rwjbh.org/hamiltonbetterhealth.

Off the Presses: Hal Foster’s ‘Brutal Aesthetics’

Hal Foster

Art critic and Princeton University professor of art and archaeology Hal Foster says his new book “Brutal Aesthetics” — the subject of a Wednesday, December 2, Labyrinth Books in Princeton live stream — was “born of my puzzling over” a paradoxical statement by 20th-century German cultural critic Walter Benjamin: modernism teaches us “how to survive civilization if need be.”

Calling it a riddle that its originator hadn’t really explained, Foster says the “reference of ‘civilization’ seems clear enough; it is the travesty of civilization authored by Fascism and Nazism, civilization turned into its opposite. This is the barbarism, exploited by the dictators that rose in the ruins of World War I, that Benjamin hopes, in a desperate dialect, to counter.”

Foster continues exploring Benjamin’s thoughts and barbarism as a means to reveal his thematic compass with the question, “Yet what kind of modernism teaches us to survive a civilization (that becomes) barbaric, and what sort of survival could this be?”

Part of the answer is in Benjamin’s unsentimental outlook that “rejects the traditional, solemn, noble image of man” and looks at “the naked man of the contemporary world who lies screaming like a newborn babe in the dirty diapers of the present” and the his Marx-influenced idea of creating new artistic language “In the service of struggle or work — at any rate of changing reality instead of describing it.”

Foster argues that the barbarism that Benjamin thought reached its apex in World War I was only a prelude of the barbarism to come — “the mass deaths of World War II, the Holocaust, and the hydrogen bomb. Only then did the positive barbarism that Benjamin glimpsed in modernist art, architecture, and literature become necessity. Only then were artists and writers truly forced ‘to start from scratch, to make a new star, to make a little go a long way,” as Benjamin had written.

Foster focuses his exploration when he says he then became concerned “with the turn, from the mid-1940s through the mid-1960s, to the brut and the brutalist, the animal and creaturely, as manifested in the world of the Frenchmen (painter and sculptor) Jean Dubuffet and (philosopher) Georges Bataille, the Dane (painter) Asger Jorn, the Italian-Scot (sculptor) Eduardo Paolozzi, and the Swedish-American (sculptor) Claes Oldenburg. Each of these figures proposed a different version of brutal aesthetics, one that pares art down or reveals it to be already bare, so that they might begin again after the compound devastation of the time.”

Then with the following series of rhetorical questions he guides the reader into a thicket of aesthetic and academic wonderings: “Why does Dubuffet invent the category of art brut? What does Bataille seek in the cave paintings of Lascaux? Why does Jorn populate his (arts group) Cobra canvases with denatured figures? What does Paolozzi see in his monstrous assemblages of industrial debris? And why does Oldenburg remake cheap products from urban scrap?”

The Princeton University Press-published “Brutal Aesthetics” — like his other dozen books written or edited by him — is connected to what Foster reveals was his first aesthetic experience, described during an Interview Magazine interview:

“My first art epiphany is more like a primal scene because it has a traumatic touch and because it’s a memory that mixes real and fictional bits. I was 12, and in the living room of an inseparable friend. Vast and uninhabited, it was composed like a picture in a magazine, appointed with furniture unlike any I had ever seen: elegant structures of aluminum tubes, glass tables so sheer they seemed to disappear. There were also objects that were not furnishings, which I understood to be sculptures, though they were not statues or busts. My friend called them abstract, which made the paintings on the walls, no less difficult to make out, abstract too. One painting in particular struck me; it was the most beautiful thing I had ever seen. A stack of hazy color in irregular blocks of paint, it was a bright apparition. At the top is a rectangle of white tinged with blue, a projection of pure light, and at the bottom, a bigger block of the same colors but in a different mix, like a midday sky shrouded with thin cloud. Below the white box on top is a yellow band almost covered by a red stripe, and below it is a final rectangle of cream, here underlined by streaks of all the colors that appear elsewhere on the canvas-blue, white, yellow, red. The painting is fire and ice at once, both calm and intense, and this is how it made me feel, too. About the size of a mirror or a window, it does not reflect anything or reveal any outside. It is its own appearance and perfect as such. “Yes, it’s the most beautiful thing,” I thought, and a second later, “Why do they have it and we don’t?” The first flush of delight made me a devotee of art; the second rush of resentment made me a critic. Every critic needs a touch of resentment — it’s his very salt — but too much produces embitterment.”

