I see life as a journey by foot through time. 

   Is there such a thing as a “pilgrim gene?” Travel writer and novelist Bruce Chatwin wrote of the “sacramental” aspect of walking. These days, a lot gets written about its therapeutic value for seniors like myself. 

   I have never given much thought to the practical benefits of my obsession. The post-war Bronx, New York, where I grew up, was haunted by a hushed word: Holocaust. No Jewish home was without it, without the distancing silence it opened up between parents and children, the loneliness contained in the unexplained. 

   I walked to get away from it, to map with my feet something that was my own, unshadowed: the soft spring light on gray buildings, the delicious silence of snow, the daggered wind. I bravely absorbed the wind. The wind absorbed me. Every gust I felt in my travels seemed a continuation of those first gusts in the Bronx. 

  Walking was the incubator of imagination. I’d find myself with Huck Finn, on his raft, navigating the Mississippi. Walking, you might say, on water. Passing the Chinese takeout as we oared deeper into the great river. 

   I was 80 when COVID hit. An inauspicious time to be an incorrigible walker. New York residents bandied back and forth a brand-new word—lockdown. Everyone was urged to remain housebound. Virtually all work places, including public libraries, and my Poets House, were shut down.  

  Immobility was more fearful to me than possible death. Immobility was death. Every morning I took my backpack and went out in search of a writing refuge. I’d pass block after block of empty streets and shops. The feeling of having wound up on an abandoned Hollywood movie set: New York at the end-of-days. 

   My shadow was the only shadow I encountered. If I cried out, no one would hear me. 

   After much searching, I found what I was looking for: a bench along one of the promontories of the Hudson River. I still go there to write. The joggers have returned. The yellow kayaks are back in the water. The past is back as though it had never been away.  

   I still remember stopping cold in the middle of a line. I’d be sitting in the sun, in the cool breeze of the river, hand poised dynamically in midair, and be jolted by the sudden awareness that all over the city old people like myself were lying stiff on gurneys.  

   Why them and not me? Who does the cosmic math that decides such things? Who turns the sun toward my face and away from theirs? 

   I’d walk back home slowly, my shame leaning heavily against my feet. Survivor shame. The shame my family felt towards relatives who disappeared into ditches in Poland. Gone one day as if they’d never been. 

   When the war ended, there was an outbreak of desperate walking throughout Europe. 

People looking for their past, for people who were part of their past, for homes and neighborhoods and hopes that needed to be reclaimed, or finally put to rest.  

   Sometimes, walking in my old neighborhood, walking is the only familiar thing I find. New layers of ethnic skin have grown over the old. New histories have replaced the old. After a while, even the soft edges of one’s nostalgia are blunted. You can’t outwalk loss. Losing, as the poet Elizabeth Bishop wrote, is an art. One that isn’t hard to master. It takes practice, she said. Aging gives us many opportunities for mastery. 

   I have lived for the past half century on Manhattan’s Lower East Side. Since COVID, one sees fewer old people in the streets. There is an emptiness beneath the sheltering trees of the Village View housing complex where many seniors live. The habit of indoor living is like any other habit. It revolves around itself. It atrophies itself from what is not itself. It sees the outside world from within, and pronounces it dangerous. 

  At Village View there lives a woman, who like myself, turned 85 last year. She leaves her house only to shop, to go to the doctor. When we were young, we were lovers and great friends, and the cafes and movie theaters we walked to were the extensions of our love.  

   Visiting her, I connect with the strange intimacy of walking. We didn’t walk as far as we thought we would. In my dreams, I walk without stopping. I am always walking. 

Robert Hirschfield is a New York-based writer and poet. He has spent much of the last five years writing and assembling poems about his mother’s Alzheimer’s. In 2019, Presa Press published a volume of his poems titled, The Road to Canaan. His work has appeared in Parabola, Tricycle, Spirituality & Health, Sojourners, The Moth (Ireland), Tears in The Fence (UK) and other publications.      

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The post A Walking Life appeared first on 3rd Act Magazine.

A friend of mine, a young man who always seems optimistic and full of life, recently told me he was feeling “blah” and kind of “down.” When I asked what he thought was the cause of this, he said he didn’t know, that he hadn’t ever felt this way.

I asked him several questions hoping to get an understanding of what he was experiencing. It seemed he’d lost interest in the activities that normally brought him joy. After talking some more it became apparent that he was experiencing malaise, the cause of which was being overly busy and not taking time for solitude and rest.

I know how that feels! I also sometimes feel out of sorts, even hopeless and despondent. Being retired from one’s career, newly single due to the death of a partner, or feeling that, as an elder, our options are more limited, can weigh heavily on us and keep us from feeling that we do, indeed, have a place in the world. Perhaps not the place we once had, but one that can still be meaningful and purpose driven.

What I have found is that if I don’t quickly do something when I’m feeling socially isolated or begin thinking I’m no longer needed in the world, I can get pulled down into depression.

Sometimes life can just wear us down. We may easily become overwhelmed. The thought of having to leave our house or apartment and run errands, attend meetings, or get to medical appointments is just too much. Performing the simplest of tasks becomes difficult. We no longer want to go out into the world. It’s just easier to stay at home and hope something will change.

I once heard a young woman talking about how she had trouble getting dressed in the morning and often spent the day on her couch rather than getting out and doing what she needed to do. She said, “I know this might sound simplistic, but what I have to do to get up off the couch and dressed is to say out loud, ‘up and out!’” She went on to explain how it’s like a mantra she repeats over and over in order to hoist herself up, walk to the bedroom, find some clothes, go to the bathroom, put on makeup, get dressed, find her purse, and walk out the door.

“Up and out!” “Up and out!” “Up and out!”
I can relate to that. To this day I can find myself on a metaphorical couch, unable to do what I know I need to do in order to get on with my life.

I also had a friend, now gone, who, after a stroke, was aphasic and didn’t have full use of one side of his body. Despite this he got up every morning, showered, shaved, and dressed as if for work. He knew that if he didn’t, he would slowly give up on life.

In the Book of John there’s a story where Jesus encounters a lame man who’s been lying for many years beneath the portico surrounding a pool of water that was believed to have healing powers. The man told Jesus he had no one to help him get up and make it into the water.

In response Jesus says, “Stand up, take your mat and walk.” He did and was healed. Jesus seems to have touched something in the man that rekindled his ability to motivate himself to take action. The fire within him was reignited, which then gave him the impetus to overcome what ailed him and to then begin to live again.

