Loving Life at 50+ – by Maria Sabando

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What a pleasant mix of a book! Sabando writes about aging with a great blend of light-heartedness and seriousness, and gives extra attention to the important balancing act of:

  1. Indulging sufficiently to enjoy life
  2. Staying well enough to enjoy life

…because one without the other will not generally result in an enjoyable life! An American proud of her Italian heritage, she blends (as many immigrant families do) cultures and perspectives, aiming where she can for “the best of both” in that regard, too.

Nor is this just a philosophical book—there’s yoga to be learned here, chapter by chapter, and recipes peppered throughout. The recipes, by the way, are simple and… Honestly, not as healthy as the recipes we share here at 10almonds, but they are good and when it comes to those indulgences we mentioned, her philosophy is that strategic mindful indulgence keeps mindless binge-eating at bay. Which is generally speaking not a bad approach, and is one we’ve written about before as well.

When it comes to health advice, the author is no doctor or scientist, but her husband (a doctor) had input throughout, keeping things on track and medically sound.

The style is very casual, like talking to a friend, which makes for a very easy and enjoyable read. Absolutely a book that one could read casually in the garden, put down when interrupted, pick up again, and continue happily where one left off.

Bottom line: whatever your age (no matter whether your 50th birthday is in your shrinkingly near future or your increasingly distant past), there’s wisdom to be gained here—it’s not a manual (unless you want to treat it as one), it’s more… Thought-provoking, from cover to cover. Highly recommendable.

Click here to check out Loving Life at 50+, and love life at 50+!

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  • Why Many Nonprofit (Wink, Wink) Hospitals Are Rolling in Money

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    One owns a for-profit insurer, a venture capital company, and for-profit hospitals in Italy and Kazakhstan; it has just acquired its fourth for-profit hospital in Ireland. Another owns one of the largest for-profit hospitals in London, is partnering to build a massive training facility for a professional basketball team, and has launched and financed 80 for-profit start-ups. Another partners with a wellness spa where rooms cost $4,000 a night and co-invests with “leading private equity firms.”

    Do these sound like charities?

    These diversified businesses are, in fact, some of the country’s largest nonprofit hospital systems. And they have somehow managed to keep myriad for-profit enterprises under their nonprofit umbrella — a status that means they pay little or no taxes, float bonds at preferred rates, and gain numerous other financial advantages.

    Through legal maneuvering, regulatory neglect, and a large dollop of lobbying, they have remained tax-exempt charities, classified as 501(c)(3)s.

    “Hospitals are some of the biggest businesses in the U.S. — nonprofit in name only,” said Martin Gaynor, an economics and public policy professor at Carnegie Mellon University. “They realized they could own for-profit businesses and keep their not-for-profit status. So the parking lot is for-profit; the laundry service is for-profit; they open up for-profit entities in other countries that are expressly for making money. Great work if you can get it.”

    Many universities’ most robust income streams come from their technically nonprofit hospitals. At Stanford University, 62% of operating revenue in fiscal 2023 was from health services; at the University of Chicago, patient services brought in 49% of operating revenue in fiscal 2022.

    To be sure, many hospitals’ major source of income is still likely to be pricey patient care. Because they are nonprofit and therefore, by definition, can’t show that thing called “profit,” excess earnings are called “operating surpluses.” Meanwhile, some nonprofit hospitals, particularly in rural areas and inner cities, struggle to stay afloat because they depend heavily on lower payments from Medicaid and Medicare and have no alternative income streams.

    But investments are making “a bigger and bigger difference” in the bottom line of many big systems, said Ge Bai, a professor of health care accounting at the Johns Hopkins University Bloomberg School of Public Health. Investment income helped Cleveland Clinic overcome the deficit incurred during the pandemic.

    When many U.S. hospitals were founded over the past two centuries, mostly by religious groups, they were accorded nonprofit status for doling out free care during an era in which fewer people had insurance and bills were modest. The institutions operated on razor-thin margins. But as more Americans gained insurance and medical treatments became more effective — and more expensive — there was money to be made.

