tag:blogger.com,1999:blog-1812431336777691886.post6298307936346879697..comments2024-02-29T03:57:00.088-05:00Comments on The Mermaid's Tale: My grandmother's dementia and meAnne Buchananhttp://www.blogger.com/profile/09212151396672651221noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-1812431336777691886.post-22639942049045431372015-10-22T16:11:41.743-04:002015-10-22T16:11:41.743-04:00Thanks, David! And, yeah, Ken and I are doing the...Thanks, David! And, yeah, Ken and I are doing the same kind of preparation for our 70's and beyond! And, yes, of course public health improvements, assessed by population-based statistics, count for a lot. Can't complain about that. But population statistics can only give us probabilities, too often based on incomplete understanding of cause and effect, so we can plan for our 70's all we want, but we have no way to know if we will actually be healthy when we get there (if we get there), and if not healthy, what we'll be suffering from, or whether we will be able to remember the languages we worked so hard to learn in our 60's. It's not so much that we're not fans of "probabilistic medicine" or "probabilistic health" but that we find it perplexing. Or impossible, even in principle. There aren't any alternatives at the moment, so what I guess we _are_ fans of is at least recognizing the limitations. <br /><br />As for taking care of aging populations, it's hard to see that the increasing numbers of elderly are likely to fare well in the US if we repeal Social Security and Medicare. But that's another story, and beyond the scope of this blog!<br />Anne Buchananhttps://www.blogger.com/profile/09212151396672651221noreply@blogger.comtag:blogger.com,1999:blog-1812431336777691886.post-63423363655447830402015-10-22T15:59:59.350-04:002015-10-22T15:59:59.350-04:00We are in the same general senior age group and do...We are in the same general senior age group and do our best to forestall deterioration. The issues here are subtle. We are not opposed to properly handled population-level statistics, because they are vital for public health measures of many kinds. Public health, in that sense, is not about over-claiming causal knowledge or individual ('personalized') prediction, which is a rather different thing and far more problematic. We are fans of water fluoridation, iodizing salt and the like, because there is a good upside and no downside even if the claimed effects were to be found to be wrong. BUT the results from countless epidemiological studies that should in principle be able to identify risk variables like exposure factors notoriously contradict each other (or even themselves) almost on a daily basis. The claims made, repeated in the news media, are a major problem, not least reason being that they change behavior and hence risks, and often for incorrect or at best inaccurate reasons. That is what we criticize. Ken Weisshttps://www.blogger.com/profile/02049713123559138421noreply@blogger.comtag:blogger.com,1999:blog-1812431336777691886.post-91082878284652334942015-10-22T15:43:22.187-04:002015-10-22T15:43:22.187-04:00"The point, as we say in the post, is that it..."The point, as we say in the post, is that it's possible that prevalence will continue to decline, but that the number of people with Alzheimer's will rise as the population ages and grows."<br /><br />Exactly. There are a couple of numbers of interest here: life expectancy at 65 and the number of elderly per 10 persons of employment age. In the US, the latter is roughly 2 elderly for 10 working-age blokes, which is predicted to rise to (a tad under) 4 for each 10 workers in 2065 or so. Sounds bleak? No, that's _good news_. Why? Japan is already at (a tad over) 4 for each 10, rising to 7 elderly for 10 workers in 2065. Ouch. Japan is doing fairly well now, so the US has no excuse for not doing well, and no excuse for whining; it's possible.<br /><br />Whatever, that prevalence seems to be decreasing is really really good news. This blog tends not to be much of a fan of "probablilistic medicine" and "probabilistic health". I appreciate it that it's no fun not knowing which of your cohort you saved (or which of your cohort you yourself are), but it's really big if you can reduce the overall burden of disease. On the other hand, I sit here at 63, and realize that I need to spend serious time every day exercising, reading Japanese, studying Go, and practicing guitar if I'm going to have fun in my 70s. So disruptions to that (e.g. work) are not appreciated. (But interesting food for thought is: thank you for this blog!)<br /><br /><br /><br />David J Littleboynoreply@blogger.comtag:blogger.com,1999:blog-1812431336777691886.post-28831076100983602962015-10-22T13:04:58.879-04:002015-10-22T13:04:58.879-04:00The point, as we say in the post, is that it's...The point, as we say in the post, is that it's possible that prevalence will continue to decline, but that the number of people with Alzheimer's will rise as the population ages and grows. It could grow as a societal problem in that case, even while risk is decreasing. That's the issue, not that risk is increasing, which I read (and More or Less reported) as the suggestion of the 1/3 of the population prediction.Anne Buchananhttps://www.blogger.com/profile/09212151396672651221noreply@blogger.comtag:blogger.com,1999:blog-1812431336777691886.post-47227576574771308352015-10-22T12:51:52.542-04:002015-10-22T12:51:52.542-04:00Sounds like an amazing group of musicians. Intere...Sounds like an amazing group of musicians. Interesting that a pianist can play without shoulders. <br /><br />You are right, the 1/3 figure is hard to interpret. I read it as warning that Alzheimer's disease will skyrocket, but if it's lifetime risk you're right. It's probably more or less true that 1/3 of the oldest old now have some form of dementia. Anne Buchananhttps://www.blogger.com/profile/09212151396672651221noreply@blogger.comtag:blogger.com,1999:blog-1812431336777691886.post-82846243152791030082015-10-22T12:43:44.320-04:002015-10-22T12:43:44.320-04:00"According to the study, prevalence of dement..."According to the study, prevalence of dementia in British people over age 65 has declined by more than 20% in the last 20 years; it's currently about 7 percent of that segment of the population.<br /><br /> This is in striking contrast to a recent report in the UK that estimates that 1/3 -- 33%!-- of the British children born in 2015 will have dementia in later life. Tim Harford, presenter of More or Less, pointed out, though, that it's odd that this number was taken seriously by anyone, ..."<br /><br />Careful there! Those numbers are _NOT_ contradictory. They could be saying that in the period 65 until death, the 33% who get dementia spend the majority of that period dementia-free, and only the last part of that period with dementia. The point is that (non-early-onset) dementia appears long after 65. My wife's aunt was quite active from 65 to 80, and gradually lost it after turning 80, finally dying of a stroke at 89. I hang out with a bunch of elderly Japanese jazz musicians, the leader of the amateur band is 85, the pros who let me sit in once a year still play beautifully despite an average age over 80. The pro pianist's shoulders are so shot he can't put on an overcoat or a scarf by himself, yet he plays beautifully. From my observations, 65 to 80 can be a _great_ period in one's life. At 63, I'm looking forward to it. After 80, things get iffier, but some lucky folks remain active and intellectually sharp past 90.<br />David J. Littleboynoreply@blogger.com