When the young woman said aloud “up and out” she called on a source within herself to overcome her lethargy. My friend used his willpower and determination to keep himself going. The man by the pool asked for help to be restored to wholeness and he was.

No matter our situation, we, too, can summon the resources within ourselves needed to become motivated and energized. If it seems too overwhelming, we can ask for help from loved ones, caregivers, or a higher power.

And remember: “Up and out, up and out, up and out!”

Stephen Sinclair holds a Master of Divinity from Meadville Lombard Theological School in Chicago, and is an ordained Unitarian Universalist minister. He’s been a pastor and chaplain in a number of churches and hospitals in the U.S., and has worked with the homeless. He lives on Capitol Hill in Seattle.

Read More by Stephen Sinclair:

Que Sera, Sera

That Box of Chocolates We Call Life

Mind the Spirit—What Do You Believe?

The post Mind the Spirit—Getting Up and Out When You’re Feeling Down appeared first on 3rd Act Magazine.

By JEANETTE LEARDI

According to the U.S. Census Bureau, in January the world’s population surpassed 8 billion. Because of improvements in public health and advanced treatments for chronic disease, there are more people everywhere and they are living longer. In this century—and for the first time in human history—our planet is inhabited by more people over the age of 60 than under the age of five.

And while this trend is good news for us older adults, it also poses some challenges, mainly because our bodies change as we get older. Our cells gradually lose some of their ability to ward off infection or other potential environmental damage and aren’t as efficient in repairing or reproducing themselves when the need arises.

While aging itself isn’t a disease but is instead a natural process, it does make us more prone to develop certain chronic diseases such as arthritis, cancer, hypertension, heart and pulmonary disease, and dementia. The National Council on Aging reports that about 95 percent of Americans ages 60 and older cope with one chronic condition and about 80 percent deal with two or more.

But biology isn’t the only way in which we elders differ from middle-agers. Our emotional and social needs change over time, and often our goals change as we envision a different life purpose. We can also find ourselves affected by negative cultural attitudes and public practices that often marginalize us and present us with greater challenges in maintaining our quality of life.

Fortunately, specially trained doctors called geriatricians can help us navigate the landscape of our later years. What do they do and when should we consider consulting one for our care?

A Person-Centered Approach

“When I tell people that I am a geriatrician,” says Suvi Neukam, DO, assistant professor of internal medicine and geriatrics at Oregon Health & Science University in Portland, Ore., “it is not uncommon for them to assume that I only ‘help people die.’ Sure, death is a part of geriatrics, but goodness, there is so much more to the field of aging.”

In addition to advising patients about hospice and palliative care, Neukam is responsible for helping them with the maintenance of their physical function and cognitive health, reduction of medications, care planning, and addressing their concerns regarding falls, bone health, urinary incontinence, and delirium.

“A 70-, 80-, 90-, or even 100-year-old is quite different from a 20-, 30-, 40-, or even 50-year-old,” she explains. “They are in a different chapter of life with different medical considerations, a different social context, and different existential questions and values.”

Wayne C. McCormick, MD, MPH, professor in the Department of Medicine at the University of Washington and head of the Division of Gerontology and Geriatric Medicine at Harborview Medical Center in Seattle, would agree. “As we reach advanced age,” he says, “there are natural changes in kidney, heart, and liver function that change the way medicines are metabolized and cleared. Some medicines may last twice as long in the body when you are 90 versus 55.”

He nevertheless clarifies that “a solid majority of U.S. citizens over age 75 are completely healthy and independent. Most do not need a geriatrician. When an older person in their 80s or 90s has multiple medical issues, cognitive and/or functional debilities, and trouble with falls or sensory impairments, it’s time to consider a geriatrics evaluation.”

For her part, Neukam believes that geriatricians don’t invariably “do less” for their patients. Instead they “do differently” by considering how each patient’s personal values and goals interface with the medical condition at hand. And that often means doing more, not less, in terms of personal care.

Says McCormick, “We focus on patients with multiple problems and seek practical objectives, embracing the patient’s goals verbatim. If they want fewer meds, you aggressively work on that. If they want a house call versus a clinic visit, you do a house call. If they do not want life-saving measures if seriously ill, you adhere to that wish.”

Providing such person-centered care involves a different way of practicing medicine. Geriatric office visits are usually more involved and last longer than the average 15 to 20 minutes that most general primary care physicians spend with younger adult patients.

Unfortunately, this difference comes at a cost to doctors who choose to be geriatricians. Because their patients are on Medicare, which has lower reimbursement rates than those of commercial insurance, a board-certified geriatrician makes about $20,000 less than internists who see a wider age range of patients. This inequity can be a factor in discouraging many medical students with large student loan debts from specializing in geriatrics.

And this has resulted in a huge problem in elder health care.

Wanted: More Geriatricians

Currently, the U.S. has a serious shortage of geriatricians. In March 2023, a total of 7,300 physicians—fewer than 1 percent of all doctors—were board-certified in geriatrics. Some public health experts estimate that our healthcare system should have more than 25,000 geriatricians to keep pace with the growing older population, and by 2030, we’ll need at least 5,000 more. Yet, according to the American Geriatrics Society, of our 183 medical schools surveyed in that same period last year, only 11 of them had full departments of geriatrics.

Low wages may not be the entire reason for this dearth of specialized training. Medical school students tend to encounter patients of advanced age primarily in hospital settings under highly stressful, acute circumstances, and may assume that there is little upside in treating people who don’t have much longer to live and therefore it’s futile to try.

Neukam reflects on the possibility that ageism might be at work. “Geriatrics is not prestigious. Is this a reflection of a lack of intergenerational respect in our society? Or perhaps an anti-aging mindset? Or a belief that medicine is only about ‘fixing’ and ‘curing’? I’m not sure.”

What can be done to grow the field of geriatrics to meet the needs of an ever-larger elder population?

Neukam suggests establishing new medical school loan forgiveness programs as well as increasing Medicare reimbursement and expanding its coverage to include “in-home care, caregiver support, long-term and memory care, nonpharmacologic treatment options, geropsychology, and hearing aids.”

McCormick offers an equally wide-ranging solution: “When all medical students receive comprehensive geriatrics training as part of medical school, we’ll be in better shape.”