In the same interview he revealed his thoughts about writing about art. “I don’t write to be pejorative or positive in any case; that never motivates me. What gets me going is to grasp the new thing — an idea, an affect, some mix of the two — that a work expresses but doesn’t articulate. That’s the service I want to render: to limn that thing in words. I don’t worry much about market valorization.”

However, he says, he is prone to make mistakes. “Along with many others, I ate up theory like it was hash brownies, and I still do, but I’m more careful about what I write when I’m theoretically high. Also, when I was a young critic, I printed some hurtful things . . . I thought it was clever; he thought it was cruel, and later told me it had devastated him. Even if it is true, a line that cuts someone seems gratuitous to me, and I’m certain there are many others who were victims of my mistaking the rhetorical for the critical.”

Saying that he has a “trace of Romantic anti-capitalism” in him, he then puts himself in the context by saying he emerged “as a critic in the 1980s, with Reagan, deregulation, the sheer awfulness of what we now call neoliberalism. Wall Street money suddenly washed over the art world, which was changed utterly, and independent space for critical work shrunk dramatically. I was an editor at Art in America at the time, and the market reformatted everything before our eyes. I ran to the academy as if it were a sanctuary, which it was — there was a short period when the humanities were taken by critical theory. But I soon discovered you’re as much a commodity there as anywhere else. The university does screen you from power, however; my own is bound up with governments and corporations in ways both good and bad, but it affects me little either way. The art world is far more naked in its involvement with power. At dinners after openings I sometimes feel like I’m watching bank accounts have sex. But I’m a very small chip in the casino that is the art world.”

Hal Foster: “Brutal Aesthetics,” Labyrinth Books. Wednesday, December 2, 6 p.m. Discussion about the book between Foster and Yves-Alain Bois, professor of art history at the School of Historical Studies at the Institute for Advanced Study in Princeton. Register. Free. www.labyrinthbooks.com.

Looking Out for Grandma & Grandpa

Families and caregivers have spent much of 2020 rightfully concerned about preventing older, higher risk family members from contracting COVID-19, but the social distancing and other safety measures required to keep grandma safe are necessarily isolating and can lead to a decline in mental and physical health.

Parker Adult Day Center, a Middlesex County-based provider of aging services including nursing care, assisted living, memory care, and post-acute rehabilitation, offers a list of eight warning signs to look out for when interacting with elderly relatives this holiday season. They can be indicators of declines in physical and/or mental health.

1. Inability to maintain physical appearances.

You may not think twice about a stain on grandma’s favorite holiday sweater, but it could indicate that there’s a larger issue.

“Often, it’s an indicator that they’re no longer able to maintain their physical appearance,” said Samara Elias, a social worker for Parker Adult Day Center. “They may be struggling to do the laundry or maintain good personal hygiene.

2. Weight loss or weight gain.

Elders can have a well-stocked refrigerator and pantry, but they might not remember to regularly eat their meals. Or, at the other end of the spectrum, they may not recall eating a short while ago and then have another lunch.

“I think it’s probably more common that someone would notice weight loss,” Elias said. “But certainly, if somebody is having some cognitive changes and they don’t remember that they’ve eaten a meal, they could make themselves another one. As people start to have challenges, they gravitate toward the things that they know they can do. They might think I don’t remember if I ate, but it seems like maybe it is time to,’ and so they make another meal.

3. Changes in mood or behavior.

“Look for an unpleasant change in their mood,” Elias said. “If you notice that your loved one is depressed it may be time to speak with their doctor.”

