pg 16 - Prefrontal cortex is one of the first areas to decline as we transition into old age (why older adults are forgetful) - Older adults are worse than younger adults at remembering things when they are required to pay attention and ignore distractions but they can be as good as, or better at remembering the distracting information (older people have trouble focusing on details) - Regardless of age, there is no shortage of factors that can make you feel as if your prefrontal cortex is fried such as multitasking

pg 15 - Many factors can affect the functioning of the prefrontal cortex such as some patients that Ranganath who seemed to possibly have Alzheimer's but really were depressed (they look similar) - Prefrontal cortex is the one of the last areas of the brain to mature - Children with ADHD struggle in school not due to a lack of comprehension but because they have difficulty paying attention in class, developing effective study habits, and using strategies to help them preform well on tests

pg 14 - Areas in the back of the brain had cell assemblies that seemed to store memories for specific kinds of information - The prefrontal cortex was intensely activated when a person had to use interruption to stay on task, focus on distinctive information, resist distractions, or initiate some kind of mnemonic strategy - The MRI studies and observations of patients supported a different theory that the prefrontal cortex was the "central executive" of the brain

pg 13 - One reason these patients had difficulty had trouble retrieving these memories that that they did not use any kind or memorization strategy and instead focused on whatever grabbed their attention - In contrast, healthy individuals typically used straggles that would help them perform well on both the recall and recognition tests - Ranganath worked with Dr. Mark D'Esposito who was pushing the envelop to develop newer and better MRI techniques to study working memory

pg 12 - Ranganath was given the job to administer a series of cognitive test to inform diagnosis and treatment - Patients with prefrontal dysfunction commonly complained that they had problems with memory but something else was going on as these patients didn't have memory problems - They struggled with focusing while faced with distractions - These patients also preformed inconsistently on test of long-term memory in which Ranganath when told to memorize a long list of words; they could recall the words without giving them any additional cues, the patients could only remember a few words but if they were asked whether a specific word was on the list, they could easily recognize whether a specific word was on the list

pg 11 - Scientists mapped the brain by scanning people while they did tasks like perception, language, and memory (a lot of radiation) - Ranganath went to Northwestern and was fascinated by the data collected with memories

pg 10 - Hippocampus is a seahorse-shaped area tucked away in the middle of your brain is regarded as the key area that determines whether you will remember or forget something - The prefrontal cortex and hippocampus are 2 different kinds of memory stems in the brain The prefrontal cortex was seen as a "working memory" system, temporally keeping information online - The hippocampus was believed to be a "long-term memory" system enabling us to store memories more or less permanently

pg 9 - If you lose your keys often, find something unique to that specific time and place - Prefrontal cortex is the part of the brain behind the forehead and takes up 1/3 of the brain - The prefrontal cortex has been misunderstood for much of history with treatment to schizophrenia, depression, epilepsy, and any forms of antisocial behavior (lobotomy and very unsuccessful) - Group of neuroscientists who were studying the prefrontal cortex began to appreciate the importance of this area of the brain

pg 8 - Through all of the memories of losing your keys while being distracted, a flood of past memories comes to mind instead where they might actually be - If we have experiences that are more or less meaningless, it becomes exponentially harder to find the right memory but experiences that are the most distinct are the easiest to remember because they stand out - We can make memories stand out through attention and intention (lock onto something specific even if brief)

pg 7 - The cell assembly for the word or memory is not yet strongly connected and neurons have divided loyalties torn between competing possibilities which is why we have trouble remembering complex experiences - People get distracted because we are taking in a lot of information at once

pg 6 - Children's brains are constantly reorganizing to optimize their perception of the environment - During their first few years, babies make dramatic progress at learning how to differentiate syllables, so that a continuous stream of sound can become sensible speech through the constant reorganization of connections between neurons - Neural plasticity is the connections in the neocortex in response to new experiences (harder to learn once older not because not because we lose plasticity but because more familiar sounds become more entrenched and it becomes harder to learn new kinds of syllables quickly)

pg 5 - Neurons function like a democracy as a single neuron plays only a small role in any kind of neural computation - Canadian neuroscientist Donald Hebb called neurons that form alliances, cell assemblies - Babies can hear the difference between sounds before knowing a language - Somewhere in the brain's speech centers coalition votes for path, and an even smaller minority votes for other candidates and the votes are tallied up within 1/2 a second and the baby understands it is time for a baby - Learning kicks in in the aftermath of the election, the winning coalition works to strengthen its base all all neurons that were correct are brought into the fold but losers aren't

pg 4 - Ebbinhaus experiment said he could only memorize 64 trigrams (3 random words) in a session because of exhaustion, headache, and other symptoms - Ebbinghaus discovered that he forgot nearly half of the trigrams within 30 min and 2/3s a day later - Humans have 86 billion neurons and are the most basic working unit of the brain (responsible for carrying messages to different areas of the brain like sensors)

pg 3 - Not all of our experiences are of equal importance while others are moments we hope to treasure forever - Although we tend to believe that we can and should remember anything we want, the reality is we are designed to forget - German psychologist Hermann Ebbinghaus said we must first be able to quantify memory objectively rather than asking people subjective questions about events such as kid's birthday parties

pg 2 - Ranganath memories with his child - Mira's 8th birthday party so Ranganath had to make the kids busy so they didn't feel bored (coloring cats, piñata, etc)

pg 1 - Over a lifetime, you will be exposed to far more information than any organism could possibly store (11.8 hours worth per day) - Why do we remember some events and forget others?

