The New Old Age Blog: A Community Time Bank

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Joan Black took a serious tumble two years ago, climbing up on a stepladder to reach for a punchbowl. She was about to host one of her frequent patio parties for a regional theater company in Montpelier, Vt.

Ms. Black had been doing quite well in her ground-floor apartment downtown. But the fall broke a vertebra, and since then she’s had trouble walking and standing for any extended period.

Daniel HechtCara Barbero shoveling snow at the home of her neighbor Joan Black.

Once she worked as an interior designer. “I take a great deal of pride in my home,” she told me in an interview. “But I couldn’t keep up with the vacuuming and dusting. I couldn’t garden. I used to start dreading winter in mid-July.” (She couldn’t shovel snow.) Living on Social Security payments since the recession plundered her savings, she couldn’t afford to hire helpers. “Seeing things in my life go downhill became very depressing,” said Ms. Black, now 80.

Happily, a city program called the Reach Service Exchange Network began operation in the fall of 2010, powered by a grant of $1 million from the federal Administration on Aging.

The network functions as a time bank. Montpelier residents of all ages join for $25 and get access to a site listing requests and offers: driving, pet care, reading aloud, help with grocery shopping, computer tutoring sessions and more. “We ask all members to provide services to the network,” explained Daniel Hecht, the network’s director. “We think people of any age or level of ability can contribute.”

We’ve talked here about various alternatives to assisted living and nursing homes that allow people to age in place, or at least age in place longer. Co-housing, shared housing, villages, N.O.R.C.’s — the approaches and the economics vary, but the goals of independence and interdependence, which aren’t contradictory in old age, are much the same. People want community, but they also want privacy; most try to maintain their own households for as long as they can. “I told my son and daughter-in-law that I want to be carried out of my apartment,” Ms. Black said, voicing a common sentiment.

Can an organization like Reach make that happen? “Volunteering and increased social interaction are known preventions that mean better health,” Mr. Hecht pointed out.

So far, 200 locals have joined Reach, half of them over age 58. The staff runs criminal background and sex-offense checks on each member and reviews the motor vehicle records of anyone who has volunteered to drive. “This sort of vetting means nobody’s going to come to your home and steal your jewelry,” Mr. Hecht said.

As a group, Reach members currently contribute 300 hours of services each month. Ms. Black, for instance, has arranged to have a member vacuum and dust her apartment each week, which takes about two hours.

Cara Barbero, who lives a block or so away, shows up to shovel snow, often before dawn. “I get up in the morning, and the path is already cleared and salted and the car is cleaned off, and I can get out and go,” Ms. Black said.

In exchange, she operates the Reach Network’s information table at the farmers’ market most summer weekends and works at the guided tour desk at the restored state Capitol building. She still hosts soirees to benefit the Lost Nation Theater — though someone else handles the punchbowl — and she arranges a high tea each March that supports a college art gallery. By helping Ms. Black, Ms. Barbero has earned hours that she uses to get child care.

Friendships develop. Ms. Barbero’s daughters came over to sing “Jingle Bells” and deliver Christmas cookies to Ms. Black last month; she invited them and their mother to her 80th-birthday celebration. She has signed up for classes that Reach is offering in the Alexander technique, which she thinks may ease her back pain.

As one downside of aging in place can be isolation and depression, “I’ve made it a point to get out and meet people,” Ms. Black said. “It keeps the juices going.”

But when the federal grant ends after three years, can Montpelier keep Reach going? It faces the same challenges as many elder care alternatives, including the much-touted village movement: It needs to raise money, if only for office space, Web site maintenance and at least a skeleton staff. And it needs to keep bringing in new members, including those younger and able-bodied. Its goal, in this small city of 7,500, is to attract 600 members who provide a collective 1,000 hours of service each month. That’s a far-off target.

Many of these experiments can keep older members in their homes when they need driving and dog-walking. As they age, a high proportion will eventually need help with the more basic activities of daily living — bathing, dressing, using a toilet. Few of these housing or community-building efforts are equipped to offer long-term care. “We can’t guarantee services to anyone,” Mr. Hecht acknowledged.

