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  • Moving … Forward? Highlights From a Fairly Long-Running Sitcom

    by Joan L. Cannon

    At this moment, I have a sense of drowning in metaphor. There are too many well-known ones dealing with major changes and long-term consequences thereof in everyone’s life for me to be honestly surprised, but truth to tell, I only half-imagined how this was going to be.Moving a piano in Christchurch, New Zealand
     
    If I had the talent, I know the saga of the actual move from what was to be my last home (after nearly 16 years) to a new one would make a fairly long-running sit-com. Without the ability to write comedy and dialogue, I’ll spare the details and mention only one or two highlights.
     
    Piano Removals in Christchurch, New Zealand,  2011. Wikimedia Commons

    Several hundred pounds of bookshelves that were to be left behind for Habitat, and one for a friend, arrived here where I have no place to put them. Such treasures as all my baking pans, including the ones that fit my toaster oven, are somewhere between here and North Carolina. How could they have lost the smallish box with my (expensive) no-line bifocals I use to watch TV? Ditto the basket of un-ironed tablecloths I left to await pressing after they got here.
     
    The list of missing is long. Yet the worst was that the day before we were leaving to drive to Connecticut, a son and his wife and I were ensconced in our motel after a punishing day when the moving crew called at about 10:30 p.m. to say I had to go and sign some papers. I was undressed, ready for bed. I said he’d have to come to me. Before midnight (just), the fellow arrived, I signed a dozen or more sheets of inventory I couldn’t read. A week later, my NC neighbors informed me the second truck left after 2 a.m.
     
    Second? It seems that an 18-wheeler would have been unable to negotiate the entry here. So two smaller trucks were used, meaning two different crews at each end! Not one spoke English as his native language, though they were willing, and two admitted to foreign university diplomas!
     
    I won’t bother to tell why, but the moving truck delivering half my household arrived without my bed. The pair of twin beds for the guest room came, and they immediately set them up where there is no way they can stay: one is lengthwise against a wall under a window. No way to make it or use the window. Two chests of drawers, a desk, and a couple of occasional (don’t you love that term?) tables remain literally scattered in the center of the floor. I spent the night in a dislodged grandson’s bed. Insult to injury.
     
    Anyway, I’m now halfway fixed in a very nice house (sans A/C!) with jumbled belongings in every direction. Five helpful children and their offspring labored like stevedores unpacking and stuffing cupboards, etc. just to get rid of boxes. In my searches for important stuff, I’ve now re-examined all but about three boxes that remain in the house to make sure the contents matches my labels, or that whatever the movers inserted has a clear consistency — like shop tools, for instance, or my husband’s enormous collection of Hi-fi and electronic miscellany that the boys said I should bring so they could take advantage of anything useful. Anyone interested in coaxial cable or USB hubs?
     
    The first week, I kind of staggered at a half run through the day, trying to make some sense of the chaos around me. My dog, not understanding why he couldn’t simply run out the door and go where he pleased as he was used to, is beginning to get the message that a leash is required. My hips complain a good deal about all the time on my feet to which I’m unaccustomed, but I’m beginning to see hope of an ordered life again. I now know that one trip a day up and down to the attic is enough, and two are an absolute limit.
     
    I did this to be near my children — all of whom live in this state, for a start. I didn’t realize how lucky I was not to have had to wait out the time I was told I’d have to in order to get into a place here. Another year, I doubt I’d have the physical capability. If there’s anything to make you feel your age, a long distance move is it!

    So here I am, on a threshold, beginning a new adventure, facing quite a lot of unknowns (but not the landscape, thanks to almost 45 years only 25 or so miles south), taking a kind of leap of faith … you can fill in a few more handy clichés … and for the first time in my life, doing it single. Right now, I’m too addled to think ahead. Find a dentist, and ophthalmologist, re-register the car and get a new license, open the page on a new chapter…

    One foot in front of the other.

    ©2013 Joan L. Cannon for SeniorWomen.com

  • A Trip to New York City: The ABC of It; Why Children’s Books Matter

    The New York Public Library explores children’s literature and its crucial role in educating and entertaining readers of all ages, and shaping and chronicling society and culture, in its new free exhibition, The ABC of It: Why Children’s Books Matter. The exhibition will run from June 21, 2013 until March 23, 2014 at the Library’s Stephen A. Schwarzman Building on Fifth Avenue and 42nd Street. 