pg 5 - What Ranganath will talk about in book

pg 4 - Sounds, smells, and sights we experience in the present can transport us back to joyful times (great memories) - Remembered experiences and the feelings they elicit speak to one of the core principles that has underpinned much of work Ranganath's work both a clinical psychologist and neuroscientist - Our memories have helped animals survive (which berries are poisonous) - Our brains are memories are malleable and sometimes inaccurate because our brains were designed to navigate a world that is constantly changing

pg 3 - Experiment to make volunteers sad by playing music and asked them to remember a sad event (they got sad) - They were able to use people's memories of the past to change how they felt and looked at things in the present - Memories can be triggered by a word, a face, a certain smell or taste

pg 2 - Your "remembering self" is shaping your present and future by influencing your decisions - Memories in our thoughts, actions, emotions, and decisions often pass unnoticed, except for those movements when it fails (what am I forgetting) - We have wrong expectations on memory (we aren't supposed to remember everything from our past) - Sir Frederic Bartlett, one of the most important figures in the history of memory research said "literal recall is extraordinarily unimportant" - We shouldn't ask why we forget but why we remember

pg 1 - Think about who you are what and makes you yourself (beliefs, experiences, etc) - Nobel-winning psychologist Danny Kahneman says that your "experiencing self" does the living but your "remembering self" makes the choices - Kahneman says that happiness and satisfaction you gain come from the outcomes of your decisions don't come from what you've experienced but what you remember

pg 25 - Most familial Alzheimer's cases have defects in 2 genes located on 3 different chromosomes: 1,14, and 21 - If a relative inherited 1 of these mutated genes, they are 100% likely to get Alzheimer's - Life is normal for Debaggio just a in subtle ways is he different than a few years ago

pg 24 - Francesco his son is heart broken by seeing his father deteriorate but also scared for himself

pg 23 - The words and phrases: "dementia" and "Rule out treatable cause" breaks anyones heart - Debaggio gets tested for Alzheimer's - 2 types existed: familial and sporadic(random)

pg 22 - Doctor asks questions related to sanity like where he was and what year, month, and day it was - Counting back by 7s was more difficult for Debaggio to do

pg 21 - There is a torture in making a patient wait for a doctor - Doctor becomes inspector and asks Debaggio questions

pg 20 - Debaggio remembers a time when Mr. Rice killed a chicken - Debaggio was not the oldest or in the most pain and he didn't look as sick as everyone else

pg 19 - Mr. Rice was Debaggio's neighbor and made honey - More results from neuropsychological evaluation - Genes are made up of 4 chemicals

pg 17 - More results from the neuropsychological evaluation

pg 16 - Debaggio vocabulary was above average - Other findings and results in tests - Debaggio was able to track his Alzheimer's but it was minor and subtle

pg 15 - Debaggio was a clean and tidy person but now Alzheimer's begun its conquest - Debaggio got a neuropsychological evaluation and the results are below average intelligence.

pg 14 - Debaggio is suddenly surrounded by clutter and doesn't remember how it all got there - It is very messy in that room

pg 13 - Alzheimer's doubles ever 5 years after you turn 65 and nearly half of all 85 year olds have symptoms - It is harder to diagnose depressed people as they have similar responses to questions

pg 12 - Debaggio had scars from pasta water falling on his back as a baby (2 years old) - Alzheimer's affects 4 million Americans - Half of them receive care at home and the other half are institutionalized

pg 11 - Mother nature is the enemy of farmers and makes Debaggio's work more stressful which might be why he was forgetting things but it wasn't - Debaggio's parents died from cancer (mother) and a bad heart (father) - Debaggio thought never going to doctors was good and didn't ever need to because he rarely got sick but he was also scared of them

pg 10 - Drugs to take as medication - Debaggio's father worked for the Bureau of Narcotics

pg 9 - We can send people to the moon but we can't find a cure for Alzheimer's after billions of dollars spent for research - The brain governs a lot of things including thinking, personality, mood, sense, and things like breathing and digesting food - 5-10% of patients seen have reversible demntia due to medication

pg 8 - News made possible link between aluminum and Alzheimer's so people threw away metal cans, cookware, etc (1999) - Aricept used to be used for Alzheimer's medication with a common side affect of diarrhea

pg 7 - You can't study the illness while you have it as it can threaten to destroy friendships and the love of those around them - Debaggio wants to stay open with no secrets (his diary is this book) - Background info (born in Iowa)

pg 6 - dying in slow motion story: I am alone and I can hear water running somewhere in the house. I don't remember going to the bathroom. Who else turned on the water? - Movies took place of books and information - Alzheimer's disease is an irreversible, progressive brain dis- order that occurs gradually and results in memory loss, un- usual behavior, personality changes, and a decline in thinking abilities

pg 5 - Alzheimer can strike as early as 30 - It is hard to understand the disease as it works slowly destroying the mind and stealing life in a tedious silent death

pg 4 - Debaggio admits that he has trouble remembering things that are basic as a farmer and personal life - Alzheimer's disease was named 100 years before (written maybe 2000s) by Alois Alzheimer a German who described the effects - Alois Alzheimer cut open the brains of people who died with the disease as they were useless

pg 3 - Debaggio losing his sacred memory long before expected (75 years old) - Debaggio couldn't remember friends names and even the year (played it off as stress) - His doctor asked him "Is there anything you want to tell me" to Debaggio

pg 1 - Debaggio feels fine but diagnosed with Alzheimer's and aging (75 years old) - Genetic secrets, locked inside before my birth were now open - At beginning Debaggio became depressed buth then he realized he had a story to tell

