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Playing in the Fourth Quarter/ Running the Last Lap

Playing in the Fourth Quarter/ Running the Last Lap

April 20, 2021

By Dave Jefferson (chronologically in his Fourth Quarter)
Stanford (AB, 1965) GSB (MBA, 1967)
Kenwood, CA 

As an American male, receiving Social Security checks for some time, I am most comfortable with using sports metaphors to describe myself on an actuarial basis: certainly I am in the last quarter of my life. (That acknowledged, my health is very good and genetically I was dealt a superb hand: Dad lasted until 88 and Mom 100, and neither suffered from dementia.) Further, if life is viewed as a game, we are all players, and how we do in the 4th Qt or on the last lap, depends a lot on how we played the first three quarters! Did we avoid tobacco, drink alcoholic beverages in moderation, if at all, keep our weight under control, minimize stress, and so on. If we did, we probably trained as well as we could for playing the last quarter. We still tire faster, and know that ultimately we all lose the game, but some of us are going to enjoy the last quarter mile a lot more than others. 

So much for the personalized preface: what I really want to discuss with my actuarial cohorts is your potential for dementia during the last chapter of your book, and what may make it somewhat easier on you and your family members. This is most germane to me as two male friends of mine (one a very talented Stanford fraternity brother/attorney from the mid 60’s, now about 78, and another chap in a local Sonoma County family that my wife has been close to for over 25 years) and about 82, are both significantly and increasingly impacted by dementia. Both fellows are living at home and assisted by bright, supportive and somewhat younger wives, but by themselves they would already be helpless and hopeless. Neither fellow anticipated this condition and likely are quite flummoxed by it. (Whether this continues into Alzheimer’s disease for each, we do not know for sure, but evidently 70% of people living with dementia (PLWDs the current acronym) wind up with ALZ.

The Dementia Problem

Within the United States, there are at least 5 million people currently living with age-related dementias. As the population increases and ages, these numbers are expected to rise significantly. To put this into perspective, it is estimated that one out of every six women and one out of every ten men, living past the age of 55 will develop dementia. Although there are various forms of dementia, around 70 percent of cases are due to Alzheimer’s. Alzheimer’s disease is the most common form of dementia, accounting for 60-80% of all cases of dementia. By the age of 85 years and older, between 25 and 50 percent of people display symptoms of dementia, more specifically Alzheimer’s.

Early screening is by far the most effective way to help detect Alzheimer’s and other types of dementia. Early detection of dementia may be able to allow intervention to ameliorate or delay the onset of symptoms. While there is currently no cure for dementia, knowing sooner can also allow families to make many important decisions, such as planning for long-term care, and organizing estate affairs.

What this should mean to all of us over 75

Friends of yours, if not in your immediate family, will soon be exhibiting early signs of dementia. Since I am not a health care professional, I am not going to be giving any sort of medical advice regarding geriatric care. But I can share some relevant information I have learned since age 70. First, having spent a lifetime in the top 1% of everything does not mean crap when it comes to dementia; having attended top schools, proving yourself in business or government, or having lead kind and generous lives means nothing if you develop dementia. And as indicated above, if you live to age 85, there is about a one chance in three of getting dementia during the remainder of your life. Clearly this is not a guarantee, but as you get older, the odds get worse.

Secondly, certain things may occur if you or you spouse/partner contract dementia. Even if you have done successful estate planning, you may have no specific plans for dealing with this type of physical ailment. Dementia can be a very severe test of the best of relationships and having a plan in advance would make sense for most. If one of the couple tires of caring for the PLWD impacted, when will they make the decision to get the partner into a health care facility? At present, the average monthly cost of such arrangements is at least $4,500 and $6,000 is not a top of range cost in nicer urban areas. Will there be the funds available for such care?  (Also many sweet people change personalities radically when dementia hits, and they are no longer the person you loved for years. They may say mean things, act out physically, and worse. If this happens while they are in a health care facility, they may be forced to leave and return home. This can be a horrible situation for an aging spouse or other family member.)  