    Curated by noted children’s book expert Leonard S. Marcus, The ABC of It features nearly 250 items from across the Library’s vast collections. Original artwork, correspondence, and recordings accompany books from significant authors from the 1600s to the modern day.
     
    This landmark exhibition presents children’s literature in the larger context of the arts, popular culture, and social history. It highlights the distinctive visions of childhood of the Puritans, Romantics, progressive educators, and others and how each inspired a new kind of book for the young. It explores the key ways in which children historically have acquired their books: as gifts, at the public library, and, as with comic books, in secret — when grownups were not looking.
     
    It provides a meaningful new context for many of the New York Public Library’s treasures: the copy of Alice’s Adventures in Wonderland that belonged to Alice Liddell, the child for whom Lewis Carroll wrote it; a rare 1666 illustrated children’s edition of Aesop’s fables that survived the Great Fire of London; Nathaniel Hawthorne’s family copy of Mother Goose, with annotations stating some passages were too scary to read to their children; the manuscript of Frances Hodgson Burnett’s The Secret Garden; Mary Poppins author P. L. Travers’s parrot-head umbrella; recordings of E.B. White reading excerpts of Charlotte’s Web; and the original Winnie-the-Pooh stuffed animals; among others.
     
    “Children’s books are our gateways to a lifelong love of literature and art,” said Leonard Marcus. “They give us the heroes we need just when we need them most: at the start of our quest to discover who and what we are. Viewed historically, children’s books give us the record of each generation’s hopes and dreams. If you want to know what any literate society cares about, you have only to look at the books it has given its children and teens.”
     
    “Children’s literature has long captured the minds, imagination, and hearts of young people, sparking a love of reading and books that lasts a lifetime,” said NYPL President Tony Marx. “The stories we read as children have shaped our perception of the world we live in and the Library’s new exhibition, The ABC of It, honors the significant impact of our childhood books. We’re also proud to continue the time-honored pursuit of reading and knowledge through a myriad of free programs, classes, materials and other offerings that promote a love of reading in the children and teens who visit our branches, who will go on to write the next chapter in the history of children’s literature.”
     
    The exhibition follows a highly accessible, thematic approach aimed at stimulating visitors’ curiosity and prompting memories of their own favorite books. Major themes explored include: the centuries’-old debate about what children’s books are best; the artistry behind the first and seemingly simplest of all books — children’s picture books; and the impact of children’s books on the worlds of theater, film, and popular culture.
     
    To illustrate the debate between competing visions of childhood, the exhibition begins by pitting the earliest known copy of the Puritans’ highly influential New-England Primer, which asserts that children are born sinful, against William Blake’s hand-colored Songs of Innocence, which celebrates children’s spiritual purity. Visitors can compare the dueling verses and illustrations to determine just how much the philosophy of a society’s adults influences the messages its children receive.
     
    In a section focusing on children’s books as tools for building national identity, The ABC Of It offers a wide array of compelling examples from around the world: graphically adventurous avant-garde picture books from Bolshevik Russia; a Civil War-era patriotic reader published for children of the Confederate States (which uses the word “victory” as an example under the letter “v”); a Noah Webster speller aimed at teaching a uniquely American English to the schoolchildren of the newly formed United States; the manuscript of James Stephens’s Irish Fairy Tales, meant to help preserve Irish cultural tradition and lore in a time of English colonial rule; Japanese comic books meant to teach children English during the post-war Allied Occupation; a fascinating recent picture book from post-colonial Francophone Africa.

  • Elaine Soloway’s Caregiving Series: Crime Scene Investigation Chicago


    It was like an episode of CSI when the team prepares to search a dumpster for some vital clue. I was pulling on a pair of white vinyl exam gloves — latex free, powder free — and smoothing each finger so the glove would hug each digit. 

    I used an empty plastic garbage bag to hold the contents of our tall kitchen trash can. Unlike the TV investigators who would be seeking elements of a crime, I was hunting for Tommy’s lost keys.

    The receptacle was an inspiration and my last hope. My husband and I had already yanked inside-out all the pockets of his clothing. Had already peered under the bed, under the nightstand, under the couch cushions, under the couch. When all of these turned up empty, a dark thought entered my head: Tommy must have left them in the front door and some miscreant absconded with them.