pg 4 - Countries that are poor like Haiti need better economies or they people will continue to suffer - World Health Organization says it is impossible to get effective treatment for people in poor settings - Dr. Farmer asks why not and says that people don't want to be declared cost-ineffective Dr. Farmer calls for large distribution of wealth in Haiti

pg 3 - Dr. Farmer got the genius grants which gave him the entire sum sent to Partners in Health ($220,000) - Dr. Farmer is the hardest-working broke man - Medicine can only address some symptoms of poverty

pg 2 - Farmer doesn't care the cost of the treatment (18k per year) because he is saving lives (sin not to help people) - Dr. Farmer gaining treatment from Haitian patients - Dr. Farmer graduated from Duke with all A's in anthropology - Dr. Farmer went on to study anthropology and medical school at Harvard at the same time in 1990 - Dr. Farmer tries to bring Boston medicine to Central Plateau - 1 million peasant farmers rely on medical complex now and there are only nominal fees with really ill women and children free - bottom right for more details on disease in Haiti and Dr. Farmer credentials

pg 1 - Maps of Haiti - Zanmi Lasante famous for medical director Dr. Paul Farmer (Haitians believed that illness came from sorcery) - A young man has AIDS - Farmer teaches to medical students that to be a good clinician you can't let your patient know you have problems or that you're in a hurry

pg 4 - The sisters (nuns) Mr. Q worked for gave him his identity as a janitor to not break him (hold him together because of his role) - Mr. Q died of a heart attack and maybe was unsure that he was anything if not a janitor - Should the doctors and nurses told him he was not a janitor?

pg 3 - Dr. M. found playing doctor in the hospital and saw that he has Alzheimer's disease and wept - He recognizes other doctors sometimes - Mr. Q was a janitor in a school and played janitor again in the hospital as a patient

pg 2 - Sacks takes notes of Dr. M's condition over the course of a year - Dr. M has lucid moments and it is unsure if he realizes what is happening to him (not self aware) - Then Dr. M. stepped into his role as hospital director again and it was very brief and suprising

pg 1 - Being a physician involves more than just hading out diagnoses and treatment (playing a role in some of the most intimate decisions of a patient's life) - How to tell your patient about life altering condition/s that might be life-threatening - Dr. M. He diagnosed with Alzheimer's (he retired as medical director of the hospital when the Sacks started working there)

pg 23 A babysitter means that the confused person is losing their independence which he may realize and react badly to. Remind the sitter that you have the authority to hire or fire the person not the confused person. By allowing the sitter for the first few visits to have you present, they will understand how to take care of the confused person better.

pg 22 Families often ask whether it is better to spoil the person's behavior or try and teach them to behave differently. Neither is appropriate but you shouldn't try and spoil them because they can't care responsibly for themselves. Say you will get them something once a timer goes off so that demands become more manageable and help the confused person understand the relationship.

pg 21 Older adults can be demanding and self centered especially when they don't seem that impaired. Is it apart of their nature or is it because of the disease but most times they aren't manipulating and are impaired.

pg 20 Reassure that these confused people aren't crazy and aren't dangerous. By changing the subject, a confused person gets distracted when you don't want to answer a personal question. Confused people still answer and talk on the phone so messages can be forgotten.

pg 19 You can always take the sympathetic route and feel for that confused person. It is important to understand the situation with mentally ill people as they might be honest but intentionally mean.

pg 18 Confused people misinterpret things and that you are the reason for their discomfort. For example if they lose something and you are standing there, their reasoning is that you stole something from them. When a confused person say I want to go home, they want to go back to the quality of life they once had. Don't try and reason with the confused person as it only upsets and confuses them even more.

pg 17 By sticking close to someone who remembers a necessity, it gives confused people security. By giving someone a timer and saying that they will be back, it allows the older adult to give you uninterrupted time. Also, by distracting confused people with tasks, you can get away with doing work. Confused people can insult you even when you are trying to help them. By taking it personally, it just makes the situation worse for both parties.

pg 16 Confused people repeat the same thing over and over again. The brain tends to get stuck on one activity and has difficulty shifting gears to new activities. By touching someone or giving them something to hold, people are able to get distracted and do new activities (sometimes words don't work).

pg 15 By pretending annoying questions as if they didn't ask it, they will eventually stop asking. Don't scold and instead distract the person from doing the annoying action. Instead of saying "sit down" give them a deck of cards. Confused people repeat questions sometimes when they are distressed and by answering the question with a calm response, it can help that person.

pg 14 Be understanding that these people are confused and shouldn't be a reflection on that person. Changing annoying behaviors by repetition of asking the same question over and over and by having all the people by asking why a confused person does something. It takes time before change starts.

pg 13 People that are senile don't develop inappropriate sexual behaviors. It might happen due to confusion but it isn't intentional. By using different types of clothing for these adults without zippers or blouse, these actions can decrease.

pg 12 It is very common for dementing ill people lose or hide things. Limiting the number of places by using locks helps decrease the amount of hiding places. Take away jewelry so that the confused person doesn't lose it. Confused people can expose themselves in public or make inappropriate gestures.

pg 11 Dementing illness people have more behavior problems in the evening. By decreasing the amount of things or activities during a confused person is at their worst, it can improve that person's behavior.

pg 10 By giving an older person some warm milk, they will go back to bed. Have precautions to prevent fires, tripping, falling, or other things that could hurt the confused person. Sedation is not a smart technique to get older adults to sleep for a wider variety of reasons (it works for some but not all)

pg 9 Older people need less sleep than younger people so try to keep them occupied during the day so that they are more sleepy at night. Making them work out like going on long walks can make a confused person more sleepy at night (make them go to the bathroom before going to sleep).