So Reach represents a model with limitations but also great benefits. “It reminds me of when I was growing up on Long Island and people just naturally helped and took care of each other,” Ms. Black said. “It’s tightened our community. I just hope it goes on forever.”

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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Recipes for Health: Mashed Turnips and Potatoes With Turnip Greens — Recipes for Health

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2 bunches turnips with greens attached (1 3/4 to 2 pounds, including greens)

1 pound russet or Yukon gold potatoes, peeled and quartered

Salt to taste

1 to 2 tablespoons extra virgin olive oil

1 leek, white and light green parts only, finely chopped

2/3 cup low-fat milk, or as needed

Freshly ground pepper

1. Cut away the greens from the turnips. Peel the turnips and quarter if they’re large; cut in half if they’re small. Stem the greens and wash in 2 changes of water. Discard the stems.

2. Combine the turnips and potatoes in a steamer set above 2 inches of boiling water. Steam until tender, 20 to 25 minutes. Remove from the steamer and transfer to a bowl. Cover the bowl tightly and leave for 5 to 10 minutes so that the vegetables continue to steam and dry out.

3. Fill the bottom of the steamer with water and bring to a boil. Add salt to taste and add the greens. Blanch for 2 to 4 minutes, until tender. Transfer to a bowl of cold water using a slotted spoon or skimmer, then drain and squeeze out excess water. Chop fine. Drain the water from the saucepan, rinse and dry.

4. Heat 1 tablespoon of the olive oil over medium heat in the saucepan and add the leek and a pinch of salt. Cook, stirring, until leeks are tender and translucent but not colored. Add the milk to the saucepan, bring to a simmer and remove from the heat.

5. Using a potato masher, a fork or a standing mixer fitted with the paddle, mash the potatoes and turnips while still hot. Add the turnip greens and combine well. Beat in the hot milk and the additional tablespoon of olive oil if desired, and season to taste with salt and pepper. Serve hot, right away, or transfer to a buttered or oiled baking dish and heat through in a low oven when ready to serve.

Yield: Serves 4 to 6 as a side dish.

Advance preparation: You can make this several hours ahead and reheat as directed, or in a double boiler.

Nutritional information per serving: 208 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 3 grams monounsaturated fat; 3 milligrams cholesterol; 38 grams carbohydrates; 7 grams dietary fiber; 156 milligrams sodium (does not include salt to taste); 6 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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Devices to Keep Track of Calories, Lost or Gained

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There is a simple reason for this. Everyone understands they have to burn more calories than they take in, said John Jakicic, a professor at the University of Pittsburgh and a researcher in the field of exercise and long-term weight control. But “most people don’t know how many calories they burn a day,” he said. “They have no clue.”

Getting a clue — or at least an accurate estimate — used to require a visit to a laboratory or the use of complex scientific equipment. Guess how often people took that approach?

Now though, there are simplified electronic monitors that are designed to accurately gauge physical activity and the calories burned, which is the silver bullet for weight loss. “There is a lot of evidence that shows they work,” Professor Jakicic said.

Some products in this area have fallen flat, like Jawbone’s Up, a wristband activity tracker that had so many technological problems that Jawbone is offering full refunds to dissatisfied customers. It is taking preorders for a new version.

How well a monitor works depends on how much it is used, which boils down to personal taste. Are you more likely to use one that offers games and challenges, one that just reports the numbers, or one that is inconspicuous? We tried four of the more common products.

STRIIV ($100) Just released in October, the Striiv may encourage even the most rooted sofa spud. Designed with the sedentary in mind, it is an ultra-simplified device that offers rewards and challenges to motivate users and keep them active.

The touch-screen device, about the size of a pack of Tic-Tacs, starts up with a jaunty song and a video with directions, though you hardly need them to operate it. Set-up is easy, and from there you wear it or carry it in a pocket to measure your steps when walking, running or climbing stairs. It was the one device tested that did not need to be synced with a computer.

Striiv has a number of ways to keep people engaged. It gives out trophies and points for accomplishments, like your record number of stairs climbed, and points can also be used to play MyLand, a game in which users build and explore an animated world.