    So, I decided to change our morning’s plans. “We’ll go to Sunday breakfast,” I told my husband, “but instead of continuing on to do our banking and our grocery shopping, we’ll come home straight away. I’ll call a locksmith then to change our bolts.” He gave my plan two thumbs up.

    As a devotee of all crime shows, I figured that whomever purloined the keys would be watching our house and burglarize it the minute we left. So after exiting the driveway, we drove around the block and crept back home. Since nothing was amiss, we proceeded to a nearby diner.

    I raced through my egg white omelet with thoughts of my iMac and iPad being lifted from the house and piled into a white van with the misleading logo of a repair company. “Finish your coffee,” I said to my husband. I was already standing and packing up. “We’ve got to get home.”

    No white van was parked in front of our house. Inside, my Apple products were safely tucked in their spots. Nothing had been disturbed. Still, I called a locksmith. While waiting for a callback, I decided on the dumpster-dive routine.

    One by one I plucked. Gingerly. First, I lifted out a white cone-shaped coffee filter filled with the morning’s Trader Joe’s French Roast. Next, crumpled paper towels that earlier held the ice pack used to soothe my aching back. Onward to dust and dirt swept up from the kitchen floor. Finally, I drew out several tiny foils that once wrapped around miniature chocolate candies.

    And there they were: Tommy’s keys, staring up at me as if to say Ta-da! First, I cancelled the locksmith. Then, dangling the keys, I raced upstairs to our bedroom where my husband had not given up the search.  “Look,” I said. “I found them! They were in the garbage.” He grasped the keys, smiled, and plunged his fist deep inside his pocket.

    This is what I figured happened: Tommy had left our neighborhood block party before me. He let himself into the house, removed his keys from the lock, but kept them in his hand. Then, he went straight to the freezer, plucked a candy from the door’s shelf, unwrapped it, and tossed foil and keys into the garbage.

    I could ascribe Tommy’s lapse to his illness, but then a list of my follies — and that of my two daughters — popped into my brain. Once, I left my fully-loaded backpack on the floor of a local McDonald’s — overnight. Gratefully, the manager spotted the bag and held it for me until I came for it the next morning.

    Another time, I left my wallet on the counter at Trader Joe’s. I didn’t discover my loss until I got home and was about to put away my receipt. An eagle-eyed employee had spotted it and kept it safe until I returned within the hour to retrieve it.

    I remembered Faith’s story of leaving her MacBook on a seat at the boarding gate and not remembering it until she was belted in. A plea to the flight attendant miraculously won her an escape to pick it up exactly where she had left it.

    And Jill left her MacBook Air still charging at her sister’s house after she had hugged goodbye and departed for Los Angeles. Federal Express brought it home to her within two days.

    I relate these tales — you are likely already contributing your own lost and misplaced examples — to emphasize that sometimes, missing objects are not a result of some sort of theft, but instead are just a case of plain old absentmindedness. Nothing more. 

    ©2013 Elaine Soloway for SeniorWomen.com

  • Don’t Look Away: Elder Justice — More Federal Coordination and Public Awareness Needed

    Editor’s Note:. We’d encourage you to share the report with others who might benefit from the information. We have added some links to organizations cited within the GAO (US Government Accountability Office) report. Regular readers of our website will be aware of SeniorWomen.com’s citing of the GAO reports as seen in the item below this one.

    Right: National Center on Elder Abuse poster

    Why GAO Did This StudyElder Abuse Poster

    As the percentage of older adults in the population increases, the number of older adults at risk of abuse also is growing. At the same time, constraints on public funds may limit assistance to the growing population of older adults in need. GAO was asked to review elder justice program issues. This report addresses: (1) the extent to which there is fragmentation, overlap, or duplication across the federal grant programs that support elder justice; (2) the extent to which federal programs coordinate their efforts and monitor elder justice outcomes; and (3) how state aging agencies, area agencies on aging, and service providers deliver federal elder justice services and what challenges, if any, they face in doing so. GAO reviewed relevant federal laws and regulations, identified federal elder justice programs, surveyed federal officials about program elements, reviewed program documentation, and visited agencies responsible for elder justice in Illinois, Virginia and Arizona. GAO selected states based on the percentage of the elderly in the state population, geographic dispersion, and percentage of the state’s Older Americans Act funds devoted to elder care.