pg 8 Health care restraints need to be jointly decided between health care professionals and family members. Posey restraint is a non-harmful restraint (like a vest or attached to wrists).Restraints should be used when wandering behavior is more than you can manage. Seek institutional care if you can't help the confused person anymore.

pg 7 Changing the environment to protect the person is an important part of coping. Locking the doors, give someone slippers instead of shoes, etc. Most people are good and want to protect the confused person.

pg 6 For people who wander because they feel lost, give them pictures of family to make them feel more secure. Also ask when this confused person gets lost or why and it will help you understand how to support that person. Medication can reduce a patient's restlessness.

pg 5 Explain the situation or refer to this card when they are not completely senile so that they always go back to that card. Easing senile people into new events. Frequent reassurance for people in cared living takes time for that person to feel secure.

pg 4 For memory loss people who like to wander, people should put cards in their pockets in case they get lost so that you and they can find them and reorient that person to a safe space or home (aka a dog collar).

pg 3 Sometimes people pace which is different than wandering because they aren't lost. Memory loss people panic easier and pace as a stress reliever. People in nursing homes wander to go home or get back to their family or normal life.

pg 2 People get angry and blame people when they forget things. People are able to hide their bad news for a long time. Dementing illnesses can be very deceiving. People with memory loss like to wander which can be dangerous and lead to people getting lost and become a burden for family members. Wandering occurs when in new situations or patterns.

pg 1 Hiding dementia is common as people don't wanna admit that they are getting senile. Families are shocked by the diagnosis as they don't want to admit that there is something wrong with them. There are coping mechanisms for dealing with memory loss such as making lists.

pg 29 Everyday living with memory loss post diagnosis. People drastically have different expressions when it comes to the diagnosis of Alzheimer's and dementia.

pg 28 Becoming an Alzheimer's patient demonstrates the fluidity of management strategies and the ways in which identity evolves over time. These patients usually need to eventually go to care taking facilities.

pg 27 Forgetful people are on the path of dementia or Alzheimer's patients. People use medicine to become less forgetful and improve their memories.

pg 26 Man doesn't want to tell his wife when he forgets something because he doesn't want her to have regrets of marrying him. Because she is 20 years younger, the husband doesn't want to become a burden on her and how it might affect their relationship.

pg 25 Man is healthy and fit but his wife of 10 years said his memory loss increased after he drank.

pg 24 We do get wrong information from doctors. They aren't perfect and it is annoying to hear "take an aspirin" and "you're just getting older". Do the research on the drugs you are going to take to understand why you need to take them and what the drugs are for.

pg 23 Women surprised by diagnosis as she still does goals that she sets for herself. She didn't realize that she was diagnosed, because it doesn't hinder her ability to complete tasks. As you get older, you have more to remember so you forgot easier but that is just a part of life.

pg 22 People scared of status associated with MCI and how it might affect his relationship with a much younger women.

pg 21 People know what happened in the past from long times ago but can't remember what happened yesterday. You can't put all your eggs in the medical field because they can't always cure you.

pg 20 Knowing the diagnosis can also scare patients as spouse might regret marrying them. Patient is scared how their significant other will react.

pg 19 Some people gain understanding for why they act a certain way and it isn't your fault. The diagnosis gives a sense of reasoning which is really helpful for some people.

pg 18 Many people were shocked when getting the diagnosis. I know other people have it, but I never thought I could have Alzheimer's disease. It is a permanent problem with no end in sight and no way to get better which is depressing.

pg 17 The Clinician is giving their best diagnosis and adding you to their fund of knowledge. Some people need space when they are getting diagnosed.

pg 16 Memory loss isn't that important as long as these people stay happy and have the love and support they need from their families.

pg 15 These Clinicians were good as they were compassionate compared to the more scientific approach.

pg 14 Clinician jokes around with patients and says they don't have anything to worry about in terms of longevity.

pg 13 What is the difference between aging and dementia? What is the difference between dementia and Alzheimer's disease? It is unclear to families because clinicians don't do great jobs explaining to the patients or there families.

pg 12 Patients are getting a real diagnosis because there isn't a test that can prove if Alzheimer's disease is in the brain or not. Sometimes Clinician will say that it is coming but they don't know for a fact which is worrying.

pg 11 There are 200 causes of dementia. 50% are AD, 30% are mulit farct (mini-strokes). There isn't a lot known about dementia and Alzheimer's disease.

pg 10 A final interview would give patients and their family time to think the news through to ask questions after.

pg 9 Some people after receiving the diagnosis wanted many details and others a small bit at a time depending on how many questions they ask after. Some people wished they never heard the new because it is the worst outcome. Sometimes the doctors don't come out and say Alzheimer's which can be confusing for a diagnosis.

pg 8 Diagnosis is supposed to come to the patient not to the family. Clinicians when not talking to patient act as if he/she is not there which is insensitive.

pg 7 Sad to get diagnosis alone as a 72 year old women. This diagnosis is the worst news a person can imagine.

pg 6 Diagnosis can also be crushing. People fear for the worst and get stressed out trying to get all things in order before someone ends up going completely crazy or aren't able to function to full capacity.

pg 5 The diagnosis for dementia includes developing a better understand of the situation, end the uncertainty, the ability to plan, access to practical and emotional support, and the chance to develop positive coping strategies.

pg 4 The delivery of poor diagnosis were for the purpose of the family more so than the patient almost as if the patient isn't there.