There is an irony in the many negative perceptions of the field. According to the American Geriatrics Association, “geriatrics ranks among the most satisfying health professions …[and]geriatricians ha[ve]the highest job satisfaction of physicians practicing in any subspecialty. Geriatrics health care professionals cite their encounters with inspirational older adults, the deep and meaningful relationships they develop, and the typically steady work hours as significant factors adding to their job satisfaction.”

“People of very advanced age bring tremendous wisdom to every encounter,” says McCormick, “if we’d only take advantage of it. It is profoundly satisfying to follow these patients on their final journeys, and to let them know you’re going to stick with them, no matter what.”

“We truly like spending time with elders, and in my experience, this sincere enjoyment is mutually felt during inpatient visits,” says Neukam. “Many of us would say ‘The patients chose us.’”

Whether or not each of us seeks out the expertise of a geriatrician for our care, one thing is certain: Geriatricians can have a promising future…only if society chooses to care for them as well as they care for us.

Jeanette Leardi is a Portland-based social gerontologist, writer, editor, and community educator who has a passion for older adult empowerment. She gives popular presentations and workshops in journaling, memoir writing, ethical will creation, brain fitness, creativity, ageism, intergenerational communication, and caregiver support to people of all ages. Learn more about her work at jeanetteleardi.com.

Looking for a Geriatrician?

To locate a board-certified geriatrician in your area, visit these websites:

https://www.healthinaging.org/find-geriatrics-healthcare-professional;

https://www.certificationmatters.org;

https://www.abim.org;

https://www.theabfm.org

A World of Wellness— Medical Tourism is on the Rise

The Benefits of Slow Medicine

The post Rx for Elder Health Care: Geriatricians appeared first on 3rd Act Magazine.

By DR. ERIC B. LARSON

In 1978, as I completed my residency and fellowship training and joined the University of Washington faculty, I had a dizzying array of interests.

Aging, and especially the aging brain and dementia, piqued my curiosity, although dementia research and care were not then in the mainstream. Demographic forces portended we would need a lot more research to understand aging processes. The predicted growth of many persons living to advanced old age is now a fact of life. But in the late 1970s, dementia occupied the backwaters of academic medicine. Back then, those who lived into their late 70s, 80s, and beyond and became impaired were typically seen as just experiencing old age or normal senility. Alzheimer’s disease was considered a cause of pre-senile dementia—described decades earlier in the rare, strange case of a middle-aged woman.

Changing demographics predicted a “silent epidemic of dementia in the elderly.” A growing fear of dementia likely contributed to the explosion of interest in Alzheimer’s disease and related dementias since the late 1970s—fueled partly by increased federal funding for research and awareness when a revered former president, Ronald Reagan, withdrew from public life with Alzheimer’s disease.

One recollection I have is of a poll asking doctors what disease they feared most. Many expected doctors might fear a common killer disease like cancer or possibly a heart attack. The surprising result was that the disease doctors feared most was Alzheimer’s disease, now recognized as the most common cause of dementia. Today, ongoing research has vastly expanded what we know about the aging brain and Alzheimer’s disease and related disorders.

No Magic Bullet Cure

Many wish for a cure. Perhaps a vaccine that might eliminate the risk altogether, or a magic bullet that provides a cure for those who develop Alzheimer’s. Nothing like this exists today.

Vast amounts of federal and industry resources have supported science in search of that “magic bullet”—a pill to prevent or cure Alzheimer’s. One drug has recently been approved and another is expected to be approved soon. These drugs are designed to remove amyloid, a degenerative protein implicated in Alzheimer’s. They are expensive, have serious side effects, and do not actually cure or prevent the disease; rather they modestly slow the rate of decline in carefully selected persons. Some smart alecks say the best way to avoid dementia as we get older is to die young!

Focus on Prevention and Risk Reduction

A smart—not a smart aleck’s—approach to epidemics like dementia is to find ways to prevent and reduce the risk of dementia as we age. Prevention research has focused on finding factors that increase the risk for dementia, especially so-called factors that are potentially reversible or at least modifiable.

The Lancet Commission on Dementia—comprised of international experts—has produced two reports and is about to publish its third. The second report estimates that 35 to 40 percent of the risk for late-onset dementia is accounted for by potentially modifiable risk factors. The keywords here are “potentially modifiable.”

A Glimmer of Hope—The FINGER Study and Trial

Is there a better, smarter way to control this epidemic? Might it be smarter to find ways to reduce risk by discovering ways to make changes based on these “modifiable” factors and see if they actually work? Several mostly international studies designed to reduce dementia risk have been published. One promising study, FINGER, or the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability, focused on nutritional guidance, exercise, cognitive training, social activity, and management of metabolic and vascular risk.

The dementia research field greeted the modestly beneficial results of the FINGER trial with enthusiasm. So-called mini-FINGER trials were launched in the U.S. and around the world. Earlier research had failed to show the cognitive benefits of efforts from changing potentially modifiable risk factors. FINGER provided a glimmer of convincing evidence supporting this concept.

Targeting Risk Factors for Better Results—SMARRT Study and Trial 

A just published new report sheds more light on the prospect of modifying risk factors to reduce cognitive and dementia risk. The study known as SMARRT, or Systematic Multidomain Alzheimer’s Risk Reduction Trial, was released electronically on Nov. 23, 2023, and published in JAMA Internal Medicine journal in January. As the first personalized intervention, SMARRT focuses on maintaining or improving multiple areas of function. This is done by targeting risk factors based on participants’ risk factor profiles, preferences, and priorities. The research team from Seattle and San Francisco who designed the study believed that a personalized approach was better than the one-size-fits-all approach used in previous research. In a planning survey of 600 older adults in Seattle, we found that most were concerned about Alzheimer’s disease. They wanted to know their personal risk factors and were motivated to make changes to lower dementia risk.

The two-year study of 172 persons, ages 70-89, at elevated risk for dementia found that participants in SMARRT had a modest but statistically significant improvement in cognitive testing of 74 percent compared to the control group. Participants also had improvements in measurements of risk factors (145 percent) and quality of life (8 percent).

