Once Just an Aging Sign, Falls Merit Complex Care

By John Leland | New York Times, November 8, 2008

Katherine Aliminosa, 93, who broke her leg in a fall in April, has regained strength and
limited mobility, as well as optimism.  (Jessica Kourkounis for The New York Times )

MEDFORD, N.J. — Katherine Aliminosa, 93, shattered her lower leg while getting snacks for her nieces.
Susan Arnold, 87, broke her hip hanging a photograph.

In mid-July, in a nursing unit of a retirement community here, the two women were at the start of a recovery process that both hoped would return them to their previous lives.

Their progress over the next few months, and their divergent outcomes, illustrate the unpredictable impact that common falls can have on the bodies of older people.

By early autumn, Ms. Aliminosa had graduated to an independent living apartment and was able to get around with a walker. She looked like a different person: more robust, content.

Though six years younger, Ms. Arnold never recovered her strength after hip surgery. Her muscles atrophied from inactivity, and she developed pneumonia. She died on Sept. 6.

Once considered an inevitable part of aging, falls are now recognized as complex, often preventable events with multiple causes and consequences, calling for a wide range of interventions, both psychological and physiological, that many patients never receive.

Even falls that cause only minor injury “need to be taken as seriously as diabetes,” said Dr. R. Sean Morrison, a professor of geriatrics and adult development at Mount Sinai School of Medicine in New York, because “they can be a real warning sign that something serious is wrong.”

Dr. Mary E. Tinetti, a falls expert at Yale University medical school, compared falls to strokes in their harmfulness, adding that people do not always report them or seek help, for fear their families will try to put them in nursing homes. For some people, Dr. Tinetti said, admitting that they fall is tantamount to admitting that they are no longer competent to take care of themselves.

Each year, 1.8 million Americans over age 65 are injured in falls, according to the Centers for Disease Control and Prevention. Some rebound as if the injury never happened. But for some, the fall sets off a downward spiral of physical and emotional problems — including pneumonia, depression, social isolation, infection and muscle loss — that become too much for their bodies to withstand.

In 2005, the last year for which statistics are available, 433,000 people over 65 were admitted to hospitals after falling, and 15,800 died as a direct result of the fall. Less visible are the many who survive the fall but not the indirect consequences.

When first interviewed in mid-July, Ms. Aliminosa and Ms. Arnold felt vulnerable and constrained, their world diminished. Both had led accomplished professional lives — Ms. Arnold as a school psychologist, Ms. Aliminosa as a medical researcher — and had been active in the community’s independent living apartments. But neither could be confident about what the future held.

Ms. Aliminosa said she was depressed, and able to walk only in very small stretches. A small woman with a soft voice and grainy New York accent, she barely filled her chair. She seemed defeated. “Emotionally I have not been well,” she said. “It’s made me very aware of my age, and that’s hard to accept.”

Ms. Arnold, by contrast, was full of emotional energy, so angry about her broken hip that she kicked out for emphasis as she talked, turning conversation into a full-contact sport. Before her fall, she had been preparing for a vacation with her daughter at a family beach house on Long Island — the same house where she had spread her husband’s ashes. Now that plan was gone.

“It kills me, it just kills me,” she said. “This was going to be the frosting on the cake, and somebody ate it.”

Of the two women, Ms. Arnold was up against the longer odds. One in five hip-fracture patients over age 65 die within a year after surgery, according to the C.D.C.; one in four have to spend a year or more in a nursing home. When younger people fall, they tend to break their wrists catching themselves, but in older people, who have slower reactions and less upper-body strength, the weight more often falls on their hips or heads. Any underlying conditions, like heart disease or respiratory problems, increase the chances of a downward health spiral.

Ms. Arnold had a history of pulmonary disease, and had been a heavy smoker, starting after high school. “She had a boyfriend in college,” her daughter, Margery Creek, said, “and it was the lesser of evils — sex, drinking or smoking.”
But her lung problems did not keep her down. In 2006, she took a 10-day trip to Sweden. Even after she fell and fractured a hip that autumn, she lived independently and was able to drive, returning to the beach house. That day in mid-July, even as she talked about depression, she took jubilant delight in photographs of her grandchildren and great-grandchildren. “Now if that isn’t the picture of a baby,” she said. “Isn’t she a sweetie?”