pg 3 Testing to see what is the best way to break the news for Alzheimer's disease. By saying pattern of memory loss normalized and medicalized the symptoms a person was experiencing as part of the biomedical lexicon but also the opposite affected people too.

pg 2 Howard Becker said that being labeled deviant by a person by someone in an authority position is crucial for accepting the master status. Potential patients were transformed into ill people because of bad news.

pg 1 Alzheimer makes people forgetful (someone told 41 times). It is sad to get diagnosed with Alzheimers.

pg 7 - Many countries have mechanisms that link the parameters of their programs to changes in either economic or demographic developments (ensure retirement plans are fully financed) - Canadians have a great approach were every 3 years, the Chief Actuary estimates the minimum contribution rate needed to finance the system over 75 years. If the required rate exceeds the legislated rate, and policymakers can't agree on a solution, the cost-of-living adjustment is frozen and contribution rates are increased by 50% between the legislated and required rate for 3 years until the next Chief Actuary report. - The U.S. doesn't need to use Canada's backstop mechanism, but some automatic adjustment would improve confidence in the long-term stability of Social Security

pg 6 - Canada has a large actively managed fund - United States the Railroad Retirement system has invest in a broad array of assets without interfering in the private market - If policymakers wait until 2033 to fix the system, recreating a trust fund would require a tax hike to cover both the program's current costs and produce annual surplus to build up reserves - Cost and revenues don't change as a result of congressional inaction - If change had been made in the early 1990s, the Baby Boom would have shared more of the burden with subsequent generations - Youngest Boomers are 60 meaning their cohort won't be affect by increase in the payroll tax and are protected from benefit cuts (Boomers won't contribute to annual cost-of-living adjustments to Social Security) - If Congress fails to act until 2035, the youngest members of Gen x. will be in a similar position as they will be 55 - Millennials and younger generations will have to pay the full cost of fixing Social Security to maintain the 75 year solvency through 2098

pg 5 - Time is running out to avoid depletion of the OASI trust fund as we have 9 years remaining - Failure to act leads to undermining retirement system and causes some to claim their benefits early as to spare future cuts - Investing a portion of trust fund reserves equities appears to have considerable support - Social Security would likely need less in tax increases or benefit cuts to achieve long-term solvency - If Social Security had begun investing 40% of its assets in equities in 1984, the trust fund wouldn't be running out today - Economists argue the efficient risk-sharing across a lifecycle requires individuals to bear more financial risk when young and less when old (young people have little financial assets)

pg 4 - 75 year deficit equal to 3.5% of taxable payrolls The shift from 3.61-3.5% from 2023-2-24 is is the result of 3 assumptions 1) Economy: Greater than anticipated growth last year led to an increase in assumed level of productivity growth over the projection period 2) Disability Incidence: It has continued to drop driven largely by the strength of the economy and a stricter process for awarding benefits on appeal 3) Fertility: Has declined sharply because of lower marriage rates, high childcare, and lower fertility from which new immigrants arrive from

pg 3 - Over the next 75 years, the Social Security financial shorfall will be $22.6 trillion which can be eliminated by raising the payroll tax by 3.5% - Social Security shortfall as a percentage of GDP - The rising deficit is because of the decline in assumed productivity growth and impact of the Great Recession

pg 2 - in 2010 when Social Security's cost rate exceeded the income rate, the government had to tap the interest on trust funds to cover the benefits - Id the OASI and DI trust funds were merged, the coverage numbers would be 83% declining to 73% - Retirement age from 65 would drop immediately from 36-29% if relying on current tax revenues (not seen since 1950s) - Calculating the difference between the present discounted value of future taxes plus the assets in the trust fund is how the OASDI calculates Social Security long-run deficits

pg 1 - 2024 Trustee Report lowered projected 75 year deficit to 3.5 from 3.61 - Old-Age and Survivors Unsureance (OASI) trust assets did not change and will remain until 2033 - Disability Insurance trust find has enough to pay benefits for the full 75-year period 3 Improvements in the outlook that Congress needs to act on fast before draconian benefit cuts: 1) Options, such as investing a portion of the trust fund in equities, that disappear as the trust fund slides towards zero; 2) the increase in the burden placed on future generations as Boomers and Gen Xers avoid tax hikes or benefit cuts 3) so we never get in this mess again - The price of the OASDI program rises rapidly from 14.7- 16.3% in 2024 because of the drop in children (baby boom had 3.2 babies vs. 1.8 now)

Policy Rec pg 5: - Federal Surveys could ask more relevant questions to immigrants and workforce - Department of Labor and HHS should collaborate to fund new studies on immigrants working across gray market such as home care sector

Policy Rec pg 4: - Department of Labor should work with community-based organizations throughout the country to expand culturally and linguistically appropriate outreach and education to direct care workers - The executive branch should continue to reverse and address the more 400 executive actions on immigration policy by the Trump administration

Policy Rec pg 3: - HHS should collaborate with Department of Homeland Security for easier access for immigrants to public health programs - Congress should enact the LIFT the Bar Act and HEAL for Immigrant Families Act to ensure that immigrant and their families have access to public health care programs - Department of Labor should give resources to immigrants to speak English as 30% don't do it well

Policy Rec pg 2: - HHS and DOL should fund and evaluate broad range of immigrant-specific direct care workforce - Congress should enact Care Advancement for Direct Support Aid Workers Act which funds direct car workforce to focus on education, training, and advancement