The SMARRT program involved participants meeting with a health coach and nurse followed by coaching sessions. Initial visits were in person but due to the pandemic, all sessions were switched to phone. In the sessions, risk factors selected by participants were reviewed. Coaches and participants met once per month. Coaches offered advice and discussed progress toward goal achievement including tracking hypertension with a home blood pressure monitor, walking a certain number of steps each day, signing up for a class, and challenges to achieving goals. In addition to tracking progress participants could add new goals. The most common risk factors that were worked on were physical activity (95.1 percent), hypertension (76.1 percent), sleep (52.4 percent) depressive symptoms (45.1 percent), and social engagement (41.5 percent). The less commonly chosen risk factors (<25 percent) were risky medications, diabetes, and smoking.

Compared to other trials of this type, the beneficial change in cognition, while modest, was greater. I believe the SMARRT results occurred because participants were motivated to try to avoid cognitive decline, were prompted to make personal goal choices, and were able to monitor and share their progress, including, for example, by tracking increased physical activity and monitoring blood pressure.

The SMARRT study results point to the “smart” approach for individuals and those working to reduce the impacts of dementia and cognitive decline in our communities.

As awareness of Alzheimer’s disease and dementia has grown, more people have become motivated to find ways to promote cognitive health. The good news is that improvements in these risk factors also promote general health and well-being. Changes don’t have harmful side effects or the high costs associated with new drugs.

The distinguishing feature—what made the SMARRT study so “smart”—was that participants chose personal targets that resonated with their lives and values. They kept track of their progress, even moving on to other targets. Smart, SMARRT moves!

Eric B. Larson, MD, MPH is a Professor of Medicine at the University of Washington. He was co-Principal Investigator of the SMARRT trial and formerly Vice President for Research and Healthcare Innovation at Group Health and Kaiser-Permanente Washington. With colleagues, he co-founded the long-running Adult Changes in Thought (ACT) study in 1986. He continues research through the UW Alzheimer’s Disease Research Center and other projects. He has participated in The Lancet Commission on Dementia since its inception. With co-author Joan DeClaire he wrote the well-received book, Enlightened Aging: Building Resilience for a Long Active Life.

More 3rd Act Articles on Alzheimer’s and Dementia:

The Latest Science on Beating Alzheimer’s

The Four C’s of Alzheimers

Why We Struggle to Prevent and Treat Dementia

Older Adults with Dementia without Close Family

Older Adults with Dementia

The post The Hard Truth about Dementia appeared first on 3rd Act Magazine.

Two days before the winter solstice I drove from my home in Columbia City to Capitol Hill to meet Steve Durrant at the Tailwind Café, which is tucked inside the Good Weather Bicycle & Repair shop on Chophouse Row, a cozy alley of restaurants and shops just off Union Street in Seattle. I would have taken the light rail, but I was picking up prescriptions for my 90-year-old father right after our meeting, I had a Christmas-related errand to do in the University District, and a cold December rain was settling into a steady pour. I didn’t mention any of this to Durrant, who bicycled to the café from Fremont and arrived looking barely touched by the rain.

There are lots of people like me in the Northwest, who love to walk or ride a bike, but regularly lame out. Durrant has devoted much of his career to encouraging us to change our habits,  not by scolding or lecturing but by designing good routes and trails for the likes of you and me.

In 2015, Durrant was named a Fellow of the American Society of Landscape Architects—one of the organization’s highest honors—in recognition of his exceptional contributions to transit, park, greenway, and on-street bikeway design. He was just about ready to retire after “a first and second act doing stuff that I really loved,” when a third act project he couldn’t resist came along—the Puget Sound to Pacific (PS2P for short) Trail. When completed, the 200-mile trail will stretch from three different starting points—the Bainbridge Island, Kingston, and Port Townsend Ferry Docks to La Push on Washington’s Pacific Coast. The goal is to “build a full-service, multi-use trail, at least 10 feet wide, with grades accessible for ADA (American Disabilities Act),” says Durrant.  In other words, to make every one of those 200 miles accessible to all. Many sections will have unpaved shoulders for people who prefer to walk or run off pavement, and some segments will include parallel equestrian trails. There are 100 miles of 34 yet-to-be-connected gaps needed to complete the full 200-mile trail.

The Puget Sound to Pacific Trail (PS2P) Coalition

The first 100 miles came about through decades of hard work by the Peninsula Trails Coalition, whose signature project is the Olympic Discovery Trail from Port Townsend to the Pacific Coast. The coalition’s work caught the eye of the national Rails to Trails Conservancy, whose mission is to create the coast-to-coast Great American Rail Trail, stretching some 3700 miles from Washington, D.C., to the western edge of Washington state. They encouraged the Coalition to apply for a $16 million federal grant to design the remaining 100 miles. Counties, tribes, cities, and towns across the Olympic Peninsula got on board. U.S. Rep. Derek Kilmer and Senators Patty Murray and Maria Cantwell endorsed the project. The grant was secured. And Durrant put off his retirement.

“It wouldn’t have happened if it weren’t for Steve,” says Barbara Trafton of the Bainbridge Island Conservancy, a partner in the PS2P project. “He brings his passion and expertise. He thinks so creatively about how to make things happen.” Durrant, she adds, is fearless about “totally changing the map permanently. I mean, once these trails are in place, they’re there forever.”

“This has been an opportunity to continue doing what I love to do,” says Durrant, modest to a fault, whose career includes developing a bicycle master plan for the entire city of Seattle. “There’s a big part of it that’s selfish because I’m a cyclist,” he says, “and part of it is altruistic—for people I know and future generations.” But what really drives Durrant are projects that encourage a healthier, active lifestyle and contribute to the societal greater good. He shares that “even as a kind of lifelong advocate and nerd in cycling when we started doing research into the health benefits of cycling, and the dollar value of those health benefits, the numbers are shocking—even for a believer.”

According to Lawrence D. Frank, professor of Urban Studies and Planning at the University of California San Diego and president of Urban Design 4 Health, research shows that when people have access to active transportation such as safe trails and routes for walkers, runners, and cyclists, “the resulting increase in physical activity translates into a host of chronic disease reductions, ranging from cardiovascular disease and diabetes to depression and dementia.” What this can mean is better physical and cognitive health in later life.

To Frank and Durrant, the health benefits of trails are every bit as important, if not more important, than the access they give us to the beauty of the natural world. Though that’s certainly an undeniable benefit. When I asked Durrant about his favorite stretch of the PS2P, he described it this way: “One of my favorite spots is Lake Crescent, where the Olympic Discovery Trail passes through the forest parallel to the Sol Duc River. It zigzags back and forth, and there are places there, maybe 20 miles, where the trail is like a cathedral.”