If Ms. Arnold were a machine, it would be simple to draw a straight line between her lung disease, her hip surgery and her chances of recovery. Older bodies typically have several weakened systems that are dependent on one another, and rely on drugs that may or may not work well together. “If you take 70-year-olds, on average they’re taking five medications,” Dr. Tinetti said. “When you get to 10 medications” — as a patient might after a fall — “the likelihood of adverse effects is close to 100 percent.”

But psychological factors can be as devastating as the physical trauma, Dr. Tinetti said. “It’s the fear of falling, the lost confidence. Good walkers stop walking, stop going to church. They become socially isolated and depressed.”

After Ms. Arnold’s first broken hip, she had reduced feeling in one foot, which added to the likelihood that she would fall again.

On July 6 this year, it happened: Ms. Arnold turned her body without moving her foot, pulling the closet door down with her when she fell and fracturing her hip bone.

“I’m outraged,” she said a week after the fall, raising her voice and then becoming fatigued. Her breathing was interrupted by coughing spasms. She said she was determined not to end up using an electric cart. “Disappointment,” she said, accenting each syllable. “I had a very good life.”

“But your life isn’t over,” said Deanna Gray-Miceli, an adjunct assistant professor of nursing at the University of Pennsylvania and an expert in geriatric falls who was looking in on Ms. Arnold in the nursing unit.

“Well, it bloody well is,” Ms. Arnold said. “I have no strength. Let’s talk about depression.”

The period of immobility after a fall is particularly dangerous, said Dr. Gray-Miceli, whose research includes studying a group of patients after falls. “Being immobile, you’re not taking deep breaths, you’re more prone to orthostatic pneumonia, or older people can develop urinary incontinence. And that can have a whole cascade of emotional consequences as well as the physical consequences, such as skin breakdown, pressure sores, bladder infection, lung infection.

“We also see temporary confusion from infection,” she added, “And that can lead to someone’s demise.”

Dr. Gray-Miceli’s work focuses on identifying the causes of falls, which might include treatable factors like changes in gait, low blood pressure, declining vision or heart arrhythmias, as well as conditions in the home. In a study by Dr. Tinetti, simple preventive suggestions from doctors, like physical therapy and changes in medication, reduced falls by 11 percent. (The C.D.C. offers tips to reduce falls at home, like removing loose rugs and making sure stairway handrails go all the way to the bottom, at cdc.gov/ncipc/duip/preventadultfalls.htm.)

For Ms. Arnold, it was too late. Shortly after surgery she grew depressed and fatalistic, her daughter said. “One morning when my brother was here, she woke up and said, ‘I’m weary, I’m just absolutely weary,’ ” Mrs. Creek said. “And she had no muscle that came back. Her arms had really gotten down to skin and bones. You hear that term — it certainly seemed that way, no muscle.”

In August, Ms. Arnold developed pneumonia and spent three nights in the hospital. Though she responded well to the medications, Mrs. Creek said: “It was just one more nail. She said she was ready to be with Dad.”

The last time Mrs. Creek called her, in early September, Ms. Arnold could recognize her voice but not respond, Mrs. Creek said. “I think she just said, ‘I’ve had it, I’m checking out.’ ”

Down the hall, Ms. Aliminosa’s response after her leg fracture was just as unpredictable.

On April 4, she was enjoying a visit from two favorite nieces — Ms. Aliminosa never married — when she found herself on the floor of her apartment, she said. She had no memory of how she fell.

Ms. Aliminosa has osteoporosis and a history of falling, so she told her relatives not to touch her until the nurses came. She needed a metal rod in her leg and began a slow process of physical rehabilitation. She said the falls were the first thing that made her feel old. “I’d love to be able to have dinner and take a short walk, and I can’t do that,” she said.

Because she was in a full-spectrum medical facility, her care was well coordinated, said Dr. Albert Siu, a professor and chairman of geriatrics and adult development at Mount Sinai.

