2016年12月31日 星期六

Here's a toast to 2017!

Happy New Year to all from the British Library. Here's a toast to 2017!


Tips for Creating a Home for Aging Owners

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If you are redoing a bathroom, grab bars save lives, experts say. These and the teak seat are by Moen. CreditMoen
A range of renovations and adjustments can be made to our apartments or houses to help us stay in our homes for as long as possible.

Easy

Add grab bars. There are many stylish models for the bathroom that look like a towel or shampoo rack but are sturdy enough to support 500 pounds of weight if properly installed, says Chrysanne Eichner, a senior occupational therapist at Memorial Sloan Kettering Cancer Center. You can also add grab bars by the top or foot of the stairs.
Replace doorknobs with lever handles that are easier to open.
Increase lighting and replace toggle switches with either a dimmer or a rocker switch.
Think about color contrast. If you have stairs, place reflective tape at the edge of steps so you can see where each one ends. Use a brightly colored bath mat so you can see where you’ll be stepping down after bathing.
Make a decision about your throw rug, which can present a trip hazard. Secure the rug to the floor with double-sided tape, throw it out, or hang it on the wall as a tapestry, Ms. Eichner suggests.
Select light fixtures with two bulbs. If one goes out, you’ll still have light from the other bulb.
Add a lazy susan to corner shelves to make it easier to reach items at the back of a cupboard.
Rearrange items in your kitchen seasonally. Crockpots, for example, can be stored on a higher shelf over the summer, says Barbara Roth, an interior designer in Manhattan.

Moderate

Replace a standard toilet, usually between 14 and 15 inches high, with a comfort-height toilet, which is 17 to 19 inches high.
Custom-build a movable kitchen island.
Widen doorways for walker and wheelchair access.

Complex

A major kitchen overhaul could include lowering counters and installing sinks that have space underneath to accommodate wheelchairs and walkers. Alternatively, if you are tall and have back problems, consider increasing the counter height. Install shelves that slide out.
Remove the bathtub and install a walk-in shower with a seat. Get a hand-held shower head.
Build a ramp or install a chairlift wherever you have steps.

Other Tips

Useful guides include the city’s Aging in Place Guide for Building Owners report and AARP’s online HomeFit Guide.
Consult an occupational therapist, an interior designer, an architect and/or a contractor who has age-in-place certifications.
For low-income households needing modifications, there is help. Individuals or families making less than 80 percent of an area’s median income as defined by the U.S. Department of Housing and Urban Development can fill out an application at Rebuilding Together NYC, a nonprofit organization that makes free repairs and modifications. Lending services can be found through nonprofit organizations, including Neighborhood Housing Services of New York City and the Parodneck Foundation.