Trafton also named the Sol Duc/Lake Crescent stretch as a particular favorite, although she loves the Bainbridge section, “because it’s home,” and because it will have a huge impact on Bainbridge life. Six of the island’s seven schools are close to the trail; pedestrians and bicycle commuters like her will be able to make use of it, too. “It’s really so gratifying,” she says, “to see this map changing and to know that this is a gift that will last long after I’m gone. Hopefully, other people will carry it on. I’m just so intensely grateful to Steve for coming out of his recent retirement and wanting to connect with people to make it happen.”

Professor Frank, who coined the term “walkability,” concurs. “Steve understands the politics and the dynamics of what it takes to get stuff like this built,” he says. “He has decades of experience overseeing the development of active transportation plans. He has both background and understanding of the research, but he’s also got that practical project-based experience.”

Durrant has all of those qualities. But he’s also been on this path, pardon the pun, all his life. He grew up in Minneapolis/St. Paul, where people bike year-round. In the snow. In sub-zero temperatures. He rode his bike to elementary and high school.

As I listened to his stories of winter biking in Minnesota (and in Oulu, Finland, known as the winter cycling capital of the world—not only a favorite place of his but also not far from where half my ancestors came from), I felt more and more sheepish about my compelling “reasons” for driving to the Tailwinds Café for our interview. But I also felt inspired. Durrant’s enthusiasm is infectious, in a low-key, Minneapolis-born, Finnish-friendly way. I’d like to be part of that statistical story of improved health via active transportation.

And I look forward to biking that section of the PS2P that goes through the cathedral forests surrounding the Sol Duc River. When I do, I’ll take a moment to think about what Trafton said—what a gift this remarkable trail is to the bikers and hikers of the future who will get to enjoy it too, whose health and well-being will benefit from the PS2P long after the people who worked so hard to make it happen are gone. Long after Durrant came out of retirement and changed the map.           

Ann Hedreen is an author (Her Beautiful Brain), teacher of memoir writing, and filmmaker. Ann and her husband, Rustin Thompson, own White Noise Productions and have made more than 150 short films and several feature documentaries together, including Quick Brown Fox: An Alzheimer’s Story. Ann is currently working on a book of essays and is a regular contributor to 3rd Act Magazine, writing about topics including conscious aging, retirement, mindfulness, and health.

Photo: Steve Durrant high-fives Congressman Derek Kilmer on the trail after the grant was announced.

Photo courtesy Bainbridge Island Parks & Trails

Here are more ways to discover beautiful Washington State:

Discover Northwest—A Day (or three) at The Beach

Discover Northwest—Cape Flattery Tribal Scenic Byway

Discover Northwest—Cape Flattery Tribal Scenic Byway

Discover Northwest— Whidbey Scenic Isle Way

Whidbey Scenic Isle Way

The post Discover the Puget Sound to Pacific Trail (PS2P) appeared first on 3rd Act Magazine.

More than one in four older adults falls every year, according to the Centers for Disease Control and Prevention. Fortunately, most falls are preventable.

Strength and balance training is one of the CDC’s top recommendations for preventing falls. I have witnessed my personal training clients achieve significant improvements in their strength and balance, reducing their fall risk and enhancing their quality of life.

Real People, Real Results

For Jack, 81, our workouts helped him play his best tennis ever. We practiced forward and lateral balance, enabling Jack to move around the tennis court with confidence.

Janet, 69, aspires to hike every trail in her guidebook, 100 Classic Hikes: Washington. Our workouts provide a safe environment to practice walking on unstable surfaces. We use a balance pad, BOSU ball, and half-round foam roller to simulate the uneven terrain of her planned hikes.

Melody, Dave, Gary, and Lesley, ages 60-72, have formed their own exercise group to motivate each other. I’ve witnessed increases in their strength, along with the ability to perform increasingly challenging balance exercises.

Balance-Improving Exercises

One way to assess balance is the single-leg stand. Stand on two feet behind a sturdy chair, then lift one foot off the floor. Count the number of seconds you can hold this position before putting your foot down. Once you can hold it for 20 seconds, you can progress by closing your eyes.

Remember: Perform all exercises described here safely. Stand behind a chair or within arm’s length of a wall, so you can steady yourself if necessary.

To improve dynamic (moving) balance, I like the tightrope walk. Walk forward in a straight line using a heel-to-toe gait, like walking a tightrope. To make it easier, instead of walking heel-to-toe, take longer steps for increased stability.

Lateral balance is also important, for example, when getting out of a car, or when stepping sideways to avoid an obstacle in your path. Try the box drill—step sideways into an imaginary box, one foot at a time, then step back out again.

Down But Not Out

One study on balance training for older adults theorizes that falls are most likely to occur when our attention is divided.

A client in his 80s was on a sightseeing walk with his grandchildren when he tripped and fell over a crack in the sidewalk. He told me that he’d been so focused on enjoying the scenery that he forgot to watch where he was walking. Fortunately, he was unhurt. He had been doing strength training consistently and I believe this helped his bones, muscles, and joints overcome his fall.

The study recommends that balance training should incorporate dual- and multi-task exercises. Try this: Stand on one leg while performing a weighted bicep curl with one arm.

Better balance is achievable. Many exercises require no special equipment. As a personal trainer, I recommend a regimen of strength training and balance-specific exercises for reducing fall risk and improving quality of life.

Mike Harms owns a personal training studio in Edmonds, Wash. He is certified in training older adults. Learn more at http://www.mhfitness.com.

The Quest for Strength

Build Your Bones

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What happens to older adults who do not have close family when they develop dementia? The truth is, we hardly know.

Population aging together with changing patterns of marriage and childrearing mean that growing numbers of people in North America reach advanced ages without a living spouse or children. This matters because the incidence of dementia increases with age, and considerable support and care are needed to live well as the condition progresses. The vast majority of this care is provided by spouses and children.

There is reason to worry that older adults who lack family in these two relationship categories may be vulnerable if they develop dementia. Until now, however, very little research has examined the topic.

Older adults with dementia without close family

I am a medical anthropologist and I research social and cultural dimensions of illness and health care. (I am also the daughter of a mother who lived with dementia for a very long time).