“For example, osteoporosis is often at root of this,” Dr. Siu said. “But in a three-day hospital stay, addressing osteoporosis is not at the top of everyone’s mind. There it’s dealing with the pain, the complications and the repair of the fractured hip.” Medications for blood pressure or pain might increase dizziness or chance of falls. In mid-July, while Ms. Arnold was angry but relatively mobile, Ms. Aliminosa seemed resigned to a loss of mobility and independence. The prospect weighed heavily on her. When asked if she had considered counseling for depression, she said she did not think she could bear talking about it. “I think as we get older it’s hard to control our emotions,” she said.

Patients’ pessimism can be self-fulfilling, because they may not walk to the extent they can. “Their stride becomes shorter,” Dr. Morrison said. “They don’t use their lungs.”

Dr. Gray-Miceli said it was important for doctors and nurses to keep the patient focused on tangible signs of progress, “so she can say: ‘Today I got up by the side of the chair and took five steps. Yesterday I only took four steps.’ ”

Ms. Aliminosa began a physical therapy regimen to build strength in her legs and upper body and improve her gait. With improvement she gained a sense of optimism and control over her body.

She said the depression returned from time to time, as did the fear of falling again. But she said: “The thought that I’m getting better has helped a great deal. I try to think so each day, really.”

She smiled; she joked. On a recent morning, she groused amiably about her fitness program, but finished, with no sign of pain or exhaustion. “I’m walking,” she said, “I wouldn’t say to my satisfaction, because I used to be a hiker. I can’t expect that yet, but I’m hoping for it.”

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Medford Leas Honors Founder

Tak Moriuchi cited for persistence, vision

Medford Leas surviving founder Tak Moriuchi is applauded by family members, including his wife Yuri (center) during last night’s program at the Medford Leas Theater. At top (from left) are daughters, Miyo of Philadelphia, and Kiyo of Moorestown. BCT staff photo / PETE PICKNALLY

By DAVID MACCAR

Burlington County Times, Monday, October 20, 2008

MEDFORD — The Medford Leas retirement community honored its sole surviving founder, Tak Moriuchi, yesterday with a series of speakers, the debut of the film documentary “Medford Leas — A Dream Fulfilled” and a reception.

The Medford Leas auditorium was standing room only, as speakers highlighted their individual experiences with Moriuchi and talked about the legacy he has left in the Medford Leas community.

Moriuchi, his wife Yuriko and 10 other family members were present as the guests of honor.

“Medford Leas is really a unique place, it’s very special,” said Medford Leas CEO, Dennis Koza, of his first experience at Medford Leas. “Tak served on the board (of directors) for another year and it was during that year that I fully gained an understanding of the Tak legacy, not from the humble board man himself, but from the many board members, residents and staff that were willing and eager to share their personal experiences.

“They spoke with pride, love, gratitude and a deep respect,” he said. “It didn’t take me long to realize that the feeling of uniqueness that I experienced here on my first day at Medford Leas ... is the heritage that began some 36 years ago with that quiet man I knew and the other founders of Medford Leas.”

Moriuchi, a Japanese American born in California, founded Medford Leas along with fellow Quakers Lew Barton and Tom DeCou as a community designed for mature and active adults in 1971.

Moriuchi was interned during World War II before moving to New Jersey and becoming a successful apple and peach farmer.

Thomas Zemaitis, chairman of the Estaugh board of trustees, the not-for-profit corporation that sponsors the community, spoke of Moriuchi’s steadfastness and vision.

“I learned something early on about Tak, it’s that he’s persistent. Some might even say stubborn,” Zemaitis joked. “But I also learned very quickly why he’s so persistent — because he has vision. Tak sees what the moves are before everyone else. We all benefit from that each and every day here at Medford Leas.

“Without Tak’s persistence, and without his vision, there wouldn’t be a Medford Leas and it certainly wouldn’t be the place it has become,” he said. “We are fortunate to be able to stand on the shoulders of Tak and the other founders of Meford Leas.”

David Barclay, member of the Estaugh board of trustees, told the audience about a tree that has been planted on the grounds in Moriuchi’s honor.

“Today, I’m very pleased to dedicate a new member of our arboretum — a tree that has been planted to honor Tak and Yuri Moriuchi,” Barclay said. “The tree is a gift from the arboretum committee. It is a yellow magnolia tree, native to both Asia and North America.”