    Not-for-profit hospitals merged with one another, pursuing economies of scale, like joint purchasing of linens and surgical supplies. Then, in this century, they also began acquiring parts of the health care systems that had long been for-profit, such as doctors’ groups, as well as imaging and surgery centers. That raised some legal eyebrows — how could a nonprofit simply acquire a for-profit? — but regulators and the IRS let it ride.

    And in recent years, partnerships with, and ownership of, profit-making ventures have strayed further and further afield from the purported charitable health care mission in their community.

    “When I first encountered it, I was dumbfounded — I said, ‘This not charitable,’” said Michael West, an attorney and senior vice president of the New York Council of Nonprofits. “I’ve long questioned why these institutions get away with it. I just don’t see how it’s compliant with the IRS tax code.” West also pointed out that they don’t act like charities: “I mean, everyone knows someone with an outstanding $15,000 bill they can’t pay.”

    Hospitals get their tax breaks for providing “charity care and community benefit.” But how much charity care is enough and, more important, what sort of activities count as “community benefit” and how to value them? IRS guidance released this year remains fuzzy on the issue.

    Academics who study the subject have consistently found the value of many hospitals’ good work pales in comparison with the value of their tax breaks. Studies have shown that generally nonprofit and for-profit hospitals spend about the same portion of their expenses on the charity care component.

    Here are some things listed as “community benefit” on hospital systems’ 990 tax forms: creating jobs; building energy-efficient facilities; hiring minority- or women-owned contractors; upgrading parks with lighting and comfortable seating; creating healing gardens and spas for patients.

    All good works, to be sure, but health care?

    What’s more, to justify engaging in for-profit business while maintaining their not-for-profit status, hospitals must connect the business revenue to that mission. Otherwise, they pay an unrelated business income tax.

    “Their CEOs — many from the corporate world — spout drivel and turn somersaults to make the case,” said Lawton Burns, a management professor at the University of Pennsylvania’s Wharton School. “They do a lot of profitable stuff — they’re very clever and entrepreneurial.”

    The truth is that a number of not-for-profit hospitals have become wealthy diversified business organizations. The most visible manifestation of that is outsize executive compensation at many of the country’s big health systems. Seven of the 10 most highly paid nonprofit CEOs in the United States run hospitals and are paid millions, sometimes tens of millions, of dollars annually. The CEOs of the Gates and Ford foundations make far less, just a bit over $1 million.

    When challenged about the generous pay packages — as they often are — hospitals respond that running a hospital is a complicated business, that pharmaceutical and insurance execs make much more. Also, board compensation committees determine the payout, considering salaries at comparable institutions as well as the hospital’s financial performance.

    One obvious reason for the regulatory tolerance is that hospital systems are major employers — the largest in many states (including Massachusetts, Pennsylvania, Minnesota, Arizona, and Delaware). They are big-time lobbying forces and major donors in Washington and in state capitals.

    But some patients have had enough: In a suit brought by a local school board, a judge last year declared that four Pennsylvania hospitals in the Tower Health system had to pay property taxes because its executive pay was “eye popping” and it demonstrated “profit motives through actions such as charging management fees from its hospitals.”

    A 2020 Government Accountability Office report chided the IRS for its lack of vigilance in reviewing nonprofit hospitals’ community benefit and recommended ways to “improve IRS oversight.” A follow-up GAO report to Congress in 2023 said, “IRS officials told us that the agency had not revoked a hospital’s tax-exempt status for failing to provide sufficient community benefits in the previous 10 years” and recommended that Congress lay out more specific standards. The IRS declined to comment for this column.

    Attorneys general, who regulate charity at the state level, could also get involved. But, in practice, “there is zero accountability,” West said. “Most nonprofits live in fear of the AG. Not hospitals.”