    What GAO Found

    In fiscal year 2011, two agencies — the Departments of Health and Human Services (HHS) and Justice (Justice) — separately administered 12 fragmented but minimally overlapping programs that directed funds toward elder justice, with low risk of duplication. Specifically, because more than one federal agency administers these programs, GAO found that these grant programs are fragmented. Further, GAO found that overlap across the 12 programs was minimal because the programs varied with respect to (1) funding mechanisms and recipients, (2) elder abuse victims targeted, (3) service providers, and (4) activities conducted. For example, a few of these programs provided formula grants to all states and most dispersed discretionary grants to a limited number of recipients. Programs that supported victims of elder abuse generally assisted all types of victims, but some also focused on certain subgroups, such as older women. Some programs that assisted service providers also targeted specific subgroups, such as judges and court personnel. In addition, elder justice programs supported a wide range of activities. For example, one HHS program provided public education to help identify and prevent elder abuse, while a Justice program trained law enforcement officers to investigate instances of elder abuse. Considering the variation across funding mechanisms and recipients, the elder abuse victims and service providers targeted by the grants, and the types of activities conducted, overlap across the 12 programs is minimal and the risk of duplication — when two or more agencies or programs are engaged in the same activities or provide the same services to the same beneficiaries — is low.

    We have previously reported that coordination is key to ensuring the efficient use of limited resources to address issues that cut across more than one agency. While federal coordination is in development — for example, HHS, Justice, and other agencies recently formed the Elder Justice Coordinating Council — federal agencies have yet to articulate common objectives and outcomes as precursors to future measures for elder justice programs, which would provide a rationale for coordination. Further, few federal programs tracked elder justice outcomes in 2011 or conducted program evaluations to assess effectiveness, making it difficult to determine what impact, if any, many programs have on victims of elder abuse.

    Officials representing state aging agencies, area agencies on aging and service providers in the three states GAO visited identified the increased demand for elder justice services in a constrained fiscal environment as a major challenge in meeting the needs of the growing older adult population. Officials also cited the need for greater awareness of elder abuse by the public and training of direct service providers who interact with older adults on a regular basis, to help prevent elder abuse or recognize its symptoms. Five of the nine regional agency officials GAO spoke with said elder justice issues need to be elevated to national attention for the general public by a national public awareness campaign. The Elder Justice Coordinating Council is considering a recommendation to sponsor a national campaign but has not yet done so.

    Editor’s Note: Additional Resource: ACL E-news

    The Administration for Community Living (ACL)  provides an e-newsletter and periodic E-news alerts. These alerts share information of importance with the Aging Network, professionals in the disability community and others interested in the needs and concerns of older adults and people with disabilities.

    To subscribe to receive these alerts click on the Subscribe button below. 

    Subscribe to the ACL E-News   Unsubscribe to the ACL E-News

  • First Flight: The Tradition of Airplanes Communicating With the Earthbound Goes On

    Flush from the post-war economic boom, Dad bought his first airplane, a 1946 cream and red Taylorcraft BC-12D. I remember exactly how the plane looked and how it felt to settle into the seat next to him. I recall the anticipation stirring in the pit of my stomach as we waited for someone to prime the propeller and yell out above the noise of the wind and the engine, “all clear”, as he waved us out onto the runway. I recall the instant the wheels left the ground, that first gentle lift into the air, and a magic I didn’t understand moved us skyward.

    The plane grew small as the earth retreated below us. Blue sky surrounded us, the sun so bright that I had to look away from its glare off the nose of the plane. Gradually my ears adjusted to the altitude, the roar of the engine, and the air rushing over the wings and the fuselage. I looked down at the farms below us, my eyes tracking the highway that led into town. Then I saw the swimming pool, the grade school, and finally our house. The little plane banked deeply as we circled. I held onto the edge of my seat and looked out the window at my side, which was now almost beneath me. The roof of our house loomed large below us, and then Dad pulled the plane out of the circling turn and dipped the wings in greeting. He turned his head towards me, the gold rim of his glasses glinting in the sunlight, and he grinned at the show we’d put on for the groundlings.