Chiyo Moriuchi, the youngest of the Moriuchi daughters, took the stage and introduced all her family members in attendance before delivering some heartfelt words.

“(Medford Leas) is an embodiment and living testimony to my parents’ lives and an example, I think, of what happens when people let their lives speak, as the Quakers say,” Chiyo said. “We hope that the community and spirit of Medford Leas will continue to live on and make a difference in the world.”

Before the short documentary was debuted, Moriuchi took a moment to thank the audience.

“Thank you all for coming to this wonderful affair,” he said, as his daughter held the microphone.

“Every last one of you, it was great to have you all here.”

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Medford Leas Distributes more than $114,000 in General and Nursing Educational Assistance Funds

This summer, Medford Leas will distribute over $114,000 in awards to its employees who are pursuing educational endeavor through two funds: The Nursing Educational Assistance Fund, and The General Educational Assistance Fund.

The Nursing Educational Assistance Fund distributes awards to employees who are pursuing education in the nursing field or other areas of healthcare. This year, fourteen staff members were awarded funds totaling $40,137 from the Nursing Educational Assistance Fund. 

The General Educational Assistance Fund distributes awards to employees dependent upon their length of service and number of hours they work. This year $73,870 was awarded to 36 employees from this fund. Many of the employees who are recipients of this fund are local students who work in the Medford Leas Dining Services Department.

These Educational Assistance Programs are a wonderful benefit to the employees of Medford Leas. In many cases these awards have enabled employees to carry on studies, which would have been difficult to accomplish without the assistance funds. Residents have long considered these awards to be a wonderful gift to those who provide such wonderful services to them throughout the year. 

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Lois forrest scholarship award is presented to lindsay gallagher

On Monday, June 16, 2008 the Medford Leas Residents Association (MLRA) awarded a $2,500 Scholarship Award to Lindsay Gallagher of Medford, NJ. The fund for this scholarship was established as a tribute to Lois Forrest, Medford resident, who for 21 years was the Executive Director of Medford Leas. Medford Leas residents organized the fund and made donations to it as a way to honor Mrs. Forrest at the time of her retirement in the spring of 2000. The award is based upon merit, community service, and academic achievement. 

A Senior Dining Room Server, Lindsay has been employed by Medford Leas since 2005. Having graduated from Bishop Eustace Preparatory School, Lindsey now attends Georgetown University as a Biology Major, with plans of pursuing either pre-med or environmental studies. An active outdoors person, Lindsay participates in hiking, backpacking, kayaking, rock climbing, and caving trips.

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Elderhostel and Medford Leas Present “Training Your Brain to Stay Young and Fit”

Elderhostel, the global leader in lifelong learning, will collaborate with Medford Leas to present a Day of Discovery program entitled “Training Your Brain to Stay Young and Fit."

The one day programs to be held on April 7, 11, 25, and 29, 2008, to be led by Medford Leas “Brain Trainers,” will focus on how older adults can stretch, flex, and extend their brain function in a dynamic program aimed to teach how to improve cognitive fitness.

Participants will take part in the nationally acclaimed computer based Posit Science Brain Fitness Program, engage in a fitness class designed to increase oxygen flow to the brain, and experience virtual sports through the use of “Wii”, the home video game system developed by Nintendo.

A Brain Healthy Lunch and tours of the Lewis W. Barton Arboretum on the grounds of Medford Leas will round out the activities for the day.

Cost per person: $67.

For more information, or to register, call 1-877-426-8056 or visit: www.elderhostel.org

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Medford Leas announces employee of the year

On Friday, February 22, 2008 Medford Leas located in Medford, NJ, recognized Denise Zaugra, as Employee of the Year. Denise was chosen from among the over 400 full and part-time workers employed by Medford Leas. Denise began her career at Medford Leas as a Licensed Nurse Practitioner in 2002. Denise exemplifies the spirit of the Medford Leas Community with her cheerful personality that she shares with both residents and staff on a daily basis.

Denise resides in Medford Lakes, NJ with her husband and two daughters.

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The Estaugh Board Appoints New Board President

 The Estaugh Board, a Quaker related not for profit corporation, is pleased to announce the appointment of Thomas E. Zemaitis as President of the Estaugh Board of Trustees. The Estaugh is the governing body for Medford Leas, a continuing care retirement community with campuses in Medford, and Lumberton, NJ.