This is a tricky one to spot because these changes can be triggered by something as common as a change in the weather or someone experiencing pain or discomfort. But it could also indicate declining mental health.

4. Unpaid bills.

If last September’s credit card bill is sitting under a stack of mail or if the check for the electric bill was mailed to the cable company, they could be warning signs that someone is struggling with executive functioning.

“It’s an early indication that they’re having a harder time managing everything,” Elias explained. “Maybe they can no longer do such tasks as writing a check or balancing a checkbook. They will need help.”

5. Messy house.

Take a look around their home. If it’s uncharacteristically disorganized with clothes strewn on the bedroom floor or dirty dishes left on the table or outdated food in the refrigerator, those are signs of concern.

6. Damage to the car.

The body of your loved one’s vehicle can tell a story. If there are scrapes, scratches and dents that you haven’t noticed before, it may be time to make the difficult decision to take the keys.

Age-related changes can affect memory and decision-making processes, the ability to see and hear, reaction times and other skills and abilities needed to safely operate a car.

If they are struggling to drive safely, it may indicate that other skills are deteriorating. So it’s something to be mindful of.”

7. Inability to manage their medications.

Americans ages 65 to 69 take an average of 15 different prescriptions per year, and those ages 80-84 take an average of 18, according to a recent study by the American Association of Consultant Pharmacists.

It could be a tall task for anyone to keep track of that many pills. It is important to double check that your family member is taking prescribed medications correctly.

“If it’s somebody who always had a pillbox to keep everything organized, and now there’s bottles around and they’re not using the pillbox, that could be a warning sign,” Elias said. “Or, check to see if they’re using expired medications.”

Not taking medication, or taking it incorrectly, can expedite the deterioration of the body and mind, which is why regular checks in the medicine cabinet are warranted.

8. Inability to follow conversations.

“Are they having a harder time following the dinner conversation?” Elias said. “Is this somebody who always used to be super involved and engaged in conversation and maybe they’re taking a little bit more of a backseat? Are they asking repetitive questions and can’t seem to follow the string of the conversation or hold on to information from the beginning to the end?”

The inability to follow a conversation from beginning to end could indicate a number of issues.

CareOne Assisted Living at Hamilton

CareOne at Hamilton’s assisted living facility.

Respite Services Benefit Both Caregivers And Their Loved Ones

Serving as a caregiver for a parent or loved one is often a full-time job. Many caregivers juggle a career, caring for their elderly loved one(s), and caring for their own children. This delicate balance can leave caregivers exhausted and with little or no time to themselves. The challenge numerous caregivers face is finding someone to handle their responsibilities so they can make themselves a priority. As a caregiver, taking time for yourself is extremely important. It enables you to recharge and provides you with the opportunity to focus on yourself.

CareOne’s respite programs are designed with the needs of caregivers and their loved ones in mind. Services allow caregivers the time to attend to personal needs while their loved ones receive high-quality, uninterrupted care in a warm and supportive environment. Respite care is also a good option for people who would like to explore long-term care services. Respite care is available for as little as one week or as long as one month.

Offering a full scope of care, respite services include:

• 24-hour nursing support

• Restaurant-style dining

• Recreation and activities

• Nutritional monitoring

• Medication management

• Assistance with personal care

• Transportation to and from personal appointments

• Spiritual services

• Social services support

• Special care for adults living with Alzheimer’s disease or other memory disorders

• End of life respite

For more information and/or to schedule a respite stay for your loved one, call CareOne at 609-586-4600.

CareOne Assisted Living at Hamilton, 1660 Whitehorse Hamilton Square Road, Hamilton. 609-586-4600. www.care-one.com/locations/careone-at-hamilton.

ARB Names New Artistic Director

Ethan Stiefel has been named ARB’s artistic director beginning in July, 2021.

American Repertory Ballet has announced that Ethan Stiefel will become its new artistic director beginning in July, 2021.