香檳泡泡學 A Universe of Bubbles in Every Champagne Bottle

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Bubbles in a hexagonal pattern on the surface of a champagne flute. CreditGérard Liger-Belair
A cork pops. The sudden change in pressure releases carbon dioxide trapped in the bottle. Bubbles form. They ride along as liquid falls from the bottle to your champagne glass. Once inside, a million of them cling against its edges before rising to the top and bursting — like supernovas — as soon as they hit the air. The explosion releases tiny droplets of liquid, and for a moment, your mouth contains a universe. The droplets dart across it like shooting stars that crash against your tongue. The aromatic landing of the fermented grapes is sharp, crisp, sweet, dry, delicate, delightful. This may be how you welcome 2017.
At least, that’s how some scientists have done it this year. For an issue of the European Physical Journal Special Topics, to be released in January, they follow carbon dioxide from where it first becomes trapped in grapes on vines until it enters the bottle and formsrises and eventually bursts and evaporates in your glass. Each pop along the way helps enhance the drink’s aroma.
Even though bubbles are part of our everyday lives, much about how they behave is still mysterious. By studying them in sparkling beverages, scientists learn how their basic mechanics and chemistry can be applied, from better tasting wine to more efficient energy.
The journey starts with grapes, which contain sugars on the inside and yeast on the skin. Breaking the skin kicks off a fermentation process, resulting in the release of alcohol and carbon dioxide. The gas escapes through open barrels where wine is first made.
But once wine goes inside a champagne bottle, a second fermentation process begins and the carbon dioxide is trapped by the cork. There it dissolves into the liquid, taking up space and causing pressure to build through a process called Henry’s Law. Although a bit of carbon dioxide will escape, most of it stays trapped until the bottle is uncorked, which, by the way, is also a science. For example, one study found that cooling a bottle to 39 degrees before serving causes trapped gas to expand less rapidly. That means when you pop the cork, it will fly at about three-quarters of the speed it would at room temperature.
Once inside your glass, the bubbles will start to congregate at the liquid’s surface. They touch one another, forming a hexagonal pattern. And where the liquid meets air, the bubbles burst.
Gérard Liger-Belair, a physicist at the University of Reims Champagne-Ardenne in France, and his team, which conducted one of the studies, captured this with high-speed cameras. The images showed that when one bubble burst, it left behind an empty space that others stretched out to occupy until they themselves burst, quickly resulting in a spray in the air. New bubbles moved up to the surface, where they burst and the process continued.
Thomas Séon, a physicist at Pierre and Marie Curie University in France, and his colleagues, found that each bubble’s spray contained tiny droplets full of concentrated aromas and flavors, or volatile compounds that you can smell and taste. An aroma can vary, depending on bubbling speed, a single bubble’s size, temperature of the liquid and even the shape of the glass. Some people say that tiny bubbles flowing constantly make a tastier drink, but actually, the researchers found, big bubbles do because they release more aromatic spray.
For a bubblier glass of sparking wine, allow your bottle to warm up for a little while after taking it out of the refrigerator or off the ice. Be careful — the cork from the warmer bottle might fly out faster. Pour into a narrow glass at an angle. Now sip. And as you share your newfound knowledge of bubbles with your fellow New Year’s Eve revelers, perhaps the ones who appreciate it are the ones to keep around in 2017.

2016年12月13日 星期二

美國 60歲至 85歲服用精神病藥品者比率高


The study also found that older adults, between the ages of 60 and 85, are now the highest users of psychiatric medicines.


One in six Americans takes psychiatric drugs, study says
WWW.CNN.COM|由 SUSAN SCUTTI, CNN 上傳

"Healthy Aging: A Lifelong Guide to Your Well-Being" 死前臥床時間 比國外高出7年?




Ben Chen Aging,如何比較輕松的老去是大學問
台灣人平均死前臥床時間 比國外高出7年 | ETtoday 東森新聞雲
隨著老年人口攀升,「長期照護」為國人重視的議題,國泰人壽日前與天下文化共同舉辦長照趨勢論壇,國泰人壽協理凃薏如表示,以統計數據來看,台…
ETTODAY.NET|由 ETTODAY 新聞雲上傳


“What part of ourselves needs to evaporate in order to concentrate our essence? What do we have to let go?”
― from "Healthy Aging: A Lifelong Guide to Your Well-Being" by Andrew Weil, M.D.
In each of his widely acclaimed, best-selling books, Dr. Andrew Weil has been an authoritative and companionable guide through a uniquely effective combination of traditional and nontraditional approaches to health and healthy living. Now he gives us a book about aging that is unlike any other. Drawing on the new science of biogerontology (the biology of aging) as well as on the secrets of healthy longevity — diet, activity and attitude — Dr. Weil explains that there are a myriad of things we can do to keep our bodies and minds in good working order through all phases of life. Hugely informative, practical, and uplifting, Healthy Aging is infused with the engaging candor and common sense that have made Dr. Weil our most trusted source on healthy living. READ an excerpt here:http://knopfdoubleday.com/book/187978/healthy-aging/