Policy Rec pg 1: - Citizenship for Essential Workers Act: allows citizenship for undocumented persons working as essential workers during Covid-19 - Caregiver Visa: provide immigrants who obtain this visa with an opportunity to live permanently in this country - Bridge Visa: this is caregiver visa program but with employer sponsorship

Statical Overview pg 1 - Immigrant direct car workers are making 4,000+ more than U.S. born direct care workers - 11%of immigrant direct care workers live below poverty line and 42% use public assistance - U.S. born are 16% and 44 - Most immigrants are from Mexico (14%)

Immigrants Support Health pg 1

3 major factors for why there is a shortage of direct care in workforce: 1. surging numbers of older adults 2. increased acuity among long-term care clients 3. Poor job quality - Between 2021-2031, the need for long-term care will be over 9 million

Intro pg 2 - 27% of direct care workers in the U.S. are immigrants vs. 17% of total U.S. labor force (and increasing)

4 areas of federal policy intervention: 1. Providing work authorizations and pathways to citizenship that allow more immigrants to work in direct care and other essential sectors 2. Supporting the creation, testing, and replication of workforce innovations that recruit, retain, train, 3. Support immigrant direct care workers strengthening immigrant specific supports for these workers 4. Improving data collection and research to fully capture the realities of immigrant direct care workers.

Intro pg 1 - 4.8 million personal care workers for older adults - Need older adults working in labor force

Pg 8 Part D - Medication you take yourself instead of having administered in a hospital or doctor's office - There are 4 distinct phases during a calendar year and each phase the same drug can cost different amounts - You must select only 1 private plan that provides Part D drugs out of many plans available to you - Different plans cover different drugs and no plan covers them all - Plans set their own co-pay for each drug, and these amounts can vary even for the same drug - Plan may need doctor's permission before being covered with certain drugs - Plans are allowed to change their costs and benefits or withdraw from Medicary each calendar year

pg 7 Part C - Part A and B called traditional or original Medicare or fee-for-service Medicare -Medicare Advantage is Medicare Part C -covers same services under Part A and B and offers extra benefits such as: - routine vision, hearing and dental care

pg 6 Part B - medical insurance helps pay for: - medical and surgical services from any doctor accepting of Medicare patients - Diagnostic and lab test outside of facility - flu shot, mammograms, screenings for depression and diabetes - medical equipment (wheelchairs, walkers) - treatment received in an emergency room, clinic, or ambulance - Inpatient prescription drugs given by a hospital or doctor's office (Chemotherapy) - some cover physical, occupational, and speech therapies - 2nd opinions for emergency surgery - Ambulance or air rescue service in endangering circumstances - free counseling to help with obesity, smoking, or alcohol abuse

pg 5 Part A - nursing care that helps pay for: - professional nurses for short stays - semiprivate room in the hospital or nursing facility - all meals proved by the facility - lab tests, prescription drugs, medical appliances, and rehabilitation therapy

pg 4 - Medicare coverage rolls over year to year unless changed but you can change your coverage in the mid Fall - Family coverage doesn't exist in Medicare and each person must wait till 65 to join unless qualified through disability at a younger age - Medicare coverage is based on medical necessity, not age (80 and need hip replacement)

pg 3 - pre-existing medical conditions don't bar anybody or mean increased pay (no pay discrimination) - Medicare isn't free and without it, most older and disabled people wouldn't find affordable insurance in open market (reasonably priced) - Medicare deductibles are relatively small compared with ones many people pay in high-deductible health plans in Obamacare - Out-of-pocket expenses can be capped depending on your plan

pg 2 - Although Medicare is a government run system, the doctors and hospitals you get treatment from are privately run (not all but can be) - Medicare offers a choice between the original and variety Medicare Advantage health plans

pg 1 - Medicare is a federal government insurance system that helps seniors ad people with disabilities par for their healthcare starting in 1966 - Only true national healthcare as it is available for EVERYONE - Medicare is different from other types of health insurance and has 4 parts to coverage (A, B, C, and D)

pg 19 Looking at bat genomes can only point us in the direction that more focused cell biology and physiology will be required to truly understand bat longevity. How do we extend human life without spending more of those years napping? We are unlikely in achieving longer and healthier human lives.

pg 18 During hibernation, bats' muscles don't wither. Also is the question of how they are able to live along with viruses. Also male Brandt's bats live longer than female bats and same with the longest-lived little brown bats. Females are usually always the longer living sex. A lot of questions about bats.

pg 17 Because of the difference in temperature in New York and Stolby, bats only hibernate in New York for 6 months rather than 9 months in Stolby which is colder. As a result, Brandt's bats might only be aging 3 months per year whereas little brown bats age for 6 months. Hibernation might give a extra longevity boost but there is something else going on as bats still 4-5 times live longer than other birds. Bats' muscles don't wither as they are constantly being used.

pg 16 Hibernation is a mammalian specialty, involves allowing body temperature to drop by a variable but controlled amount to conserve energy. Most animals that hibernate are small but bears hibernate as well. Brandt's bats and little brown bats hibernate in deep caves which allows for closer annual average temperatures of their environment. Cold is not the same as freezing which can make ice crystals and burst cells apart killing the bat.

pg 15 Brandt's bats need to maintain the stamina to fly many miles every night to snatch insects. As echolocating hunters, these bates must preserve their high-frequency hearing because if they don't it is a death sentence. Climate could be a reason for the 20% longer life for Brandt's bats than little brown bats. To preserve a constant high body temperature, small animals must produce enough heat to compensate for this rapid heat loss which is why animals in colder weather worsens their chance of survival.