“This appointment marks a wonderful new era for our organization,” says Board Chair DonnaJean Fredeen. “We believe Ethan Stiefel’s unparalleled expertise and innovative vision will bring American Repertory Ballet into an exciting new chapter. We are delighted to welcome him, and look forward to supporting his leadership.”

Stiefel began his professional career at age 16 with the New York City Ballet where he quickly rose to the rank of principal dancer. He was also a Principal Dancer with Ballett Zürich and American Ballet Theater where, in July, 2012, he gave his final performance.

“I am very fortunate to again have the opportunity to become an artistic director,” Stiefel says. “I believe most arts organizations have taken stock during these times and are exploring ways to pioneer, diversify and reinvigorate how they approach their internal culture while seeking to offer current and relevant inspiration for communities and audiences. I am looking forward to helping American Repertory Ballet emerge from these challenging times and to being a part of developing the art form within the organization and the communities we serve.”

Stiefel served as artistic director of the Royal New Zealand for three years, which followed his position as dean of the School of Dance at the University of North Carolina School of the Arts. He is currently the principal guest instructor at American Ballet Theatre.

“We are beyond thrilled to have Ethan join our organization in this capacity,” says Julie Diana Hench, executive director of ARB. “His incredible breadth of experience and accomplishments, combined with his inspiring vision, generosity of spirit, creative talents, and professionalism, will shape the future of American Repertory Ballet and Princeton Ballet School. With Ethan at the helm, it feels like the possibilities are endless.”

More information: www.arballet.org.

 

How a Community Without Walls Was Built

Richard, left, and Vicky Bergman were inspired to start Community Without Walls after their end-of-life experience with Richard’s father.

Community Without Walls co-founder Vicky Bergman says one of the catalysts for the creation of the Princeton-based senior citizen support organization came when her husband’s parents’ golden years went dark.

“They were in their mid-80s, and his father had Parkinson’s and his mother was doing the best she could,” she says about husband Richard’s parents.

Then, when her father-in-law died, her husband’s mother announced she “was not going back to ‘that’ house” and moved in with them.

“We were in mid careers and had an active life,” says Bergman. “That was difficult because all she wanted to do was to sit in the living room and have Dick sit with her. We got someone to sit with her for four hours a day, but it didn’t work.

“What distressed us about Dick’s mother was she had no idea of what might happen or what she would do after her husband died.”

After researching and finding a retirement community for her, Bergman says, “We felt there had to be a better way to address aging.”

With a master’s in public administration from the University of Cincinnati and a career in government work — including serving as a White House Regulatory Council public affairs officer, New Jersey State Legislature budget and program analyst, Atlantic County health planner, and Princeton Township Planning Board member — Bergman was already primed for finding and accumulating information for decision making.

One activity she and her husband attended had an unexpected result. “The Omega Institute had a conference on aging. It was in New York, and there were sessions on housing, health, spirituality, social connections, and transportation.”

Also attending was Harriet Bogdonoff, a Princeton geriatric social worker the Bergmans knew and who showed an interest in the subject. The three decided to continue to discuss the topic and engaged retired Princeton Packet manager Roz Denard, who had recently experienced a situation with an elderly parent.

“We had a couple of meetings and decided that if we were interested others would be interested, too. So we went to our rolodexes and made a list of 80 names we thought would be interested in coming to talk about it. Everyone showed up, and we decided it was worth getting together to talk some more. After a few years we incorporated and applied for (nonprofit status) and kept having monthly meetings. We had over 100 people and talked about how what was missing was social support.

“Harriet said the greatest need was social connection. What happens if you spouse gets ill or your friends get ill or move away? So we decided to focus on social connections.”

She says the Community Without Walls name was selected because “it wasn’t for a senior center or retirement community.” It was for seniors living in their homes in a larger community.

The initial organizers also decided there should be two different types of meetings: informative and social. The former would include topics ranging from nutrition to sexuality. The other would engage and connect members.