    Fifty years later, after the death of my oldest brother, who soloed at the age of sixteen and never lost his fascination with small planes, I looked up into the blue sky of a late afternoon in July to see a plane flying loops and rolls over his house in Harlan. A friend was up in his stunt plane performing aerobatics to honor my brother’s memory with a heartbreakingly stunning show. The tradition of airplanes communicating with the earth bound goes on.

    Taylor BC-12D©Margaret Cullison for SeniorWomen.com

  • Internet Pharmacies: Federal Agencies and States Face Challenges Combating Rogue Sites, Particularly Those Abroad

     What GAO FoundViagra (Sildenafil)

    Rogue Internet pharmacies violate a variety of federal and state laws. Most operate from abroad, and many illegally ship prescription drugs into the United States that have not been approved by the Food and Drug Administration (FDA), an agency within the Department of Health and Human Services (HHS), that is responsible for ensuring the safety and effectiveness of prescription drugs. Many also illegally sell prescription drugs without a prescription that meets federal and state requirements. Rogue sites also often violate other laws, including those related to fraud, money laundering, and intellectual property rights.

    Rogue Internet pharmacies are often complex, global operations, and federal agencies face substantial challenges investigating and prosecuting those involved. According to federal agency officials, piecing together rogue Internet pharmacy operations can be difficult because they may be composed of thousands of related websites, and operators take steps to disguise their identities. Officials also face challenges investigating and prosecuting operators because they are often located abroad. The Department of Justice (DOJ) may not prosecute such cases due to competing priorities, the complexity of these operations, and challenges related to bringing charges under some federal laws.

    Despite these challenges, federal and state agencies as well as stakeholders have taken actions to combat rogue Internet pharmacies. Federal agencies have conducted investigations that have led to convictions, fines, and asset seizures from rogue Internet pharmacies as well as from companies that provide services to them. FDA and other federal agencies have also collaborated with law enforcement agencies around the world to disrupt rogue Internet pharmacy operations. The Department of Homeland Security’s (DHS) US Customs and Border Protection (CBP) and US Immigration and Customs Enforcement (ICE), which are responsible for enforcing laws related to the importation of goods such as prescription drugs, have also worked with other agencies, including FDA, to interdict rogue Internet pharmacy shipments at the border. Given that most rogue Internet pharmacies operate from abroad, states have faced challenges combating them, and generally focus their oversight on licensed in-state entities that fulfill orders for rogue Internet pharmacies. Companies that provide services to Internet-based businesses, such as search engines and payment processors, have also taken action — primarily by blocking services to them.

    FDA and others have taken steps to educate consumers about the dangers of buying prescription drugs from rogue Internet pharmacies. FDA recently launched a national campaign to raise public awareness about the risks of purchasing drugs online, and the National Association of Boards of Pharmacy (NABP) posts information on its website about how to safely purchase drugs online. However, rogue Internet pharmacies use sophisticated marketing methods to appear legitimate, making it hard for consumers to differentiate between legitimate and rogue sites.

  • Women of Note: Deborah Hersman, NTSB Chairman

    “Since 1967, the NTSB has conducted more than 132,000 aviation investigations and issued over 13,000 safety recommendations. Each year we investigate about 1,400 general aviation accidents – and we assist in dozens of foreign investigations around the world. Right now, we are supporting efforts from Bagram to Bali and from Paraguay and Pakistan.”

    — Deborah Hersman’s talk,  “Defying Gravity, Safely and Surely”, The Wings Club, New York, New York. June 12, 2013

    NTSB Chairman Deborah Hersman is recognized as one of the nation’s most visionary and passionate safety leaders who advocates for safety across all modes of transportation. Among her many initiatives, Chairman Hersman has focused attention and actions on distracted driving, child passenger safety, and helping accident victims and their families. She emphasizes the NTSB’s role as ‘the conscience and the compass of the transportation industry.’ “NTSB Chairwoman Deborah Hersman

    Chairman Hersman has been the Board Member on-scene for 19 major transportation accidents, chaired scores of NTSB hearings, forums and events, and regularly testifies before Congress. Her leadership has created a more transparent and accountable organization by significantly increasing the quantity and quality of NTSB information available on the agency’s website, holding more public meetings to highlight safety issues, and embracing social media to communicate with stakeholders and citizens. — From the NTSB website

    Created as an independent federal agency in 1967, the NTSB has investigated more than 132,000 accidents and made more than 13,500 safety recommendations. The NTSB is recognized internationally as a preeminent accident investigation organization. Hersman serves as the chief executive of the agency, which has 400-plus employees and an annual budget of more than $100 million.

