Over the river and through the woods

I love it when the fact that most extended families live in close geographic proximity makes front-page news! According to the December 24, 2015 New York Times, “Over all, the median distance Americans live from their mother is 18 miles.”

Gerontologists have known for decades that the primary caregivers of frail older adults are family members. It turns out that a great many grandparents care for grandchildren as well. Even though the perception is that boomers neglect their aging parents, and millennials pay for childcare, in fact we are a tightly-knit nation of multi-generational familial caregivers.

Should you buy long-term care insurance?

When I give my talk, “7 Actions You Can Take to Stay Out of a Nursing Home”, people often ask about long-term care insurance. This insurance might be a prudent investment, unless you are in one of two income categories.

If you have few assets and would easily qualify for Medicaid, then check with a lawyer who can advise you specifically about spending down if you need to qualify for Medicaid. It will pay for skilled care (most residents of nursing homes are on Medicaid), but will limit your choices on where you go to live, often for the rest of your life.

According to the AARP in 2015, people with sufficient resources to pay $100,000 a year for extended long-term care, can afford to self-pay. Having enough money to fund your own long-term care will give you more options such as home care, high-end assisted living, and some of the more elegant nursing homes, which do not accept Medicaid.

I’m going to include this information in the 3rd edition of my book, to be published soon. Please email me at jfranks1@comcast.net if this is not clear. It’s complicated!

Is it weird to google yourself?

I was honored when a dear friend recently bought 3 copies of To Move or To Stay Put to give as holiday presents. Thank you! I was even more pleased when she asked me to sign them. Thank you a hundred times, Roxanne!

This slender book mails for only $2.72 and is a nice gift for those adult children telling mom or dad, “You ought to move.” As I often point out, a major predictor of people who perceive a high quality of life in old age is how they answer the question, “Who decided you were going to live here?” Of course those who answer, “I did” are the happiest.” If you want your offspring to understand this, give them the book!

This brings me to my question, “Is it weird to google yourself?” I wanted to see what pops up when I google my book. Naturally, for better or for worse, Amazon is at the top. They spend the big bucks and make the big bucks. And I was absolutely delighted to see favorable reviews. I hope you consider adding yours—but only if you write from your heart, please.

I wrote this book for one reason only—to get into print what I’ve learned in 30 years working with older people and does not pop up in other books. I’ve now broken even in terms of cost (my labor being free) and must decide whether to do a third edition. Please let me know what YOU think.

Upcoming 2015 and 2016 talks and an 8th component to increase quality of life (in addition to 7 actions to minimize the risk of living in a nursing home)

I fully enjoyed speaking  November 16, 2 pm, in Seattle at the “Brig” Community Center in Magnuson Park, 5751 33rd NE, 98105. This interactive discussion of maximizing your later decades was hosted by ”North East Seattle Together” (NEST), one of our 3 local villages http://nestseattle.org. NEST was well represented at the excellent National Village to Village Network Conference in Seattle Oct. 5, 6, and 7. NEST has the greatest participation of any of the 3 Seattle Villages. info@nestseattle.org

Thursday, November 19, 11:30 I’ll be at the White Horse Golf Club. The Pt. Ludlow Yacht Club Women’s Group has been kind enough to invite me to speak. If you are a member, I hope you’ll come!

Keep posted for the development of a village on Bainbridge. The Village concept is all about aging in place, which is surely what most of us want! Next meeting Nov. 21, at the Waterfront Park Community Center; call 206-842-1616 for details.

Kitsap Library Talks in 2016:

 Poulsbo, Tuesday March 15 at 2

Silverdale, Friday March 18 at 3

Port Orchard, Tuesday March 22 at 2

Bainbridge Island, March 26 at 3

These interactive and ever-changing talks focus on decisions in your later decades to minimize living in a nursing home.

My goal in my last decades of life is to examine issues crucial to quality of life—everyone’s and mine. Hubris, I know, but also increasingly urgent.