2016年12月11日 星期日

宮本顯二、宮本禮子《不在病床上說再見》書摘

★為什麼歐美少有長年臥床的老人?/《不在病床上說再見》書摘 
原文網址:http://npost.tw/archives/30681
Post on: 十二月 8, 2016 

「當歐美只有 20% 的人在醫院過世,亞洲卻剛好相反。」
啟示出版社於 11 月底出版了日本高齡者臨終醫療學會醫師宮本顯二、宮本禮子夫婦的《不在病床上說再見》,探討另一種臨終的選擇。宮本醫師主張人到老時應順應自然生息,不應違背人的尊嚴,用各種無效醫療延長人類的痛苦餘命。
適逢衛福部昨日宣布第 2 階段長照 2.0 試辦計畫啟動,是時候思考即將在 2025 年邁入超高齡社會(65 歲以上老年人口占總人口比例達 20%)的臺灣,是否能帶領新一代的老年長者,在生命的終點走得更快樂。


 宮本顯二、宮本禮子《不在病床上說再見》書摘

不管哪一本關於社會福利的書刊,都會提到在歐洲的人權社福大國丹麥、瑞典等國,沒有所謂的長期臥床的老人。我不禁想知道其它國家的情況,因此在學會的邀請演講中,請教了幾位來自英國、美國、澳洲的醫師,他們的回答是:「在我們國家,也沒有長臥在床的老人。」相對的,在日本的老人醫院呢? 不必我多說,長年臥病在床、無法行動,正在做中心靜脈注射或經腸道營養的老人不計其數。
非常不可思議,日本的醫療水準絕對不低,甚至可說比其它國家更加先進才對。
「為什麼其它國家沒有臥床的老人呢?」
我在瑞典找到了答案。2007 年,我和同為醫師、專攻失智症醫療的妻子一起,經由塔克曼醫師的引薦,有幸拜訪位於斯德哥爾摩近郊的醫院及老人照護設施。如我們的預想,諸院所中,連一位長臥的老人都沒有。不僅如此,也沒有任何一位高齡患者使用胃造口或經腸道營養法。
其原因在於,在歐美人的普遍認知裡,高齡者到了臨終期會自然而然失去食慾,這是天經地義的事情,使用經腸道營養或點滴等人工補充營養的方式為高齡者延命,也就是干涉他人的自然發展,反而被視為一種侵害人權與倫理的行為,更會被認為是在虐待老人。
當地並不會在高齡者開始無法進食時,給與經腸道營養或點滴,就算發生感染引起肺炎,也不會施打抗生素,僅投以內服藥。當然也就不會有必要將患者的手腳綁起來。
單刀直入地說,大多數的患者在進入意識不明的長臥狀態前,就自然的壽終正寢了,這樣的社會不會製造出長期臥床的高齡患者。
民族性與社會觀,左右臨終生活品質
高齡者的臨終醫療觀,是歐美比較好、還是日本比較好,無人能夠下定論。但是,以某些狀況來說,關節全都扭曲僵化、為了不要讓胃造口的導管歪掉而將患者的雙手綁起來……眼前所看到的高齡老人所受的種種待遇,實在很難讓人感受到他們身為人類應有的尊嚴。
內人和我都已留下書面文件,清楚表達我們在臨終期進入無法飲食的階段時,均不願接受胃造口等各種人工補給營養的延命醫療,不僅如此,也向子女們再三耳提面命,不可因一己之私,讓我倆承受無效醫療之苦。
和國外自然壽終正寢的方式相比,日本的高齡者臨終醫療,在患者已經不省人事的狀態下,還要用點滴或經腸道營養來讓肉體繼續活下去,不管怎麼想都太怪異了。
入住瑞典高齡者照護機構的人,除了仍能享受人生中的美食和美酒,還擁有可貴的自由。由於失智症患者會迷路,因此在散步時會有看護員隨行在側,避免發生意外。我們在機構中認識的一名 80 歲女性失智症患者,每天定時都要出門散步,但固執拒絕看護隨行。硬要阻止她單獨出門的話,她會打破窗子逃出去,因此機構在和家屬會商之後,決定讓她攜帶具有衛星定位功能的手機,允許她每天進行 2 小時的單獨散步。