Bergman says the “house” concept came from examining data. “I went into the sociological literature to find how large a group could be so there could be interaction. It was 125.”

Providing an example, Berman cites a company that once it hires 125 employees in one division begins a new division rather than expand.

She says CWW applied the practice early after a group of women with whom she interacted became interested and “asked if they could start another division. That took off. So we decided to name them houses” and use numbers.

Among the early challenges, Bergman says she asked herself, “How can this work with so many groups and people interested in different kind of things? You say, ‘We’re going to build a community’ and it sounds all touchy-feely. But people participated, and we found it worked.”

Bergman says she was surprised by “how many people were interested and wanted to be involved. At the height of our membership we had more than 400 members. It declined because all who started it are 20 years older. Some who started it were in their late 60s.”

The D&R Greenway’s Johnson Education Center is a frequent host of CWW events. Above, a gala celebration for members of House 4.

She says the reason is that the founders touched a universal nerve: “Everyone gets older. And with that comes uncertainty and challenges. Some retain their stamina, and some people lose pieces of memory. You don’t know how it will work or what hand you’re going to be dealt.”

With numbers and connections, CWW proactively began cultivating the community and in 1995 held two conferences. One was White House Mini Conference on housing needs, co-sponsored with the Princeton Senior Resource Center. The other was on issues related to growing older.

Still engaged with the company they founded, Project Masters, and active with area nonprofits, Bergman says, “A major lesson is that people don’t think about aging or about getting older. But when you do, you be proactive, decide what your aging is going to be like.

What CWW has done is to help people think about what life will be like in five or ten years: “What happens when my spouse dies? Where will I move?”

From discussions of health, housing, transportation, and social support, one of the things that came out was a need for support for people who wanted to age in their homes and not go to a retirement community.

“If you look at research, something like 80 percent of people wants to age in their homes. If the support exists, you can do that.”

In the aftermath of CWW’s 20th anniversary conference hosted by Princeton University, the group was able to see the creation of Secure@Home.

Part of the Jewish Family and Children Services, Secure@Home is a membership organization that connects aging homeowners to social workers and nurses to provide home and health support assessments.

Overall, Bergman says, despite an increase in services for seniors, “An important thing is people coming together to talk about how you, want to age, take charge of your aging, and choose how you want to age.”

Maplewood at Princeton

Staying Connected While Apart

Isolation and subsequent loneliness are not new concerns when it comes to seniors. However, social distance protocols put in place as a response to COVID-19 have many families growing even more concerned about their loved ones and looking for options to keep them happy, healthy, and safe.

Luckily, technology provides a positive solution to staying connected with loved ones while complying with social distancing guidelines. And a growing number of older adults are embracing it. Here are a few examples of how they are using technology to stay active and engaged:

Connecting with Friends and Family. A survey out of the University of Michigan reported that 59 percent of older adults use social media to connect with others at least once a week, while 31 percent use video conferencing platforms. Apps like FaceTime, WebEx, and Zoom are being used to host virtual cocktail parties, dinner gatherings, and book clubs.

Staying Active. Many older adults use exercise and physical activity as a way to connect with others and make new friends. YouTube offers virtual exercise classes like Pilates, dance classes, and chair yoga that can be done with a group, but from the comfort of your own home.

Lifelong Learning. Social connection can occur when people bond over similar interests. For those who like to learn, there are many online options available. Open University offers many free classes, most of which offer online forums that allow classmates to connect with and learn from each other.

When technology alone is not enough to ease your concerns, you may want to consider moving your loved one into a senior living community. Here are a few benefits of a senior living community in a post-COVID-19 world, and what you can look for if you’re thinking of a move:

Everything is handled for you. Senior living communities have built-in 24/7 support system of dedicated on-site employees from nursing, lifestyle, culinary, housekeeping, and security. The staff is there to cater for your specific needs, reducing your need to rely on adult children or other family members should you be unable to help.