A life-enhancing factor often excluding from talks on aging is that we all need a clean and healthy planet to age well. No credible scientists deny global warming; I think of it as global boiling. Our oceans are dying, our forests are burning, and outdoor activities are increasingly downright dangerous. Skin cancer from sun exposure is on the increase, cancer from pollution is going up, respiratory illness all over the world is rampant.

We can only save ourselves, or at least leave a decent planted for grandchildren, by saving the earth. How do we do that? Please, I honestly entreat your suggestions.DSCF0108-2-2

Rotator Cuff Tears are a Pain in the Neck (and shoulder)

Watch Out for Rotator Cuff Tears

Jeannette Franks, PhD

Reviewed by David Belfie, MD, Orthopedics and Sports Medicine, Virginia Mason Medical Center, Seattle

September 2015

Sometimes I wish I could take my body in for repairs just like I take my car to a mechanic to get new parts. “New battery or headlights—no problem!” But while we can replace more and more parts of the human body, some areas are less amenable to repairs and yet more subject to breakdown, particularly the knees and shoulders. Rotator cuff tears are one of the most common injuries in older people. The risk factors for a rotator cuff tear included a history of trauma, dominant arm, and age.

My first shoulder injury happened twenty years ago while hiking uphill on a rugged trail, fully-loaded with a heavy backpack. I grabbed a tree to keep from falling when I slipped, and while I broke my fall, my shoulder was clearly and seriously annoyed.

How the shoulder works

The shoulder is the most flexible joint in the body. While this allows us great range of motion, this same flexibility makes us more vulnerable to instability and injury. The shoulder is a ball-and-socket joint made up of three bones: the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone).

The joint capsule surrounding the shoulder joint is a thin sheet of fibers. The rotator cuff consists of four muscles (the supraspinatus, the infraspinatus, the subscapularis, and the teres minor) and their tendons covering the shoulder joint and joint capsule. Tendons are the stretchy cords that connect muscles to bones.

These tendons and muscles enable you to lift your arm, reach overhead, participate in sports, and perform normal activities of daily living.

How the rotator cuff can become injured

A rotator cuff tear is most common in people over 40. However, it can occur at any age, either as a result of trauma, such as a fall or sharp tug on the arm, or a repetitive injury such as in sports, weight lifting, or overhead activities. Often tennis players, swimmers, pitchers, and basketball players will tear a rotator cuff. Workers in jobs such as construction, painting, or stocking overhead shelves are also at risk. A tear may also occur as a result of an accident causing a dislocation or fracture.


Most people with an acute tear immediately know something is wrong. The primary symptom is pain, especially on raising the arm or reaching behind. In an injury such as a collision, there may be a snapping sensation and weakness of the arm, as well as pain. Many tears are asymptomatic—you don’t even know it’s there.

Of course, one should never continue to use the shoulder or participate in a sport if one suspects an injury has occurred. Use the “RICE” protocol as soon as possible:




Elevation (for a leg, foot, or ankle)

In the case of wear and tear over time, the repetitive activity becomes more and more difficult. As the tendon degenerates, one may feel pain radiating down the side of the arm or a burning sensation. It may be mild at first and easily alleviated with over-the-counter analgesics, ice, and rest. But the range of motion may be steadily decreasing, while the damage worsens.

Other symptoms include weakness in the arm, or a clicking or crackling sound or sensation when the arm is moved.

Diagnosis and treatment

The physician will subject the patient to a variety of positions and stresses to elicit the major sign of a rotator cuff tear—pain. In addition to the physical examination, x-rays and an MRI (magnetic resonance imaging) may be required. Some cases may call for an arthrogram, where dye is injected into the joint in order to see the tear clearly.

Since there may be some ambiguity, the first line of treatment is generally ice, rest, and physical therapy. Non-surgical treatment options may also include the use of a sling, anti-inflammatory medication, and a steroid injection. If these do not restore the joint to normal function, the patient should revisit the doctor promptly for further examination and testing.

If the tendon or muscle has truly separated or become detached from the bone, surgery may be required. Tendons do not regenerate or reattach to the bone, no matter how excellent the physical therapy. Since there is no blood circulation in tendons, there is no re-creation of tissue. In some instances, delaying the surgical repair can increase the possibility that it will be less likely to be amenable to repair later.