在日本的相關院所中,除了那些身體硬朗、腦子還清明的患者,絕不允許失智症患者單獨出門散步,萬一發生意外,院所將遭到管理失職的訴訟。
2007 年,一位失智症男性患者(當時 91 歲),趁家屬及看護疲勞以至於不注意時,出門獨自行動,意外死於平交道事故。日本 JR 東海鐵路公司對其家屬提出賠償告訴,繼而掀起嚴重的議題。由於一、二審時家屬皆認同照護過失,因此最後判決死者 91 歲的妻子必須對 JR 東海鐵路公司支付賠償金。如果最高法院也做出同樣的判決定讞,無疑地,全日本的失智症患者將面臨此後被徹底禁閉在家中的命運。這怎麼可以呢!像這種因為失智症患者引發的損害事故,不應當由家屬進行賠償,受害者(本案例中為 JR 東海鐵路公司)應向社會性的賠償制度求償才對。
除了外出,日本對高齡者的行動還有許多其它的限制。例如有些醫院碰到長期臥床的高齡患者出現劇烈身體動作時,會用布條將他們的身體或手腳綁在床欄上。醫院常會有這類解釋:「亂動時腳卡進床欄裡,有可能會骨折」、「一切以患者的安全為優先」。相比之下,瑞典的國民卻願意承受一定的風險,以換取身為人的基本自由。民族性和社會觀念的不同,也如此鮮明地反映在高齡者的醫療面上。
醫療介入太少,各有利弊
瑞典在 1992 年曾進行保健福祉改革。這是因為整個社會系統都面臨高齡化及金融危機,社會保障財政大為吃緊,其改革的目的在於解除住院普遍化的問題,以及提高高齡者的生活品質。保健福祉改革最後將醫療劃分給政府負責,而社福、福祉院所則交由各市、鄉、鎮負責,當時約有 540 間長期照護院所轉型為照護之家,改由各地方市、鄉、鎮系統負責管理營運。
當患者在醫院的治療告一段落後,各地方市、鄉、鎮公所不得不盡快為患者找到適當的收容院所,因為當患者遲遲不出院,自第 5 天開始,醫療費用規定必須由各地方市、鄉、鎮公所負擔。這樣一來,各地方市、鄉、鎮公所自然會加快速度為患者安排出院。此外,患者的住院時間也比日本短很多,心肌梗塞大約 5 天、乳癌或骨折則在手術當天就會出院移往照護機構。但也因此,形成許多人因復健不完全而落入輪椅生活、檢查不完全等各種問題,照護之家在無形間也被迫背負原本醫院負責的範圍。
在瑞典,入住照護院所的高齡者,通常也會在同一機構中進行安寧照護,不像日本,視病況移送到其它院所或醫院。例如發生肺炎時,患者通常只會服用院所內駐院醫師開立的內服藥。視症狀輕重,在日本的做法下原本有痊癒機會的患者,很有可能在歐美的療養院中會撐不過去。
不過少、也不過多的醫療環境是所有人的理想,而醫療環境則取決於該國本身的醫療制度,想要實現理想的醫療可說難上加難。瑞典的高齡者醫療可能介入得太少,但也有其優點所在。譬如瑞典就不可能出現日本那樣將患者綁在病床上的景象。在人生接近終點、已不再進食的人,醫院也不會用點滴或經腸道營養干涉,患者就以自己能吃得下、喝得下的量為主,讓生命依循自然的腳步逐漸枯萎、回歸。和我國(日本)可說是對照組。
當入住者過世後,醫師也沒有必要火速趕到現場,遺體會保管在照護院所中 2-3 天,醫師在這期間內過來確認死亡開立證明即可。
原本我想,瑞典不做延命醫療,平均壽命想來會比日本短,在經過調閱普查資料後發現,2012 年瑞典平均壽命為 81.7 歲,日本為 83.1 歲,意外的,落差遠沒有想像中大。也就是說,日本在各階段極力進行沉重的臨終期醫療及延命措施之後,壽命也不過就延長了一年半而已。