Our team has worked with information collected as part of a long-running medical research study of dementia called the Adult Changes in Thought (ACT) study. Since the early 1990s, this study has been following participants recruited from the membership of an integrated health-delivery organization in Seattle to identify those who develop dementia.

Our team has been examining the research data and administrative documents generated by the ACT study, with an eye to what they can tell us about the circumstances and needs of older adults who were kinless when they developed dementia.

Qualitative analysis of ACT administrative documents, some of which contained clinical chart notes from participants’ medical records, proved to be an especially rich and informative source of data.

Surprising findings

We recently published what we believe is the first article on kinless older adults with dementia, and some of the findings might surprise you:

• This circumstance is not rare. In our sample of community-dwelling older adults, we found that 8.4 percent were kinless at the time they developed dementia. (This is probably a conservative estimate because more would likely become kinless after the onset of dementia, upon the death of a spouse and/or child).

• This is a predicament to which anyone may be susceptible. The life trajectories that led people in our sample to be kinless at the time they developed dementia were quite varied. Some had never married or had children, but others had outlived both spouses and children.

• The average age of the kinless older adults in our sample at the time they developed dementia was 87. Half were living alone at that point, and one-third were living with unrelated persons such as hired caregivers. Most were women who became kinless late in life and unexpectedly.

• A person’s role as caregiver (at the time they developed dementia, or prior to that) could have important consequences for their own ability to access care. For example, some in our sample had previously moved to a residential setting to meet the needs of a spouse, which could mean that they were well situated to access care later. On the other hand, at least one of the 64 kinless older adults with dementia in our sample was serving as caregiver for a roommate (who also had dementia), which triggered an intervention when it led to a situation that was dangerous for both parties.

• Some of the kinless older adults in our sample seemed to have little support, but others received considerable support from relatives such as nieces, nephews, sisters, grandchildren, and others.

• Some received support from neighbors and friends that could in some cases involve quite extensive hands-on care. In many instances, however, neighbors and other community members appeared to have gotten involved only at moments of crisis, as a form of rescue.

This research affords a rare window into the circumstances and needs of a potentially very vulnerable group that up to now has remained largely invisible. Our findings have implications for clinicians and health systems, but also for society more broadly.

“Who cares?” is, on one level, an informational question about caregiving networks—one that our team, through this research, has begun to answer. On another level, however, “who cares?” is a provocation. The predicament of kinless older adults with dementia should provoke all of us to work to better support people facing a form of precarity that anyone may be susceptible to in late life.

Janelle S. Taylor is a professor in the Department of Anthropology at the University of Toronto. Her research focuses on social and cultural dimensions of illness and health, and over the years has addressed a range of topics, including reproductive technology and medical education as well as dementia and caregiving.

Credit: Previously Published in The Conversation

Tips for Solo Agers

 For people who are aging solo, this research offers no easy answers, but it does point toward some questions worth considering:

• Would your current living situation make it easy to access help and support, if you should need it in the future? If not, consider looking into available options sooner rather than later.

• Have you ever spoken with your health care providers about your living situation, who is most important in your life, and/or your concerns about your future? Having such information may help them better support and care for you.

• Do you have an active network of social relationships? Neighbors, friends, fellow volunteers, fellow members of clubs or other organizations can all be valuable sources of support.

• Are publicly supported dementia programs available in your area? If not, consider getting involved in efforts to advocate for them.

• Have you thought about what would be your wishes (for medical care or for your finances) if in the future you were unable to articulate them? Have you talked about these matters with people close to you and documented them in ways that can have legal force?

Related stories:

Time to Get Real About Aging in Place—the biggest challenge of aging in place is the profound shortage of people—both family members and paid—to care for us.

Moving Closer to Your Family—Longer term, it will benefit you because at a time you may need help, your family will live closer and know you more deeply.

The post Older Adults with Dementia without Close Family appeared first on 3rd Act Magazine.

BY CONNIE MCDOUGALL

At 6 feet 2 inches and 250 pounds, wearing full-body protection, Alan Moe makes a formidable assailant. So it feels pretty liberating that, at 73, I’m slamming an elbow into his helmeted face then sending a swift kick to his padded groin. It’s an excellent way to practice self-defense skills without worrying about hurting him. Too much. “I can take the hits but sometimes I get my bell rung,” he laughs. “It’s an honor to give people the experience of using full force.” And it’s especially important to know skills of self-defense as we age.

He role-played the bad guy at a one-day class led by instructor Andy Wilson, 52, owner of the martial arts school, MKG Seattle, where self-defense students learned the five A’s of personal safety: Attitude, awareness, avoidance, assessment and action.

“Being prepared mentally is half the battle,” Wilson says. “Having the right attitude includes how you carry yourself—shoulders back, eyes up, confident with a good stride. You don’t look like a victim.” Awareness also means to trust your instincts. “If you’re uncomfortable, don’t ignore it. Pay attention to those feelings.” Be alert to inadvertent signals, he says. Flashing expensive tech draws unwanted attention. “If an attacker sees something valuable, including jewelry or a watch, that’s a target. Keep any signs of wealth out of sight,” he advises.

Situational awareness is essential, yet people walk around with their heads down, fiddling with a smartphone. “Not only is that a distraction but it takes away the very senses you need,” Wilson explains. “That goes for earbuds and headphones, too.” Being alert allows for another skill—avoidance. “Your best option is always to avoid a problem if you can. Cross the street. Go into a store. Run away. There’s a phrase in self-defense: Distance equals time equals options.”

If it comes time to do something, a quick assessment is in order, Wilson says. Look for a way out. Are there people nearby? Is there a car, a door, anything that can be used as a barrier? Escape is always the first priority. Then, depending on the threat level, taking action follows a force continuum, which starts at one, do nothing, ramping up to five, maximum force. Level one isn’t passivity. “If someone has a gun to your head and wants your purse, give it to him,” says Wilson, “and be a good witness to give police information.” Sometimes it’s best to be verbally assertive. “Take a step back and give clear commands,” he says. “That can be calls to stop or back off. But if he keeps coming and gets in your face or grabs you, defend yourself.”