Wellness and health care services on-site. Many senior living communities offer on-site primary care, medication management, and even specialty services like physical therapy. Having health care and wellness services fully integrated into the living community, with staff who take a whole-person approach to care, provides an extra layer of protection and reassurance during a pandemic.

Strict infection control policies. Common areas like lobbies, elevators, dining rooms, amenity spaces, and hallways are being heavily sanitized. At Maplewood Senior Living communities, all staff members are trained to follow best practices to prevent community spread of COVID-19. Staff are routinely tested and screened for symptoms at the beginning and end of each shift. Additionally, a dedicated COVID-19 Task Force works closely with local and state health officials to stay on top of the latest guidance from the Centers for Disease Control and Prevention.

Safer socialization. New practices like scheduled dining, small group gatherings, and frequent sanitation allow residents to safely continue their active lifestyle with comfort. Across Maplewood Senior Living communities’ residents have access to virtual, interactive programming including lectures and discussions, spiritual worship, fitness classes, book clubs, travel, and more. Staff are also there to help introduce residents with similar interests, allowing for new friendships to develop easily.

Every senior living community has different policies and protocols, so be sure to explore them closely. Moving to the right senior living community can provide a host of advantages in a very uncertain time.

For more information about Maplewood Senior Living’s newest community, Maplewood at Princeton, scheduled to open Summer 2021 on the Penn-Medicine Princeton Health Campus in Plainsboro, please contact us at 848-200-0131 or visit our website at www.maplewoodseniorliving.com.

State-of-the-Art Lung Center Opens at Capital Health

From left, Dr. Africa Wallace, director of Thoracic Surgery; Gina Petrone Mumolie, senior vice president, Hospital Administration; Dr. Diane Kolman, director of Interventional Pulmonology; and Rona Remstein, director, Oncology Services, officially open the new Capital Health Lung Center.
Comprehensive program specializes in the diagnosis and treatment of lung diseases and lung cancers

As part of its commitment to providing leading-edge care, Capital Health has announced the launch of its comprehensive, state-of-the-art Lung Center located at Capital Health Medical Center — Hopewell. The program is designed to address the need for integrated, comprehensive lung services in the region.

“The launch of the Lung Center is an another example of Capital Health’s commitment to providing the highest level of specialized care,” said Al Maghazehe, president and CEO of Capital Health. “We are delivering extraordinary, patient-centered care for a broader range of patients and lung conditions — from asthma to COPD, emphysema, pulmonary hypertension, tumors and lung cancers. The Lung Center also gives patients access to a range of specialists with significant experience an extensive training with the most advanced medical diagnostic tools and technology.”

As co-leads in the development of Lung Center, Dr. Diana Kolman, director of Interventional Pulmonology, and Dr. Africa Wallace, director of Thoracic Surgery, share a common goal — to identify and treat potentially life-threatening lung conditions early, when they are most treatable. “We know that getting a fast and accurate diagnosis of a particular condition and receiving timely treatment can be critical, especially when it comes to cancer,” said Dr. Wallace.

Comprehensive care at the Lung Center includes a multidisciplinary team of experts focused on each patient and their particular condition. The team includes physicians from surgery, pulmonology, radiation oncology, and medical oncology as well as nurse practitioners, clinical researchers, and support staff. “Our goal is to provide the most effective treatment pathway with a holistic, integrated approach in order to achieve the best possible outcome,” said Dr. Kolman.

The Lung Center offers a full range of lung disease care, including lung cancer screenings, a lung nodule clinic, thoracic surgery, interventional pulmonology, pulmonary rehabilitation, and smoking cessation. To learn more about Capital Health’s Lung Center, visit capitalhealth.org/lung. To schedule an appointment or for more information on the Lung Cancer CT Screening, lung nodule clinic, pulmonary rehabilitation, or smoking cessation, call 1-844-303-5864. To schedule an appointment with Dr. Kolman, call 609-815-7390. For an appointment with Dr. Wallace, call 609-537-6000.