    Today’s big hospital systems do miraculous, lifesaving stuff. But they are not channeling Mother Teresa. Maybe it’s time to end the community benefit charade for those that exploit it, and have these big businesses pay at least some tax. Communities could then use those dollars in ways that directly benefit residents’ health.

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

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  • Ridged Nails: What Are They Telling You?

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    Dr. Yaseen Arsalan, a Doctor of Pharmacy, has advice on the “nutraceutical” side of things:

    Onychorrhexis

    Sounds like the name of a dinosaur, but it’s actually the condition that creates the vertical ridges that sometimes appear on nails. It’s especially likely in the case of thinner nails, and/or certain nutritional deficiencies. Overuse of certain chemicals (including nail polish remover, hair products that get on your hands a lot, and cleaning fluids) can also cause it. It can also be worsened by various conditions, including eczema, psoriasis, hypothyroidism, anemia, and amyloidosis, but it won’t usually be outright caused by those alone.

    There are two main kinds of ridges on nails:

    • Vertical ridges: associated with hypothyroidism, anemia, and aging. Often an indicator of low iron.
    • Horizontal ridges (Beau’s lines): caused by interrupted nail growth, brute force trauma, chemotherapy, acrylic nails, and gel nail polishes. Can also be an indicator of low zinc.

    There are an assortment of medical treatments available, which Dr. Arsalan discusses in the video, but for home remedy treatment, he recommends:

    • Nail-strengthening creams (look for coconut oil, shea butter, beeswax, vitamin E)
    • Hydration (this is about overall hydration e.g. water intake)
    • Careful nail trimming (fingernails with a curved shape and toenails straight across)
    • Nail ridge filler (he recommends the brand Barrielle, for not containing formaldehyde or formalin)
    • Moisturization (with cuticle oil or hand creams, because that hydration we talked about earlier is important, and we want it to stay inside the nail)

    For more on those things, plus the medical treatments plus other “how to avoid this” measures, enjoy:

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  • An Unexpected Extra Threat Of Alcohol

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    If You Could Use Some Exotic Booze…

    …then for health reasons, we’re going to have to say “nay”.

    We’ve written about alcohol before, and needless to say, it’s not good:

    Can We Drink To Good Health?

    (the answer is “no, we cannot”)

    In fact, the WHO (which unlike government regulatory bodies setting “safe” limits on drinking, makes no profit from taxes on alcohol sales) has declared that “the only safe amount of alcohol is zero”:

    WHO: No level of alcohol consumption is safe for our health

    Up there, where the air is rarefied…

    If you’re flying somewhere this summer (Sinatra-style flying honeymoon or otherwise), you might want to skip the alcohol even if you normally do imbibe, because:

    ❝…even in young and healthy individuals, the combination of alcohol intake with sleeping under hypobaric conditions poses a considerable strain on the cardiac system and might lead to exacerbation of symptoms in patients with cardiac or pulmonary diseases.

    These effects might be even greater in older people; cardiovascular symptoms have a prevalence of 7% of inflight medical emergencies, with cardiac arrest causing 58% of aircraft diversions.❞

    Source: Alcohol plus cabin pressure at higher altitude may threaten sleeping plane passengers’ heart health

    The experiment divided subjects into a control group and a study group; the study group were placed in simulated cabin pressure as though at altitude, which found, when giving some of them two small(we’re talking the kind given on flights) alcoholic drinks:

    ❝The combination of alcohol and simulated cabin pressure at cruising altitude prompted a fall in SpO2 to an average of just over 85% and a compensatory increase in heart rate to an average of nearly 88 beats/minute during sleep.

    In contrast, that was 77 beats/minute for those who had alcohol but weren’t at altitude pressure, or 64 beats/minute for those who neither drank nor were at altitude pressure.

    Lots more metrics were recorded and the study is interesting to read; if you’ve ever slept on a plane and thought “that sleep was not restful at all”, then know: it wasn’t just the seat’s fault, nor the engine, nor the recycled nature of the air—it was the reduced pressure causing hypoxia (defined as having oxygen levels lower than the healthy clinical norm of 90%) and almost halving your sleep’s effectiveness for a less than 10% drop in available oxygen in the blood (the sleepers not at altitude pressure averaged 96% SpO2, compared to the 85% at altitude).