Finally, you can choose one of three charities to receive a donation based on your activity (you’ll have to sync to a computer to make this happen). Walk 60,000 steps to immunize a child against polio. Fewer steps help provide clean water in South Africa or save a patch of rainforest. The Striiv is unique in that it offers both carrot and stick — it occasionally offers challenges, like “Do three minutes of activity.” Accept and you get a bonus 3,000 points; decline and you lose 300 points.

Striiv does suffer in a few regards. It measures only calories burned. You’ll need a separate app to measure calories consumed, like Livestrong.com’s MyPlate. And the device recognizes only the motions of walking, running and stair climbing, so it won’t spot an activity like weightlifting or cycling. That can throw off your calorie count.

FITBIT ULTRA WIRELESS ACTIVITY TRACKER ($100) Fitbit, a monitor about the size of a large nail clipper, has been around for a while, but the Fitbit Ultra brings some new features to the earlier version, which automatically transmits your data when you are within 15 feet of a Fitbit base connected to a computer.

The Ultra adds an altimeter to count stairs climbed. Like the Striiv, it won’t recognize exercise other than walking, running and stair climbing, but you can use a new stopwatch feature to log a block of time that you can later assign to an activity, like a Zumba class, using the Fitbit Web page or the companion iPhone app.

The Ultra will help you track the amount and quality of your sleep, but you have to manually set the stopwatch to do that as well. Tracking sleep is worthwhile because research shows a correlation between adequate sleep and weight loss.

There is now added inducement for the lazy in the form of digital badges, and you can share your exercise progress on Facebook. As before you can also share challenges and encouragement on the Fitbit Web site by creating groups or joining public ones.

Fitbit has a food log where you can enter what you eat to see how your calorie intake stacks up against calories burned, as well as the percentage of fats, carbohydrates and proteins you’re eating. The list of foods leans heavily toward chain restaurant meals, so you may have to approximate for food you make yourself.

For an additional $50 a year, premium membership provides more detailed data and lets you anonymously compare your stats with other Fitbit users.

BODYMEDIA FIT LINK ($200 PLUS $7 A MONTH SUBSCRIPTION) BodyMedia’s monitors were originally built for researchers like Professor Jakicic. They are worn on the upper arm and they measure heat, moisture and movement to get a picture of activity. As with other monitors, BodyMedia’s wasn’t good at recognizing exercise other than walking or running (it recorded lifting heavy weights as “moderate” exercise, which it is not).

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F.D.A. Orders More Study on Surgical Mesh Risks

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The Food and Drug Administration issued an order on Wednesday requiring makers of implantable surgical mesh used to treat urinary incontinence in women to study its risks.

The move comes after years of reports of serious injuries linked to the devices, including infections, pain and other complications. It follows a recommendation in September by an F.D.A. advisory panel that the agency require such studies.

The move Wednesday by the agency is similar to one it took last year when it ordered producers of all-metal artificial hips to undertake patient studies. The mesh products and the hips belong to a class of implantable devices that manufacturers do not have to study in patients before they are marketed or closely follow in patients afterward.

Female incontinence is often caused by two conditions. One is called pelvic organ prolapse, in which muscles that support organs like the bladder weaken, allowing them to descend and press against the vaginal wall. The other, stress urinary incontinence, is also caused by muscle weakening.

In 2008, the F.D.A. issued a warning that the use of vaginal mesh was associated with complications but said at the time that such problems were rare. However, from 2008 to 2010 there was a fivefold increase in adverse event reports related to the use of vaginal mesh to treat pelvic organ prolapse, said Dr. William Maisel, the chief scientist of the F.D.A. division that oversees medical devices.

Dr. Maisel emphasized that the order Wednesday did not cover all uses of surgical mesh to treat incontinence. He added that the safety of such devices when surgically implanted through the abdomen was “well established.”

The top producers of vaginal mesh include Boston Scientific, C. R. Bard, Ethicon and W. L. Gore & Associates.

In 2010, about 185,000 women underwent procedures in which mesh was implanted vaginally to treat urinary incontinence.

That same year, researchers reported in a medical journal that about 15 percent of the women treated with vaginal mesh experienced potential complications. The study, which appeared in the journal Obstetrics and Gynecology, also concluded that mesh did not provide greater benefits than the traditional surgical treatment in which a patient’s own ligaments are used to strengthen the vaginal wall.