pg 14 In the 1960s, a Stolby reserve biologist banded about 1,500 Brandt's bats. Some 20 years later, people entered the cave and the bats-all males were still there. Myotis species live to different ages but is the bat genus for both Brandt's bat and little brown bats. Brandt's bats have the precisely calculated LQ of 10 which is over 40 years.

pg 13 Bats in zoos dying around the same age making records more reliable with age. Brandt's Bat is the longest lived bat. Alexander Khritankov was the biologist who discovered the bat.

pg 12 At about 3 months old, the pup is about 90% their adult age. After 5 months, their mothers cut off milk and they start to reproduce. They can at least leave up to 44 years and the oldest bat species we know. Animals in zoos can move around and there are mishaps with mixing up birth records.

pg 11 Indian fruit bats reproduce with as many men as they wish. Sexual encounters info on this pg!

pg 10 These bats live off of fruits using their eyes and night vision. They are crop thieves and have many viruses that spill over to domesticated animals and humans such as Nipah virus through pigs and then humans. The Indian flying fox is one of the largest species of flying foes and is about the size of a seagull. They also eat flowers and nectar.

pg 9 Bat mothers give blood to their babies. Vampire bats live 30 years but males live a bit shorter lives. Vampire bats have an LQ of 5.5. Indian Flying Fox are larger than other bats and hang on the branches of trees and live in the thousands. They don't hide away in caves but on tree branches in the middle of the day.

pg 8 Vampires will start to die if they don't eat for 3 days. Bats will regurgitate blood for other bats to survive but not usually with blood relatives. They need to be "bat buddies" which means they spend a lot of time together. Bat babies require 7 months before its single large pup is born. bats have the largest babies relative to maternal body size of any other mammal.

pg 7 Austad seeker medical attention. Bats have to find sleeping mammals and use infrared sensors in their nose to find a spot where blood flows near the skin. They use specialized teeth and shave away fur to expose the skin and cut a hole about the diameter of a pencil through the skin and begin lapping the blood. There saliva keeps the blood flowing. A vampire drinks blood for about 30 minutes and drink about 60% of their body weight in blood. While drinking the blood, they pee out unnecessary water weight.

pg 6 Vampire bats are the size of a mouse. There diet is 100% blood but pups drink their mother's milk. There prey is horses and cattle. A big agricultural problem is rabies but rabies kills bat too. Austad was bit by a bat once while conducting his research.

pg 5 The little brown bat is most common in North American. During warmer months, they can be found during the day roosting and sleeping while hanging by there feet and in the colder months they hibernate in caves or abandoned mines. Little brown bats could live at least 34 years. Little brown bats have LQ of 7.5 at least and greater than any wild bird. Bats have one pup per year and have one once a year where they have to nurse the pup for another year till they are ready for reproduction themselves.

pg 4 Viruses such as rabies, Ebola, Hendra, Nipha, Marburg, SARS, and more. Bat researchers are rare unlike bird observers and little is know about their age compared with birds. Information about bats is come across by accident.

pg 3 Bats live on all continents except for Antarctica. There are a lot of individual bats that they show up on weather radars. Bats take to caves, mines, and leafs. Bats have different appetites. Bat echolocation is very precise where they can track prey and move around really easily. Bats and viruses are best friends as they and can spill over into humans (like COVID).

pg 2 65 million years ago, bats existed. insects took to air 300 million years ago and birds 150 million years ago. We are uncertain to how old bats are because it is hard to preserve their delicate bones with the humid tropics. The closest living relatives to bats are horses. There are about 1,000 living bat species which accounts for 1/5 of all mammals but we know relatively only a few dozen.

pg 1 Donald R. Griffen discovered bat echolocation. Bats can live to over 20 years old.We don't know where or how bats evolved from.

pg 15 Austad never got the documentation from the originals owners. Dunnet died in 1995 and the bird lived at least 1 year longer than Dunnet when it disappeared for good.

pg 14 For old animals, we can't prove it because there is no proof and there are a lot of upsides to lying about age for financial reasons and shows what good care the zoo gives to its animals. Stanley Flower proved that a famous elephant named Little Princess was 157 years old but changed from an African to Asian elephant (LOL). Austad said that he and his wife own a parrot named Hector that is approximately 70 years old because they have had him/her (hard to tell gender in parrots) for 25 years on top of the previous owners having Hector for another 35 years.

pg 13 Thomas Parr turned into a celebrity because people believed he was 152 years old and people couldn't prove it wrong. Every time a tortoise dies, the owners claim it to have been 175 years old and other bs.

pg 12 Small animals are more vulnerable to temperature extremes. Austad and Keyt Fischer in 1991 came up with a longevity quotient also referred to as LQ. It calculates the longevity of an animal based on size and protection from environmental hazards. An average mammal is LQ 1 but if that animals of the same size lives twice as long they are given an LQ 2 and if half as long then it lives LQ .5. When you stray outside of human longevity and other mammals, it looks pretty unimpressive as some animals live for really long times.

pg 11 Among reptiles, you can find the same patterns of aging but there are exceptions. For example humans or mice. Biological time flies by faster for small animals than compared with larger animals. Their metabolic rate that burns up energy changes based on the animal. For example mice's metabolic rate burns energy some 15 times faster than cells in a horse. Small animals grow up and reproduce fasters, there heart beats faster, breathing happens faster, they need to eat and drink more often and so on.

pg 10 Old Tjikko has a root system sending up other trees when they die or are cut up. The root system is how old the tree is. Trees are a lot different with longevity than animals which will be the focus of this book. Aristotle said that larger animals generally live longer than smaller animals like whales than horses and dogs.