    We say “almost halving” because the deep sleep phase of sleep was reduced from 84 minutes (control) to 67.5 minutes at altitude without alcohol, or 46.5 minutes at altitude with alcohol.

    Again, this was a pressure cabin in a lab—so this wasn’t about the other conditions of an airplane (seats, engine hundreds of other people, etc).

    Which means: in an actual airplane it’s probably even worse.

    Oh, and the study participants? All healthy individuals aged 18–40, so again probably worse for those older (or younger) than that range, or with existing health conditions!

    Want to know more?

    You can read the study in full here:

    Effects of moderate alcohol consumption and hypobaric hypoxia: implications for passengers’ sleep, oxygen saturation and heart rate on long-haul flights

    Want to drop the drink at any altitude? Check out:

    How To Reduce Or Quit Alcohol

    Want to get that vacation feel without alcohol? You’re going to love:

    Mocktails – by Moira Clark (book)

    Enjoy!

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    A sports coach’s job is to prepare a plan, give it to the player(s), and hold them accountable to it. Change the strategy if needs be, call the shots. The job of the player(s) is then to follow those instructions.

    If you have trouble keeping yourself accountable, Kavanagh argues that it can be good to separate how you approach things.

    Not just “coach yourself”, but put yourself entirely in the coach’s shoes, as though you were a separate person, then switch back, and follow those instructions, trusting in your coach’s guidance.

    The book also provides illustrative examples and guides the reader through some potential pitfalls—for example, what happens when morning you doesn’t want to do the things that evening you decided would be best?

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  • Common Hospital Blood Pressure Mistake (Don’t Let This Happen To You Or A Loved One)

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    There’s a major issue in healthcare, Dr. Suneel Dhand tells us, pertaining to the overtreatment of hypertension in hospitals. Here’s how to watch out for it and know when to question it:

    Under pressure

    When patients, particularly from older generations, are admitted to the hospital, their blood pressure often fluctuates due to illness, dehydration, and other factors. Despite this, they are often continued on their usual blood pressure medications, which can lead to dangerously low blood pressure.

    Why does this happen? The problem arises from rigid protocols that dictate stopping blood pressure medication only if systolic pressure is below a certain threshold, often 100. However, Dr. Dhand argues that 100 is already low*, and administering medication when blood pressure is close to this can cause it to drop dangerously lower

    *10almonds note: low for an adult, anyway, and especially for an older adult. To be clear: it’s not a bad thing! That is the average systolic blood pressure of a healthy teenager and it’s usually the opposite of a problem if we have that when older (indeed, this very healthy writer’s blood pressure averages 100/70, and suffice it to say, it’s been a long time since I was a teenager). But it does mean that we definitely don’t want to take medications to artificially lower it from there.

    Low blood pressure from overtreatment can lead to severe consequences, requiring emergency interventions to stabilize the patient.

    Dr. Dhand’s advice for patients and families is:

    • Ensure medication accuracy: make sure the medical team knows the correct blood pressure medications and dosages for you or your loved one.
    • Monitor vital signs: actively check blood pressure readings, especially if they are in the low 100s or even 110s, and discuss any medication concerns with the medical team.
    • Watch for symptoms of low blood pressure: be alert for symptoms like dizziness or weakness, which could indicate dangerously low blood pressure.

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  • Are you over 75? Here’s what you need to know about vitamin D

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    Vitamin D is essential for bone health, immune function and overall wellbeing. And it becomes even more crucial as we age.

    New guidelines from the international Endocrine Society recommend people aged 75 and over should consider taking vitamin D supplements.

    But why is vitamin D so important for older adults? And how much should they take?