    Hersman was first appointed as a Board Member by President Bush in 2004 and reappointed to a second five-year term by President Obama. Appointed Chairman by President Obama in 2009 and 2011 with unanimous Senate confirmation votes, she is now serving her second term as Chairman. Her Board position and chairmanship both expire in 2013.

    Previously, Hersman was a senior advisor to the US Senate Committee on Commerce, Science and Transportation from 1999-2004 and served as Staff Director and Senior Legislative Aide to West Virginia Congressman Bob Wise from 1992-1999. Her efforts contributed to the passage of milestone bills such as the Motor Carrier Safety Improvement Act of 1999, Pipeline Safety Improvement Act of 2002, Transportation Equity Act of the 21st Century, and Amtrak Reform and Accountability Act.

    Chairman Hersman received B.A. degrees in Political Science and International Studies from Virginia Tech, and an M.S. in Conflict Analysis and Resolution from George Mason University.

    Quotes from Chairman Hersman from QuoteTimes.com.

    2013

    • June 19, 2013 – Testimony to Subcommittee on Surface Transportation and
      Merchant Marine Infrastructure, Safety, and Security Committee on Commerce, Science, and Transportation United States Senate
      Hearing on Staying on Track: Next Steps in Improving Passenger and Freight Rail Safety
    • June 18, 2013 – Railroad Accident Report – Collision Involving Two Freight Trains, Goodwell, OK, June 24, 2012 – Chairman’s Opening and Closing Remarks
    • June 12, 2013 – “Defying Gravity, Safely and Surely”, The Wings Club, New York, New York
    • June 4, 2013 – Safety Study: Characteristics of Single-Unit Truck Accidents Resulting in Injuries and Deaths – Chairman’s Opening and Closing Remarks

  • Swinging From the Branches of My Family Tree

    I had located my great-grandfather’s Civil War unit; a piece of information my family didn’t have until that very moment. The volunteer handed me forms to fill out and for a nominal fee I was able to order copies of his military records from the National Archives. A bulging manila envelope arrived in the mail a few weeks later and now I was really hooked. The process was thrilling eventually, but rather lacking in the ‘instant gratification’ department. Aunt Bessie was quite pleased, by the way; she had the information she wanted and she knew another member of the family had ‘the bug’.

    Microfilm can also be ordered to examine at a nearby LDS  Family  History center if you know what you need, thus bypassing the whole bus trip experience. Somehow I just never got around to exploring that system during the ensuing years.

    Periodically I worked on organizing boxes of photographs I had inherited. It was time consuming and frustrating; most were unidentified. I had everything from inexpensive snapshots to antique tintypes. I arranged branches of the family tree by typing out the layers of generations and adding bits of information along the way. Most the time I did nothing at all. I suppose one could say my ‘sickness’ went into remission for about 15 years. Last winter, however, two cousins (also successfully infected by dear Aunt Bessie) and I spent some time together comparing notes on our common ancestors. The result was that the fever is upon me again.

    Read the article at: http://www.seniorwomen.com/news/index.php/swinging-from-the-branches-of-my-family-tree

  • CDC: Overdoses of Prescription Opioid Pain Relievers and Other Drugs Among Women

    Abstract

    Background: Overdose deaths have increased steadily over the past decade. This report describes drug-related deaths and emergency department (ED) visits among women.Morphine ad

    Advertisement for curing morphine addictions from Overland Monthly, January 1900. Wikipedia

    Methods: CDC analyzed rates of fatal drug overdoses and drug misuse- or abuse-related ED visits among women using data from the National Vital Statistics System (1999–2010) and the Drug Abuse Warning Network (2004–2010).

    Results: In 2010, a total of 15,323 deaths among women were attributed to drug overdose, a rate of 9.8 per 100,000 population. Deaths from opioid pain relievers (OPRs) increased fivefold between 1999 and 2010 for women; OPR deaths among men increased 3.6 times. In 2010, there were 943,365 ED visits by women for drug misuse or abuse. The highest ED visit rates were for cocaine or heroin (147.2 per 100,000 population), benzodiazepines (134.6), and OPR (129.6). ED visits related to misuse or abuse of OPR among women more than doubled between 2004 and 2010.