Mr. Zemaitis, live in Moorestown, NJ, and is an attorney and partner with Pepper Hamilton, LLP located in Philadelphia, PA. His practice is concentrated in commercial litigation.

Mr. Zemaitis has served in leadership positions for many community-based organizations, including Moorestown Friends School, Women’s Law Project, Philadelphia Volunteers for the Indigent Program, and Support Center for Child Advocates.

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Nanotech, biotech: Seniors say the darndest things

Tuesday, August 7, 2007

By Betsy Anderson | For the Courier-Post MEDFORD

The college professor was discussing the ethical implications of mixing frost resistant genetic material from cold water salmon with that of thin-skinned tomatoes to make tomatoes easier to transport and to bolster the food supply.

“This is a new science,” acknowledges Dr. Mark Manion, associate professor of ethics and director of the philosophy program at Drexel University. “If you remember (pioneering geneticist Gregor) Mendel and his bean plants from your high school biology, it’s been less than 100 years since we've come all this way.”

The technological advances of the past century just happen to be something that this particular class could appreciate. Residents of the Medford Leas retirement community were the students at Manion’s lecture, “The Promises and Perils of New Mega-Technologies.”

And while they may not all be as familiar as younger college students with the mechanisms of biotechnology, nanotechnology and artificial intelligence, these class members had a quick grasp of the far-reaching impact of technological changes on society as a whole.

“It seems we have to find a higher motivation that transcends the profit motive and the power motive” in deciding how to apply the findings of technological research, Kay Cooley says during the lecture’s question-and-answer period.

“We need to talk to each other about all this. How much real dialogue is going on?” asks Toby Riley, an industrial researcher for IBM before starting his own company, Riley Systems Corp., to use the scientific method in management decisions.

“I’m very curious about Prince Charles’ condemnation of cloning I couldn’t help but feel it had a religious basis and then Nancy Reagan’s insistence that cloning be relied upon,” notes Nannette Hanslowe. “I’m after an ecumenical dialogue where we treat each other’s ideas with more respect,” she adds later.

And so it went during last week’s session at “Medford University,” a six-year-old Medford Leas’ program in which college professors discuss a wide range of subjects with residents here.

Manion, a Medford resident teaching his second course in the program, said the adult audience is an attentive one. “They are very alert and interested in what I have to say. They’re engaged and responsive and ask intelligent questions,” he says. “hey bring their life experiences to the table and aren’t shy about asking questions.”

His lecture included references to eugenics, deontology, utilitarianism and a system of futuristic totalitarian control illustrated in the Tom Cruz movie “Minority Report.” Manion also referred to “the citizen competency problem” a perception by some experts that some issues are too complex to be decided by the public. Paraphrasing Thomas Jefferson, Manion says the principles of democratic decision-making instead indicate “the solution is not to take decisions from the average citizens, but to inform them.”

Informing the citizenry, imparting knowledge for its own sake and keeping minds active are all goals of Medford University. Cooley established the program when she was president of the Medford Leas Residents Association with the help of Kris Dixon, then associate dean of cultural enrichment at Burlington County College.

“It was a niche that needed to be filled,” said Cooley. The program now features a fall and a spring program of six classes each as well as a four-part summer lecture series. Residents pay a small fee for the courses, which often are condensed versions of those the professor teaches on campus.

“Humanities are the most popular draw,” Cooley says, noting the fall and spring sessions attract between 100 and 200 students; about 50 attend summer lectures. Cooley is a retired Connecticut high school English, history and psychology teacher as well as a human resources staffer for a direct mail business. She recruits the speakers and manages enrollment.

Recent topics include “Film Studies,” “Ecosystems from the Pinelands to the Atlantic Shore,” “Italy in the Short Stories of Three American Writers” and “Views of the Ancient World: Sumer through Classical Greece." This fall, Kristin J. Jacobson, assistant professor of American literature and women’s studies at Stockton College, will direct course attendees to a Web site listing additional resources and to a chat room for follow-up discussion on American culture.