    OPPO Find X5 Pro/Unsplash

    Young people get most vitamin D from the sun

    In Australia, it is possible for most people under 75 to get enough vitamin D from the sun throughout the year. For those who live in the top half of Australia – and for all of us during summer – we only need to have skin exposed to the sun for a few minutes on most days.

    The body can only produce a certain amount of vitamin D at a time. So staying in the sun any longer than needed is not going to help increase your vitamin D levels, while it will increase your risk of skin cancer.

    But it’s difficult for people aged over 75 to get enough vitamin D from a few minutes of sunshine, so the Endocrine Society recommends people get 800 IU (international units) of vitamin D a day from food or supplements.

    Why you need more as you age

    This is higher than the recommendation for younger adults, reflecting the increased needs and reduced ability of older bodies to produce and absorb vitamin D.

    Overall, older adults also tend to have less exposure to sunlight, which is the primary source of natural vitamin D production. Older adults may spend more time indoors and wear more clothing when outdoors.

    As we age, our skin also becomes less efficient at synthesising vitamin D from sunlight.

    The kidneys and the liver, which help convert vitamin D into its active form, also lose some of their efficiency with age. This makes it harder for the body to maintain adequate levels of the vitamin.

    All of this combined means older adults need more vitamin D.

    Deficiency is common in older adults

    Despite their higher needs for vitamin D, people over 75 may not get enough of it.

    Studies have shown one in five older adults in Australia have vitamin D deficiency.

    In higher-latitude parts of the world, such as the United Kingdom, almost half don’t reach sufficient levels.

    This increased risk of deficiency is partly due to lifestyle factors, such as spending less time outdoors and insufficient dietary intakes of vitamin D.

    It’s difficult to get enough vitamin D from food alone. Oily fish, eggs and some mushrooms are good sources of vitamin D, but few other foods contain much of the vitamin. While foods can be fortified with the vitamin D (margarine, some milk and cereals), these may not be readily available or be consumed in sufficient amounts to make a difference.

    In some countries such as the United States, most of the dietary vitamin D comes from fortified products. However, in Australia, dietary intakes of vitamin D are typically very low because only a few foods are fortified with it.

    Why vitamin D is so important as we age

    Vitamin D helps the body absorb calcium, which is essential for maintaining bone density and strength. As we age, our bones become more fragile, increasing the risk of fractures and conditions like osteoporosis.

    Keeping bones healthy is crucial. Studies have shown older people hospitalised with hip fractures are 3.5 times more likely to die in the next 12 months compared to people who aren’t injured.

    Older woman sits with a friend
    People over 75 often have less exposure to sunlight. Aila Images/Shutterstock

    Vitamin D may also help lower the risk of respiratory infections, which can be more serious in this age group.

    There is also emerging evidence for other potential benefits, including better brain health. However, this requires more research.

    According to the society’s systematic review, which summarises evidence from randomised controlled trials of vitamin D supplementation in humans, there is moderate evidence to suggest vitamin D supplementation can lower the risk of premature death.

    The society estimates supplements can prevent six deaths per 1,000 people. When considering the uncertainty in the available evidence, the actual number could range from as many as 11 fewer deaths to no benefit at all.

    Should we get our vitamin D levels tested?

    The Endocrine Society’s guidelines suggest routine blood tests to measure vitamin D levels are not necessary for most healthy people over 75.

    There is no clear evidence that regular testing provides significant benefits, unless the person has a specific medical condition that affects vitamin D metabolism, such as kidney disease or certain bone disorders.

    Routine testing can also be expensive and inconvenient.

    In most cases, the recommended approach to over-75s is to consider a daily supplement, without the need for testing.

    You can also try to boost your vitamin D by adding fortified foods to your diet, which might lower the dose you need from supplementation.

    Even if you’re getting a few minutes of sunlight a day, a daily vitamin D is still recommended.

    Elina Hypponen, Professor of Nutritional and Genetic Epidemiology, University of South Australia and Joshua Sutherland, PhD Candidate – Nutrition and Genetic Epidemiology, University of South Australia

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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