Dr. Maisel said he expects that mesh manufacturers, once studies are started, will follow patients for about three years to determine the frequency and severity of complications.

Over the last year, the F.D.A. has increasingly used its authority to order manufacturers to conduct emergency studies. But the effectiveness of that procedure in preventing patient injuries is questionable because by the time the agency acts, a device has been on the market for years and been implanted in hundreds of thousands of patients.

Also, while the F.D.A. in May ordered makers of all-metal hips to conduct postmarket studies of their risks, the agency and company officials are still discussing study designs, Dr. Maisel said.

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Marijuana Use Most Rampant in Australia, Study Finds

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The study, an analysis of global trends in illegal drugs and their effect on public health published in The Lancet, a prestigious journal, found that Australia and neighboring New Zealand topped the lists globally for consumption of both marijuana and amphetamines, a category of drugs whose use the study found to be growing rapidly around the world.

The study’s co-authors, Professors Louisa Degenhardt of the University of New South Wales and Wayne Hall of the University of Queensland, reported that as much as 15 percent of the populations of Australia and New Zealand between the ages of 15 and 64 had used some form of marijuana in 2009, the latest year for which data were available.

The Americas, by comparison, clocked in at 7 percent, although North America batted above the neighborhood average with nearly 11 percent of its population partaking. Asia demonstrated the lowest global marijuana use patterns at no more than 2.5 percent, the study said, although difficulties in obtaining accurate data in less developed countries were cited as one possible reason for the low figures.

The results were not surprising and reflected trends that have been in place for more than a decade, Mr. Hall said in an interview on Australian radio Friday. Despite the high figures in the report, he said, the rate of marijuana use in Australia has actually been dropping “steadily for the better part of a decade.”

Mr. Hall blamed both the ubiquity of the drug — Australia and New Zealand have no shortage of remote rural areas where policing is difficult and the plant grows like, well, a weed — and cultural mores that place the consumption of intoxicants at the center of social life.

“Just look at the way we take alcohol as an integral part of everyday life. I think a lot of young people see cannabis in the same way that we see alcohol: as no big deal, as a drug just to use to have a good time,” he said.

Stepping back for a global perspective, the study found that marijuana was the world’s most widely consumed illicit drug, with anywhere from 125 million to 203 million people partaking annually. Use of the drug far outstrips that of other illicit drugs globally, with 14 million to 56 million people estimated to use amphetamines, 14 million to 21 million estimated to use cocaine and 12 million to 21 million estimated to use opiates like heroin.

Still, despite marijuana’s significantly outpacing other illicit drugs in terms of the volume of use, the study found that it was the least likely of all illicit drugs to cause death. Additionally, barely 1 percent of deaths in Australia annually can be attributed to illegal drugs, the report said, compared with almost 12 percent from tobacco use.

The prevalence of marijuana use in Australia is widely accepted if not openly condoned, and at least three states have moved to decriminalize the possession of small quantities for personal use.

But the findings in the report most likely to cause concern to the Australian government were those relating to the use of amphetamines, and particularly methamphetamine, which has become a major public health concern over the past two decades. As much as 3 percent of the Australian population has used amphetamines like speed, compared with just 0.2 percent to 1.4 percent in Asia.

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British Seek Data to Help Decide on Breast Implant Removal

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“The question really comes down to the extent to which these implants fail relative to normal implants and the relative risks of their removal compared to the risk of having an operation,” Mr. Lansley told BBC radio.

Mr. Lansley was acknowledging that the British authorities did not have reliable statistics on ruptures or oozing of the implants, throwing into doubt the basis for their earlier recommendation that women with the implants in question not undergo “routine removal.”

The French government recommended on Dec. 23 that the 30,000 Frenchwomen with the implants have them removed, citing a failure rate of around 5 percent, a figure they have since raised to about 5.5 percent, calling it unacceptably high. The silicone gel inside them causes inflammation.

British officials at the time cited their own finding that the failure rate among more than 40,000 British women was closer to 1 percent to support their recommendation against removal, an operation performed under general anesthesia that carries its own potential risks.

Nigel Mercer, a former president of the British Association of Aesthetic Plastic Surgeons, said the government lacked data on how many British women have implants that have ruptured. But he said the real issue was not the numbers, but the risk posed by the implants’ use of industrial-grade, not surgical-grade, silicone.