The Medford Leas program is an example of a national trend to develop college courses for older adults. Beyond Medford University, there is the One Day University program, currently active in the New York and Boston areas, but with plans to expand to Philadelphia and Washington, D.C. Some continuing care retirement communities are being built adjacent to college campuses to allow residents to enroll.

For the Medford University schedule, go to the Calendar page.

This article first appeared in the Courier Post, August 7, 2007.

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Medford Leas Receives Innovation of the Year Award

Medford Leas has been awarded NJANPHA's (New Jersey Association of Not-for Profit Homes for the Aging) Innovation of the Year Award for 2007, at the Annual NJANPHA Convention held in Atlantic City, May 31 - June 3, 2007. This award is presented in recognition of the year's most innovative program or service in a senior community, and one that makes an extremely positive impact on resident quality of life.

This award has been presented for the Cognitive Fitness and Brain Gym Program, which has been implemented by Gerry Stride, Director of Community Life at Medford Leas.  This program has been highlighted in feature articles in both The Inquirer and Burlington County Times.

Working in conjunction with San Francisco based company, Posit Science Corporation, Medford Leas residents are given a chance to give their brains a workout with a computer based program designed to improve the speed, accuracy, and strength with which the brain receives, records and recalls what people hear. 

In addition to the Posit Science Program, residents are engaged in additional programs to stimulate their brains through specific activities, which are designed to strengthen memory. 

Since its opening in 1971, Medford Leas has been recognized for its outstanding programs, facilities, and wide range of home design options. This award is especially meaningful to residents and staff who have participated in the program. 

Linda Schultz, Pam Fake, Gerry Stride, Director of Community Life, Davina Cornish, and Rachel Conte

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medford leas awarded carf-ccac accreditation

On May 3, 2007, CARF-CCAC announced that Medford Leas has been accredited for a five-year term. This latest accreditation is the 22nd consecutive year that CARF-CCAC accreditation has been awarded to Medford Leas.

An organization receiving a five-year term of accreditation has voluntarily put itself through a rigorous peer review process and demonstrated to a team of surveyors during an on-site survey that it is committed to conforming to CARF-CCAC’s accreditation conditions and standards. Furthermore, an organization that earns CARF-CCAC accreditation is commended on its quest for quality programs and services.

Medford Leas is a not-for-profit Quaker related community with campuses in Medford and Lumberton, New Jersey. It has provided a wide range of home designs, innovative services and programs, and superior health and wellness services to older adults for over 35 years.

The Continuing Care Accreditation Commission (CCAC) was founded in 1985 as the nation’s only accrediting body for continuing care retirement communities and similar organizations. Medford Leas played a vital role in the establishment of CCAC, and is proud to have been one of the first accredited CCRCs in the nation to earn this distinction. In January 2003, CCAC merged with the Commission on Accreditation of Rehabilitation Facilities (CARF), a nonprofit accreditation system founded in 1966 that touches more than 5.1 million individuals served in a wide range of human service organizations.

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The Estaugh Board Appoints
New Board Members

The Estaugh Board, a Quaker related not for profit corporation, is pleased to announce the appointment of David M. Barclay, MD, Paula M. Fairley, and Harry Scheyer, CPA/PFS,CFP to its Board of Trustees.

David M. Barclay, MD is a practicing physician with the Department of Family and Community Medicine of Temple University School of Medicine.  In addition, Dr. Barclay is an Associate Professor, Undergraduate Education, Department of Family & Community Medicine. He lives in Haddonfield, NJ.

Paula M. Fairley is recently retired from SES Americom, Princeton, NJ where she served as SVP, Human Resources and led the HR development and operations for the business in North and South America, Asia and the UK. Past business experience also includes fourteen years with General Electric, Penn Mutual Life Insurance Company and Travelers Insurance.  Ms. Fairley resides in Moorestown, NJ. 

Harry Scheyer received his CPA certification in 1975, and has been a Certified Financial Planner since 1982. Mr. Scheyer has worked for a number of firms, including E.I Dupont deNemours and KPMG Peat Marwick. He is cofounder and partner of Pinnacle Financial Advisors, LLC, with offices in Marlton, NJ and Bala Cynwyd, PA. A member of the Rowan Foundation Board of Directors, Mr. Scheyer is a resident of Medford, NJ.

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