    Conclusions: Although more men die from drug overdoses than women, the percentage increase in deaths since 1999 is greater among women. More women have died each year from drug overdoses than from motor vehicle–related injuries since 2007. Deaths and ED visits related to OPR continue to increase among women. The prominent involvement of psychotherapeutic drugs, such as benzodiazepines, among overdoses provides insight for prevention opportunities.

    Implications for Public Health Practice: Health-care providers should follow guidelines for responsible prescribing, including screening and monitoring for substance abuse and mental health problems, when prescribing OPR. Health-care providers who treat women for pain should use their state’s prescription drug monitoring program and regularly screen patients for psychological disorders and use of psychotherapeutic drugs, with or without a prescription.

    Introduction

    In 2010, enough opioid pain relievers (OPR) were sold to medicate every adult in the United States with the equivalent of a typical dose of 5 mg of hydrocodone every 4 hours for 1 month (1), a 300% increase in the sales rate over 11 years. This rise in distribution of OPR is concomitant with increasing rates of drug overdose death and chronic, nonmedical use of OPR (2,3).

  • Clarifying Patients’ Wishes: New End-of-Life Measure Quietly Sweeps the US

    By Michael Ollove, Staff Writer
    Stateline, Pew Charitable Trusts

    The emergency call came in at 10:47 on a Saturday night: “Woman in Overland Park with difficulty breathing. Code one closest.”

    Angela Fera, a paramedic in Johnson County, Kan., and her partner raced to the house, sirens blaring. When they arrived, six minutes after the first dispatch, a man told them that his 62-year old wife had terminal cancer and was unconscious. The paramedics found her sitting upright in bed, ghostly pale with a weak pulse and shallow breathing. Death seemed imminent.refusal of treatment document

    The woman was under hospice care, and had signed a “Do Not Resuscitate (DNR)” order. She had made her wishes clear: She did not want to be taken to the hospital if a life-threatening medical emergency arose.

    Photo: A “refusal of treatment” form from an ambulance service; photograph taken by Jacob Windham. Wikipedia

    But the woman was not in cardiac arrest, the situation specified in the DNR order. Protocol required that Fera try to save her life, probably by inserting a plastic tube into her trachea to restore breathing and transporting her to a hospital, where she’d be put on a ventilator. Fera guessed that was precisely what the woman did not want. But the husband felt that his wife’s children — his stepchildren — should be the ones to decide whether to withhold treatment.

    “We were completely fighting all our instincts to jump in and save her, but on the other hand we really wanted to do what was right,” Fera recalled.

    New End-Of-Life Document

    A new end-of-life document, more explicit and binding than a DNR and advanced directives, is designed to clarify patients’ wishes — and spare caregivers such as Fera from facing such wrenching choices.

    A “physician order for life-sustaining treatment” (POLST) is a medical order, signed by a doctor or other authorized medical provider. The product of a conversation between patient and provider, a POLST specifies a patient’s goals and desires as death closes in. Unlike a traditional DNR, it covers such medical interventions as resuscitation, hospitalization, use of antibiotics, hydration, intubation and mechanical breathing ventilation.

    See new documentSee POLST Form

    Without much opposition or attention, many states have adopted POLSTs. This year, Indiana and Nevada approved legislation to allow their use, leaving only seven states and the District of Columbia without POLSTs in at least some stage of development.

    They tend to come in garish colors — neon pink, orange, and green, for example — so they stand out among other documents in a home. People are encouraged to put them on their refrigerators, and paramedics are trained to look for them there. In Oregon, where POLSTs originated in the early 1990s, they are recorded in an electronic registry so first responders can access them online. Other states are moving in the same direction.

    Research suggests POLSTs are effective in matching treatments to patients’ wishes. According to one study, patient preferences noted on POLST forms matched the actual treatment—or non-treatment—in more than nine out of 10 cases.

    Vague or Irrelevant

    Dr. Susan Tolle, one of the creators of POLST and director of the Center for Ethics in Health Care at the Oregon Health and Science University, said DNRs and other end-of-life documents tend to be vague or irrelevant to many medical situations. In many cases, they are signed by somebody whose authority may be in question during a medical crisis.