“The British government is all hung up on the rupture rate, but that’s missing the point,” Dr. Mercer said. “It’s what’s inside the implants. It’s not fit to be inside a human being.”

The silicone gel inflames body tissues if it leaks, and the leaks also raised fears of a possible link to cancer. Health authorities around the world have issued statements saying no link has been found.

With British private clinics reportedly charging up to $4,690 to remove the implants, the overall cost could be more than $187 million for 40,000 patients, a burden the National Health Service is loath to bear.

The French government is paying the cost of removal for its citizens. The national health system estimated that it would cost about $77 million to treat all 30,000 French patients.

Mr. Lansley, the British health secretary, acknowledged in a statement that “this is a worrying time” for women who have implants made by Poly Implant Prothèse — known as PIP — and he sought to place the responsibility for care on the doctors who implanted the devices.

More than 300,000 women outside France — mostly in Western Europe and Latin America — also received PIP implants. None are known to have been sold in the United States.

The French daily Le Monde reported on Tuesday that TüV Rheinland, the German company responsible for assuring that PIP implants met European regulations, was being sued by distributors in Brazil, Bulgaria, Mexico, Thailand, Syria and Italy.

TüV Rheinland said last week that it had been deliberately deceived by PIP, which used high-grade silicone when TüV’s inspectors were present and returned to the substandard product after they left. It said it filed a criminal complaint against PIP.

French officials are also turning up their scrutiny of Jean-Claude Mas, the founder of PIP. Mr. Mas, who is already the subject of a fraud investigation by Marseille prosecutors over the implants, was questioned on Monday by the French agency that deals with the safety of health products, French news media reported.

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The New Old Age Blog: Happier Staffers at Nonprofit Nursing Homes

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Reading between the lines of a study published in The Gerontologist recently, I noticed another vote for nonprofit nursing homes.

This isn’t a surprising finding, really. For years, researchers have reported that ownership status is one of the factors related to quality care. “Most studies show that nonprofits do a better job of caring for patients,” said JiSun Choi, a postdoctoral fellow in nursing and long-term care at the University of Kansas Medical Center School of Nursing. “But we’re not sure why that happens.”

We could speculate about the role that money plays, of course. A nonprofit nursing home doesn’t have to worry about paying shareholders dividends or keeping stock prices high. It can also rely on philanthropy to help bridge the gap between what it takes in from residents and government reimbursement and what it needs to spend.

But we also know that staff members’ feelings about their jobs appear to play a significant mediating role. Past studies have shown that in commercially operated homes, for instance, the certified nursing assistants who provide the bulk of the hands-on care are less satisfied with their jobs than those in nonprofits. Directors of nursing in commercial homes are less satisfied as well, and more likely to be planning to leave. In general, such homes are associated with higher — in some cases, shockingly high — staff turnover.

Dr. Choi and her colleagues, surveying nearly 900 registered nurses working in almost 300 skilled nursing facilities in New Jersey, found several characteristics that contributed to the nurses’ job satisfaction: their ability to help set the facility’s policies, their sense of having supportive managers, their feeling that they had adequate resources (translation: enough staff to get the job done well). “A more supportive practice environment,” the researchers called it.

At any rate, R.N.’s working in nonprofit nursing homes were significantly more satisfied with their jobs, the study showed.

Though turnover lay outside the scope of her study, Dr. Choi thought that greater satisfaction might keep them in their jobs longer and affect the work environment for the nursing aides and licensed practical nurses whom R.N.’s supervise. Those staff people would then also be less likely to leave, leading to better outcomes for the residents they come to know. Her next research project will look at the relationship between work force satisfaction and patient outcomes.

Trying to find the right nursing home is such a stressful and sometimes bewildering task that an industry has sprung up to try to guide, or steer, the adult children who often make the decisions.

Ownership isn’t a fail-safe way to choose, sadly. Good commercial homes do exist, and so do lousy nonprofits. In any case, there aren’t enough nonprofits for all the older people who will need long-term care.

But the evidence is mounting that as a group, they still do a better job. That’s where I would start, if I were beginning the search.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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