That means total commitment. “At level five we say, go nuts and go home,” Wilson says. Aim for the most vulnerable parts—eyes, throat, groin, knees and feet. He offers this pointed prompt: balls and eyeballs. “One of those will always be open. If he’s protecting his groin, his eyes are vulnerable. If his hands are over his eyes, his groin is vulnerable.” It’s not a matter of inflicting pain, he notes. “People high on drugs may not feel pain. It’s about getting a reaction. A thumb in the eye or a hit to the throat; everyone reacts to that. And then you escape.” If something isn’t working, try something else, like stomping on the top of a foot. “We don’t advocate punching, though,” says Wilson. “Effective punching depends on ability and mass.” The idea is not to defeat an assailant or knock him out. It’s to discourage and end an attack, then escape.

Weapons are a personal choice, Andy says, but if you’re going to carry something, including pepper spray, know how to use it under stress. “And remember, a weapon can be taken away and used on you.”

In his self-defense classes, ages range from teens to people in their 80s, but the strategies are the same for everyone. “I tell people, do everything to the best of your ability and modify according to those abilities,” Wilson says. “In class, you get a good sense of your strengths and weaknesses. Most important, it promotes thought.”

Taking the class was freeing for 58-year-old Mary O’Brien, especially being told to shout “No!” when delivering a kick or chop. “Nice girls don’t yell,” she laughs. But even more, as a nurse who must walk to and from her car in downtown Seattle, and as a woman who experienced sexual assault in the past, she found empowerment. “I feel a greater confidence to respond by setting boundaries to protect myself, my community, and even for the perpetrator’s own good,” she says, “because wounded people don’t get a license to wound others.”

Connie McDougall is a former news reporter, and current freelance writer of nonfiction and personal essays. A lifelong student and proud English major, she has pursued lessons in flying, scuba diving, tai chi, Spanish, meditation, hiking, and Zumba.

To protect yourself you also need to be strong. Check out these articles on gaining strength as we age: 

The post Self-Defense as We Age—When No Means No appeared first on 3rd Act Magazine.

Throughout my career I have often asked older patients and research subjects if they want to live to be 100. The most common answers are, “Yes,” “Yes if I can stay healthy,” or “I can’t imagine living to 100 with all the disabilities of old age and being a burden to others.”

Gerontologists, other scientists, and popular writers study populations and geographic areas experiencing remarkable longevity (Blue Zones, for example) looking for common genetic traits and lifestyles that characterize long-lived families and individuals.

I am fascinated by what we can learn from the stories from persons who live so long. All of us experience personal changes, triumphs along with adversities. Persons living to 100 must adapt and carry on in the face of life’s adversities—for a long time.

I recently enjoyed reading The Book of Charlie: Wisdom from the Remarkable American Life of a 109-Year-Old Man by David Von Drehle. People often asked Charlie White his “secret” of longevity. His answer: “It was just luck.” He avoided dying in a freak accident through no actions of his own. His genome didn’t predestine him to get early heart disease or a stroke. Even as a smoker he believed “luck” allowed him to avoid lung cancer, while others, with less luck, who never smoked, got lung cancer.

Persons living to 100 years old—less than one half of one percent, according to the Social Security Administration and even fewer who live years beyond 100—can teach us a lot through their stories and experiences about navigating the bittersweet nature of life.

Resilience, the ability to bend, not break in the face of adversity, loss, or sorrow characterizes thriving centenarians. Evangeline (Van) Shuler, an extraordinary research subject featured in the book I co-authored with Joan DeClaire, Enlightened Aging, traveled, at age 100, from Seattle to Argentina to dance in a tango festival. Earlier, she’d experienced the unexpected death of her husband while the pair were working as “retired” Peace Corps volunteers in India. Despite her loss, she returned to India to complete her tour of duty. After age 100, when she lost friends, her secret was to “make new friends.” When she needed to move from independent to group living, she organized a breakfast table and her requirement for membership was to “bring a joke to breakfast everyday.” As an avid reader, when her eyesight failed, she turned to books on tape from the library.

Ben Stevenson, who lived to be 101, was a devoted caregiver for his wife when she suffered a series of strokes and dementia. Later, living by himself, he had a horrific accident when he was dragged by his horse. He was hospitalized in a local ICU and I told his daughters that, given his very old age, he might never recover. Stevenson, however, had built physical, cognitive, and social reserves throughout life. He proved resilient and was able to adapt to extreme adversity. He not only recovered, but much faster than expected and went on to have an active social life in an adult living community. On his 100th birthday, I enjoyed his hilarious doggerel about his life, along with his family and the many friends he gained after his accident.

What about Charlie White? Was he “just lucky?” Yes, and he did have a remarkable life. One bit of White’s general advice when faced with disappointments and losses was “let it go.” Later, when asked how he managed, especially the death of his father when he was young White said, “I just ploughed along and followed my mother’s advice to do the right thing.”

As White approached his life’s end, he distilled his philosophy of life into a list of brief commands. Each phrase reflects wisdom he gained from a remarkably long life:

“Think freely.”

“Practice patience.”

“Make and keep friends.”

“Tell loved ones how you feel.”

 “Forgive and seek forgiveness.”

White’s list contains familiar, simple truths. I like a conclusion author Von Drehle drew from White’s life—confirmed by my experience observing long remarkable lives. A life well-lived may consist of two parts: From youth through adulthood, we discover the complexities of life and are “complexifiers.” Then, if we live long enough, we become simplifiers. Our lives may still be complex, but our response to that complexity can be distilled into simple phrases leading to discrete actions—from White’s mother Laura’s advice to “do the right thing,” to “do unto others as you would have them do unto you,” to sound advice from White, “Make some mistakes. Learn from them.”

The experiences and wisdom centenarians leave us are simple truths even if life itself is complex, even bittersweet.

More from Charlie White:

“Work hard.”

“Spread joy.”

“Take a chance.”

“Enjoy wonder.”

 From this aging author: “Accept, be grateful, and cherish aging.”

Eric B. Larson, MD, MPH, is the author, with Joan DeClaire, of Enlightened Aging. He is the founding principal investigator of the Adult Changes in Thought (ACT) study, ongoing for about 30 years. ACT recently was awarded a $55.6 million expansion grant from the National Institutes of Health.

Related stories on living a Long Life:

“Striving for Immortality”

The post Resilience: The Simple Truth About Living to 100 appeared first on 3rd Act Magazine.

Part 1: Preparing for Caring

Part 2: Looking After Yourself

Part 3: Getting Extra Help

Part 4: When Caregiving Ends

Doing the best you can for your loved one requires meeting your own needs, too.