One drug relief regime for such difficult behavior, as well as various other ailments, is medical marijuana (aka MMJ) or cannabis. Notably the Medical Board of California has listed the following medical conditions for which medical marijuana may be useful:

    • Pain Easing nausea/vomiting
    • Arthritis Appetite stimulant
    • Cancer Glaucoma
    • Anxiety Spasticity
    • Migraines HIV
    • Or any other illness for which cannabis may provide relief.

On the other hand, for those of us who grew up warned repeatedly since elementary school about Reefer Madness, threatened with criminal prosecution for possession or use of marijuana, not lifetime smokers, and generally turned off by the Stoner Image at any age, suggesting consideration of marijuana/cannabis may be viewed as quite radical. However, far better to become better educated on the subject now rather than later. If you are the one with growing dementia, you will not really be in position to do research; if you are the caregiver or responsible family member, you will likely be stressed with multiple issues. Further, there will certainly be other friends and family members adamantly opposed to any sort of MMJ/cannabis treatments, based only on a lifetime of bad press about a much-maligned herb. 

There is certainly no shortage of stumbling blocks that must overcome if one is determined to do a rigorous study of this new and unusual medicine.

    1. As of April 2021, cannabis remains federally classified as a Controlled Substances Act Schedule I Drug with no medical efficacy with high potential for abuse; this also makes it illegal for a doctor to help a patient obtain such a “dangerous drug.” 
    2. While “medical marijuana” has been legal in CA since 1995, the historical national stigma (and prohibition) against cannabis is still a fact of life. The very limited amount of research available about cannabis has been hampered by strict federal laws and severe restrictions on medical marijuana lab studies.
    3. Complicating the issue is that even in states like CA where medical cannabis is legal, doctors cannot prescribe it while it is illegal; they can only make a recommendation, even for ALZ patients. Care facilities also cannot prescribe drugs; therefore, it ultimately becomes the decision of the relevant family members to request cannabis products. (Fortunately, one CA company has been benefitting by some health care professionals willing to push the limits in this area and more are anticipated.)
    4. The American Alzheimer’s Association www.alz.org   is unsupportive of the use of cannabis, until “randomized, controlled clinical trials are carried out.” http://alz.org/media/documents/cannabis-and-cannabis-derived-products-statement-updated-feb-2020.pdf Nonetheless, while they continue to fund research in numerous areas relating to the disease, it may be they are not researching cannabis at all. Further, colleagues I respect believe their current policies are to recommend ardently against the use of any cannabis regimes.
    5. Not more than 25% of CA dementia sufferers are presently living in care facilities; the balance are chiefly with families or living alone.  Obviously, the patients themselves are not in a condition to evaluate the drug itself and the ability of families to seek adequate information in this area is conjectural.
    6. Even though the country’s medical cannabis designation is what pushed cannabis to legalization, the medical designation for cannabis is now far lower in sales than recreational and an often disregarded segment. Getting practitioners as well as adopters (patients, care providers, facilities) to be on-board with medical cannabis becomes a hurtle when the cannabis industry is thriving on recreational “dabs,” “joints,” “brownies,” and “vape pens.”

In CA there are numerous “store front” retail cannabis dispensaries but few, if any, are staffed with personnel who can advise on cannabis products for the elderly. For this reason, I am now associated with a company that has developed specific products for the elderly and is growing a professional staff of CA regional cannabis concierges that work with families and health care facilities. The Farmacann website (www.farmacann.com ) may be a good first step in expanding your knowledge about geriatric cannabis. 

Returning to my sports analogy, personally I want to play as good a game in the fourth quarter as I can. Yes, I will tire faster, miss more shots, forget some words, repeat some favorite old stories, and do other “old timer” antics like many who came before me. But if certain cannabis drugs can make my life easier, if not also reduce pain, keep me anxiety free, and help me sleep better, or for that of a loved one, I want the drugs available. I do not want others, certainly those without current medical product knowledge and knowledge of our medical conditions, denying me or others beneficial cannabis therapies. To the extent they are involved, I also will need health care facility staff, fellow patients, physicians family/caregivers knowledgeable of the benefits of cannabis for those of us who become PLWD. Lastly, I hope many of my actuarial cohort also take the time and learn more now about cannabis; you may be very thankful later that you did. Remember that for all of us the fourth quarter does not last forever, and the last lap is exactly that. Let’s enjoy it as best we can.