Current techniques and instruments often permit surgeons to repair the rotator cuff through a very small incision—a “mini-open repair” using fiberoptic instruments.

An open surgical repair is indicated if the tear is large or complex or further reconstruction is required. In some cases, shoulder replacement may be an option, especially with severe arthritis.

Be sure to notify your physician immediately if you have any of these symptoms following surgery:

Fever after the 2nd day following surgery

Increasing pain or swelling

Redness, warmth, or tenderness

Unusual bleeding

Numbness or tingling of the arm or hand


The duration of immobilization depends on the type of tear and type of surgery. Physical therapy tends to begin quite soon after the operation, often the same week. It is absolutely crucial to follow the regimen faithfully. Human nature being what it is, we tends to be dutifully compliant at first and then slack off once the arm starts working again. However, hard, painful work for at least several months is required for full recovery.


An important prevention to shoulder injuries is to increase upper body strength. This must be done very slowly and with proper technique and form. Usually a class or trainer is required, but make sure that he or she is an excellent certified professional. Many injuries occur at the gym under the supervision of someone who should have known better. Physical Therapist Keith Heinzelman, DPT, MTC, CHT, suggests that everyone should start learning how to strengthen their rotator cuffs at least before his or her 40s. Prevention is so much more effective than treatment.

Arms should not be raised above the shoulder when standing and working out with weights in exercises such as the upright row. Many overhead lifts are performed in the safer prone position. I’ve witnessed many injuries in process when a group weight instructor demonstrates poor technique or fails to correct participants with incorrect form.

After mastering good form with an instructor, it’s easy for the patient to work out with weights at home; there are also many excellent DVDs for guidance. Or it may be more motivating to work out while watching a favorite TV show or listening to music. It’s also important to do daily stretches, especially during and after working out.

It’s extremely important to “listen to your body.” Athletes no longer say, “No pain, no gain”. Pain is the body’s way of indicating that something is wrong. A bit of muscle tenderness or soreness is fine the day after. But pain during or immediately after a sport or working out indicates a problem. People need to learn to differentiate between the mild, tight feeling a muscle gets the day after being challenged, and the pain (even slight) during or immediately after doing damage to a joint, muscle, or tendon.

Regular exercise is the absolutely most important thing one can do to avoid injury. Tendon injuries often occur in poorly conditioned muscles or “weekend athletes.” Older people are especially at risk and even simple activities such as getting out of a car can cause a serious injury in a sedentary person with poor upper body strength. Poor mobility leads to an even more restricted life and a downward spiral to frailty.

Join me in Bremerton Aug. 14 for a talk, or Seattle Sept. 27, or Bainbridge Oct. 19. Different talks but similar themes.

Jeannette Franks, PhD  Yay! The book, To Move or To Stay Put, is up on Amazon as an ebook.

Next talks: “Enlighten” in Bremerton at the Elks Club, Aug. 14, 6 pm. Featuring the most popular talk, “7 Actions You Can Take to Stay out of a Nursing Home.” After 3 days at a national conference in Chicago on nursing homes, it reconfirms that while there are many good ones, the probability is that most people won’t be in one of the best–yet. We’re working on that!

Sat., Sept. 27, Seattle University Christian Church, 9 am. Same themes, but I want to emphasize the importance of engagement, meaning, and purpose as part of living well in old age.

Monday, Oct. 19, Cedars Unitarian Universalist Church on Bainbridge, noon. Emphasis on end-of-life planning, yet another key action to keep you out of a nursing home

Call  206-755-8461 for more information

Speaking at Bainbridge Island Library Wednesday, July 8 at 1 pm

“7 Actions You Can Take to Stay Out of a Nursing Home”, at the Bainbridge Library meeting room (on the left when you enter.) Hosted by the VIPs (Visually Impaired Persons). Of course you need not be visually impaired; Wednesday, July 8 at 1 pm. This is for those of you who missed SWERVE. Or for anyone who wants to stay out of a nursing home. Although of course there are excellent nursing homes. And I know which ones they are!

from the 70s

from the 70s