澳洲人 七十歲才能退休; 德國央行:德國退休年齡應推遲到69歲

【延後退休】
退休年齡上修對年長者來說,是對體力負荷的一大挑戰;對年輕人來說,則是害怕工作機會被年長者佔走。延後退休年齡,真的能紓緩高齡社會帶來的沉重負擔嗎?
「澳洲是全球第一個把退休年齡提高到七十歲的國家,但可能不是最後一個。近年來,美國、英國、德國、西班牙等歐美國家,接連計劃將退休年齡延後到六十七歲。」
退休養老不只是個人生涯規劃,更是政府必須面對的財政風險。…
CW.COM.TW|作者:天下雜誌

德國央行:德國退休年齡應推遲到69歲

德國政府已計劃在不晚於2029年時把退休年齡推遲至67歲。但德國央行計算後表示,2029年後退休年齡還得再推遲兩歲。



德國央行(Bundesbank)表示,為了給父輩的養老金買單,德國年輕人需要工作的年頭恐怕得比他們以前擔心的還要長。德國央行的計算結果與德國政府的說法相左。德國政府的說法是,既有的推遲退休年齡的計劃,足以覆蓋德國日益老齡化的人口的開銷。

目前,在德國這個歐元區最大的經濟體,上了年紀的勞動者可在工作年頭滿45年後或65歲時退休。德國政府已計劃在不晚於2029年時,逐步把退休年齡推遲至67歲。但供職於頗具影響力的德國央行的經濟學家表示,這麼做不大可能湊出足夠的資金,給日益增多的退休者發養老金。

相反,2029年後退休年齡將不得不再次推遲——在不晚於2060年時再推遲兩歲。這意味著,眼下加入德國勞動力大軍的25歲年輕人,將不得不比當前這批退休者多工作四年,到69歲才能退休。

德國央行在周一發布的最新月度公告中稱:“總體上看,有證據表明,應當更多地考慮延長工作年頭、提高法定退休年齡。”......

2016年12月10日 星期六

老年人需要較少睡眠的真實原因 - BBC 主页

......整個晚上,他們監測被試者的大腦活動,一旦發現慢波,他們就在房間製造噪音,打斷被試者睡眠。第二天,筋疲力盡的老年人和年輕人一樣容易入睡。這就說明當老年人真的需要睡眠時,他們也能睡著,而當他們睡不著時,可能是因為他們並不缺覺。
美國睡眠基金會(National Sleep Foundation)召集了一個專家委員會,在審閱了320項研究後,提出了64歲以下成年人每天睡七到九小時、65歲以上七到八小時的建議。
不過,人們仍然願意相信,隨著年齡的增長,生物鐘背後的生理過程會發生變化。所以,目前仍不能確定老年人需要較少的睡眠是不是一個謎。不過已知的一點是,在漫長的、寂寞的、黑暗的清晨,你已經醒過來但感到沒有得到充分的休息,這會讓人難受,而且應當認真對待。
Cochrane(一個國際性的非贏利的民間醫療保健學術團體)組織調查了對60歲以上老人的睡眠問題進行認知行為干預療法的案例研究,通過研究其中最佳的療法,他們發現在某些情況下,干預有可能發揮作用,醫生值得考慮將其作為安眠藥的替代療法。

年紀越大,所需睡眠時間越短,似乎是大家公認的說法。不過,老年人早上醒的早可能另有原因。
http://bbc.in/2hqlck5