SENIOR POWER . . . on a binge

By Helen Rippier Wheeler,
Friday December 06, 2013 - 11:58:00 AM

I recently went on a Babette’s Feast rewind binge. I had feasted some time ago when it-she was on TV, PSB probably. Decades later I come to Babette with a new perspective as well as greater appreciation and pleasure. And not just because it’s seventy-six year old Jorge Mario Bergoglio’s favorite film.  

Babettes Gæstebud was a 1987 award-winning motion picture from Denmark. Adapted by Gabriel Axel from a story of 19th Century Denmark by Karen Blixen aka Isak Dinesen, Babette’s Feast is mostly about two Protestant sisters hosting a French Feast. They and their guests are old. There’s one young person, a simple and efficient “lad” who charmed me. Babette herself is no spring chicken, but she’s French. Also Catholic. 

Axel chose to place Babette’s Feast in stark cold desolate brrrr Jutland, rather than in Norway as Dinesen had done. The DVD jacket describes a “…tale of a French housekeeper with a mysterious past who brings quiet revolution in the form of one exquisite meal to a circle of starkly pious villagers….” The DVD is in Danish, French or Swedish dialogue, with English subtitles possible. 

The final portion of the film is the preparation and serving of several sumptuous courses lavishly deployed by chef Babette in the austerity of the sisters' home for their guests. Up to this point, the film has been mainly in whites and grays. Now it gradually picks up colors, focusing on the lovely tableware and various and delectable dishes once served in Paris’ "Café Anglais," where Babette Hersant had been head chef before fleeing to Denmark. 

Folks at PBS, it’s time to show Babette’s Feast again. Also, Martha Stewart’s original Thanksgiving production that appeared on TV decades ago. There’s a hard-to-get video titled Martha Stewart's Secrets for Entertaining: A Holiday Feast for Thanksgiving and Other Festive Occasions [VHS] (1988) that I assume followed.  



Where in the world should one go in order to be happily elder? Which nations are the best and which are the worst for people who are old? According to a new study that looks at the welfare of people ages 65+ in 91 nations, the United States of America ranks eighth in the world for seniors’ wellbeing. (Read Max Fisher in the Oct. 4, 2013 Washington Post.) Sweden ranks first, followed by Norway and Germany. At the bottom of the list are Pakistan, Tanzania and Afghanistan. 

The report was conducted by the United Nations Population Fund and the HelpAge International group, an advocate for policies in support of the elderly. This action research used a number of metrics: health, income security, employment and education opportunities as well as something described as "enabling environment" measuring how friendly a society is to the elderly-- friendlinesses might include physical safety, access to public transportation, and ease of maintaining social connections late in life, a key component of mental health and happiness.  

The United States typically ranks near the bottom of the developed nations list on these sorts of human welfare indices, but performs unusually well here. An under-performer among developed nations on such things as public health and income equality, it outperforms much of the developed world, ranking above Iceland, Japan, Britain and much of Europe. Why? Education and employment opportunities for elderly Americans are some of the best in the world. Behind only Norway. As the report explains, "Older people value their capacity to work" because they "wish to maintain social contacts and self-worth" as well as remain self-sufficient. In most countries, people start getting locked out of the labor market as they age. The United States is unusual in that the elderly face less age discrimination and have an easier time getting the education and skills to remain competent members of the workforce. 

The Rand Corporation is offering Postdoctoral Fellowship[s] in the Study of Aging. (Contact Lisa Turner, RAND Corporation, 1776 Main St., Santa Monica, CA 90407-2138.) Scholars are expected to come from various disciplines including economics, demography, sociology and psychology. Let’s hope that geriatricians and gerontologists are interested too and that Rand is interested in them! 

The Center for Hearing and Communication has recently begun a new, unique program to raise awareness around the issue of seniors’ hearing impairment/dementia and to serve at-risk seniors and develop new best practices for combined emotional/mental and hearing health. Contact Laura Grasso. (50 Broadway, 6th floor, New York, NY 10004).  

For an introduction to the very significant yet confusing difference between nursing homes and assisted living facilities, read Paula Span’s “Assisted Living or a Nursing Home?” (New York Times June 10, 2011). End-of-life and advance directives discussion groups appear rarely on senior center calendars, and yet they are both of great importance to most senior citizens. Again, Span is worth reading. “I rarely write about advance directives and end-of-life discussions without a few readers asking, sometimes plaintively: What if one does not have a family?” Finally! A reader commented, “The presumption is that everyone has someone available, someone most likely younger or in better health, and better able to carry out one’s wishes or make decisions with your guidance.” (September 24, 2013 New York Times)  

Nick Mulchay asks the 672-word rhetorical question, "Are Interns Too Green for End-of-Life Talks?" (Medscape Medical News, December 3, 2013). Apparently so. I must abstract some here: 

In discussing end-of-life care with patients, young clinicians might have to learn by doing rather than by special schooling, suggest the results of a first-of-its-kind randomized trial. Doctors and nurses in residency and fellowship programs who practiced end-of-life talks in simulated training sessions did not subsequently communicate with their patients any better than their counterparts who received usual education. 

Worse yet, depression scores were significantly higher in patients counseled by trainees than by those who received usual education. First-year residents (i.e., interns) fared especially poorly in the study, having a number of worse outcomes than the more senior clinicians. 

The study, the first-ever to measure patient opinions of providers trained in such simulations, was published in the December 4, 2013 JAMA. It had a "worthy goal" because communicating clearly with patients at the end of life has been proven to be "profoundly beneficial when done correctly." The investigators adapted their 4-day program from a workshop originally designed to teach medical oncology fellows how to deliver bad news. 

Study participants were internal medicine and nurse practitioner trainees at the University of Washington and the Medical University of South Carolina. The subsequent interaction between patients and healthcare providers took place up to 10 months after the training or usual education. Scores were significantly lower for interns (first-year residents) than for other, more senior trainees. Depression scores were also higher in the patients of interns than in the patients of more senior trainees. The editorialists call this specific finding "intriguing." 

"One conclusion from the study might be that end-of-life conversations should be left to more senior physicians." About this depression-related finding, "Patients could experience depressive symptoms or feelings of sadness as a result of discussion about end-of-life care;" increasing awareness of prognosis "may trigger negative experiences."  

Ultimately, the investigators argue that some clinical experience counts for a lot at the end of life. They suggest that the increase in the depressive symptoms score associated with first-year residents "might be associated with the skill level of the clinician having the discussion."