pg 9 Old Tjikko is 9558 years old but it is only 16 feet tall and you can wrap your arms around it. but the oldest tree in California is 2,500 years old and it is 275 feet tall and 36 feet in diameter.

pg 8 Aristotle attempted to establish patterns of longevity among different species some 2500 years ago but he was wrong quite often. Like mollusks like squid, snails, and clams loved for only a year which was wrong by a few hundred years and that humans and elephants were the longest living animals. But Aristotle noticed 2 major patterns that are real. 1. While plants live only a year- we call these appropriately enough annuals-some plants live far longer than any animal. Specifically trees but they can live for centuries measuring tree rings. Oldest living tree is called Old Tjikko and it is approximately 10,000 years old.

pg 7 Life expectancy has increased by 30 years due to economic development in countries. Deaths in early life are rare. In U.S. 1 in 20 die before the age of 50. The majority of deaths die from aging diseases like cancer, heart disease, Alzheimer's disease, stroke, and kidney or lung failure. Methuselah is the longest-lived person mentioned among the book of Genesis living 969 years and having his first child at the age of 187.

pg 6 Some species don't go through aging. We know why they don't age and why some creatures aging is slower than other species. When mice are out in the wild, they die from disease, stress, cold, prey, or something external. But mice in a laboratory die from internal failures.

pg 5 Cancer cells are immortal. Henrietta Lacks cervix cancer. It has been used for testing vaccines on diseases such as polio. The older the animal, the more mutations possible. 1 and 200 cancer deaths are people under 25. Some animal species are resistant to cancer.

pg 4 Dog Spot goes through live faster than man. 1 year=7 dog years. All animals have the risk of cancer. Your cells need to replace each other into new cells. Cancer happens when cells DNA mutates to make it lose control of its tightly regulated replication schedule.

pg 3 Nature imposes 2 general impediments to long life that species are unable to overcome: 1. Environmental hazards-external threats to survival such as predators, famine, storms, drought, poisons, pollutants, accidents, or infectious diseases Domesticated animals live longer than in the wild. For example mice and ravens. Aging occurs different in animals species but there are similarities like the deterioration of the body or the body losing strength and endurance.

pg 2 Bird species live a very long time and are very fit till the end of their lives.

pg 1 Scottish ornithologist George Dunnet with bird in his hands in 1951. Dunnet studying these birds for the rest of his life. The bird still looks young some 35 years later and fertile as could be.

Anglo-Saxon men were buried with weapons while women were buried with jewelry. Men were identified by their martial qualities while women were admired for their beauty. Men increased their status well into their 60s while women peaked in their 30s and declined with age.

Max human life span is 125 and 3 main causes of death now are cardiovascular disease, stroke, and cancer.

People in these cemeteries ranged from 50-75 years old.

Marc Oxenham studied cemetery populations that have seen little change over the life of the cemetery. People ate similar food and behaved in similar ways with their teeth.

Average life expectancy ranges from 50-84 in Japan.

Someone's age of death can't be determined by age alone. The factors of died, activity, stress, attitude, etc all play a role in our longevity.

We label people such as young, middle aged, and old based on appearance but anthropologist use skeletons to judge biological age.

Mortality rates in tradition populations are high for babies, decreased risk till 40s and increased again in 70s.

Age at death is about 70 for traditional people who live far way from modern medicines and markets.

Not all ancient people died when they were 30. In fact some lived into their 80s.

How can this be if they are healthier than ever?

Polio was thought be have been gone with just 1 case in 1993, however in Rockland County, New Jersey, whih has low vaccination coverage, there was a case of polio which created a public health emergency.

Polio is one of the most known illnesses with the creation of the iron lung to support the body's paralysis. The epidemic occurred for decades in the 1900s.

The U.S. has declared Rubella eliminated but the infection is still around the world. However, with vaccines, the cases dropped from 50,000 to only 6,000 in 2020.

Rubella is very harmful towards pregnant women which proceeds to give the baby many different problems and a third of them don't live to their 1 year old. Over 30,00 annual worldwide cases.

Increase of mumps cases because of parents lack of care for children.

Mumps can be on sexual organs as well.

Mumps swells up the face and glands and can stay dormant for a month.

A few hundred cases per year in 1940s to 50 cases in the past 20 years.

Very lethal illness even with treatment.

Tetanus affects the entire body.

Unknown benefits of vaccines.

Very deadly disease.

Very dangerous disease.

Diphtheria given a horrible nickname.

Diphtheria is lethal from suffocating.

Because of parent's not giving children measles vaccine, the illness is starting to resurge.

Another 95% of vaccines prevent other viruses that are contagious in communities.

Almost 100% effective rate for vaccine.

Most people before 1963 caught the disease and hundreds died of it.

Measles is worst on 5 year old children who can die from the illness.

Measles is highly contagious without vaccination.

Vaccines have erased illnesses from public memory over the past 50 years.

I spoke too soon,

Isn't this a bad thing? Shows Baumgaertner's bias.

pg 11 Increase funding for aging research that includes the biological, psychological, and societal determinants of aging health, as well as studies of the best policies and programs to take advantage of increased longevity.

pg 10 Reduce the social isolation of older persons by insisting that the government provide adequate age-inclusive and accessible public transportation. End the neglect of older people during natural disasters that can leave them trapped in dangerous places. End the practice of exclusion for older patients in clinical trials.

pg 9 Ask media outlets to provide time and space on TV and radio and newspapers for interests of their older viewers and readers. Eliminate the age-based digital divide by which older people are significantly less likely to have access to the internet at home than younger persons.