While traveling on an airplane, have you ever wondered why, when demonstrating the use of emergency oxygen masks, flight attendants tell you to put on your own mask first before putting one on your child? That’s because it’s important for you to maintain your energy in order to then be able to help someone else.

The same thing goes for caregiving. For many people, taking care of a loved one might be a temporary, short-term situation, but for many others, it can last months or even years. While the responsibility of meeting your care recipient’s needs can be very emotionally and spiritually satisfying, coping with its ongoing challenges can be draining, both physically and mentally.

As a caregiver, how do you keep going?

Often caregivers don’t realize the gradual toll that performing various responsibilities over time are taking on their body and mind. They may not be aware of just how tired and possibly burned out they are becoming. Fortunately, there are many great ways to actively nurture yourself. In order to do this, the first step is to be aware of the cumulative signs of ongoing strain.

The Three Stages

1. Caregiver stress. Of course, caregiving can be stressful, particularly because you need to handle any unexpected changes in your loved one’s condition, or overcome obstacles that can arise when you lack family or other support, deal with medical and/or insurance bills, try to remain productive at work, and seek time to relax and socialize.

The hormones and other chemicals your body produces during ongoing stress can affect your mental and physical health. Some mental signs of caregiver stress are poor concentration, forgetfulness, frustration, irritation, and anger. Stress-induced physical symptoms include fatigue, poor sleep, nighttime teeth gnashing, high blood pressure, heart fluttering or skipped beats, headaches, body pains, and indigestion.

2. Burnout. If caregiver stress goes unaddressed and unrelieved, it can turn into burnout, which is characterized by a change of attitude toward the role of caring itself. People who feel caregiver stress still believe they can be effective helpers, but burned out caregivers tend to lose faith in that effectiveness and may become cynical, resentful, apathetic, and even depressed. They may begin to withdraw from family and friends, procrastinate, or be neglectful in completing home or work tasks, rely on unhealthy habits (smoking, alcohol/drug abuse), and experience a loss of libido.

3. Compassion fatigue. This last and most extreme stage is marked by taking negative attitudes of hopelessness, frustration, impatience, or anger and redirecting them toward the person who is receiving the care. This is the last thing that loving, devoted caregivers ever expect to do.

While these stages paint a dark picture of providing care, there’s very good news: You don’t have to go through any of them. Instead, by adopting the following important, effective strategies, you can maintain your physical and emotional energy, thus ensuring that the caregiving experience for you and your loved one is a smooth, rewarding one.

Self-Care Strategies

Look after your own health. Be mindful of eating healthy foods, exercising, and getting enough sleep. If you start to feel any of the physical or mental symptoms of caregiver stress, burnout, or compassion fatigue, seek help from your doctor, therapist, or other health care provider as soon as possible. Don’t be reluctant to “put on your own oxygen mask.” Remember, you’re doing it to be a better caregiver.

Prioritize tasks and the time you spend on them. Caregiving is not the time to focus on being perfect at everything you do. Go easy on yourself, refrain from feeling guilty, do the best you can, and save your energy and enthusiasm for your loved one.

Let technology work for you. Depending on your needs, and with your care recipient’s permission, consider using in-home or wearable devices that track activity, offer virtual/audio reminders to take medications, or alert others of a medical emergency. These can be especially valuable in long-distance caregiving.

Ask for—and accept—help. Too often, caregivers feel they must do everything themselves instead of reaching out to share some of the responsibility with others. Believing in this is a big mistake, for a couple of reasons. For one thing, there is probably a task that a family member, friend, or neighbor can do better or more quickly than you can in your current situation (particularly if you’re a long-distance caregiver). Also, the people around you might be looking to contribute in some way, and involving them can be a gift to them as well as to yourself.

When requesting help, be specific. If someone asks, “Is there anything I can do for you?” state a particular task, either for your loved one (“Can you pick up the medicine that is ready at the pharmacy?”) or for yourself (“Could you collect my mail?” “Would you walk my dog?”). If you don’t have the energy or even the presence of mind to think about what you need, ask others for their own specific ideas of how they can aid you.

If at all possible, take occasional breaks from caregiving. It helps to have alone time, a change of scene, and/or a brief return to a favorite activity (reading, doing a hobby or sport, etc.). In fact, asking someone to sit with your loved one for a couple of hours can be a fitting request for help. Depending on your finances, using professional respite-care services can also help.

Stay connected with others. This can be a real challenge, especially since social isolation is often one of the first effects of intensive, long-term caregiving, in which it becomes more difficult to meet friends for dinner or attend a party. But you can maintain connection in other ways, such as by scheduling a daily or weekly “check-in” phone call or in-person visit. You can even combine socializing and exercising by walking regularly with someone who is a supportive listener, and someone who can make you laugh!

Share your experience with other caregivers. Consider joining a caregiver support group in your area. You might learn innovative ideas, be acknowledged for handling your situation, and perhaps even make new friends.

As a loving and responsible caregiver, your heart is clearly in your work. All you may need are concrete, effective ways to engage your brain in the ongoing problem-solving required of anyone in that very important role.

Speaking of the heart, here’s a question to answer: As each heartbeat moves oxygenated blood out of the chambers of your heart, what’s the first organ that this blood feeds? No, it’s not your lungs, or your brain, or any other organ. It’s the heart itself, through the vessels that surround it. On a purely physiological level, even your heart knows that it will be of no help to the rest of your body if it loses its own capacity to function.

Therefore, follow your heart by caring for yourself as you care for another, and you’ll succeed in staying strong and capable for the one you love.

Want to Know More?

Check out these resources for more tips, strategies, and support:

Caregiver Action Network’s Caregiver Help Desk: https://www.caregiveraction.org/helpdesk

Eldercare Locator: https://eldercare.acl.gov/Public/Index.aspx

National Respite Network and Resource Center (ARCH): https://archrespite.org/us-map

Washington Association of Area Agencies on Aging: https://www.agingwashington.org/

Jeanette Leardi is a Portland-based social gerontologist, writer, editor, and community educator who has a passion for older adult empowerment. A former caregiver to her late parents for more than a decade, she now gives popular presentations and workshops in journaling, memoir writing, ethical will creation, brain fitness, creativity, ageism, intergenerational communication, and caregiver support to people of all ages. Learn more about her work at jeanetteleardi.com.

The post The Caregiver’s Journey Part 2: Looking After Yourself appeared first on 3rd Act Magazine.