Sage Advice

By staff June 1, 2004

Fred Astaire once said, "Old age is like everything else. To make a success of it, you've got to start young." The good news is, even if you haven't made plans for your senior years, it is never too late to start.

In July, local geriatrician Dr. Kevin O'Neil and estate planning attorney Renno Peterson will release Optimal Aging Manual: Your Guide from Experts in Medicine, Law, and Finance, a collection of medical and financial tips for seniors culled from national experts in a variety of fields. Part of the book's profits will sponsor scholarships at Ringling School of Art and Design, whose students illustrated the book, along with geriatric education and research. Here's a sampling of O'Neil and Peterson's tips for a healthier, wealthier old age.


VISION: Many changes that occur in our eyes as we age are normal, but sometimes these changes can be difficult to distinguish from serious diseases. Regular examinations by an eye doctor can identify diseases early so that treatment can be started to avoid vision loss.

Cataracts affect nearly one out of seven Americans and are the most common cause of visual loss in the elderly. However, they are also the most treatable cause of visual loss. Macular degeneration is the most common cause of legal blindness in people over the age of 50, and while incurable, there are measures that can compensate for the visual loss. Glaucoma does not exhibit any early symptoms, but early detection and treatment can help prevent vision loss.

HEARING: Hearing loss is the most common medical condition in people over 65 years of age. But it often takes a spouse, relative or friend to bring it to your attention.

Do not use cotton-tipped applicators to clean your ears! This may push earwax further into the ear canal and pack it down so that it is more difficult to remove. Even worse, you can accidentally perforate your eardrum.

Be aware of noise levels in your environment. Excessive noise can damage your hearing. If you have hearing loss, suggest that family members and friends face you and speak more clearly instead of shouting. Eliminate background noise from television and radios if possible. In restaurants or at social functions try to sit in quieter places.

OBESITY: Some 37 percent of Americans over 70 are considered overweight and 15 percent are obese. Yet even a modest weight loss of 10 percent can reduce cardiac risk factors and other obesity complications.

A low-calorie diet is central to weight loss, which can occur with increased exercise, but is quicker when combined with a low-calorie diet. Before lowering daily calories, though, seek advice from a health care professional. Do not use weight loss medications except under the supervision of a physician. And be aware that weight loss surgery has not been adequately studied in older adults.


INSURANCE: Each of the five basic types of life insurance policies (whole life, universal life, variable life, indexed life, and term life) has a distinct purpose, and deciding which one works best for you depends on your personal situation and risk tolerance.

To protect yourself, your family, and your estate plan and get the best underwriting, work with qualified experts who specialize in financial planning and insurance. Analyze several insurance companies, their financial strength and their ratings by the major agencies.

Not all insurance companies look at your health and age in the same way, so never assume that age or current health problems preclude you from obtaining coverage. Add safety to your insurance portfolio by splitting coverage between two or more companies and averaging the cost. If you have existing policies that you no longer need or want, try to sell them for more than their current cash value via a transaction known as life settlement.

Accumulation annuities offer income tax deferral, creditor protection, and a variety of financial planning situations, including protecting Social Security income from taxation. And insurers are getting more creative in providing policy owner options, including extra death benefits, nursing home income, cost-of-living increases, and rights of commutation in payout policies.

RETIREMENT INCOME: Because Social Security accounts for less than 40 percent of all retirement income, take advantage of individual and employer retirement plans as well. Most of these plans provide incentives to save in the form of tax-deductible contributions and tax-deferred growth, so money inside such a plan will generally grow faster than money outside of one.

Individual and employee plans are subject to a 10 percent penalty tax if you take money prior to retirement, and once you reach your required beginning date (usually April 1 of the year in which you reach 701/2), you must take annual minimum distributions in order to avoid a 50 percent penalty tax.

After your death, your beneficiaries must continue to take annual minimum distributions until your retirement plan has been exhausted. Since the amount of these distributions will depend on the named beneficiary and whether you die before or after your required beginning date, consult an estate planning professional before naming a beneficiary.

MEDICAID AND MEDICARE: An estimated one out of every four seniors over the age of 65 will require nursing home care, and half the people over 85 will require long-term care. Medicare, as structured, provides inconsequential financial coverage for nursing home costs. If a person does not precede nursing home placement by a hospital stay of at least three nights and four days, Medicare will pay nothing. Even with the hospital stay, Medicare only pays for 20 days in full, then 80 days for anything in excess of $100. After three months, you're on your own.

Medicaid pays for nursing home care (and, in a few situations, a portion of assisted living care), but myths surrounding Medicaid eligibility can result in families waiting too long to apply for assistance or trying to protect their assets in ways that could permanently exclude them from coverage. Often, Medicaid will cover some or all the costs of nursing home care, but understanding its rules can mean the difference between a family's financial security and impoverishment.

Although the material in Optimal Aging is oriented to those over 50, it can benefit anyone who wants to learn how to reduce risk for problems later on. For a preview of the book, visit Dr. O'Neill's Web site at


Shaping up with stretch exercise

Ann Smith, a lithe, 76-year-old dance teacher with the body of a gazelle and the strength of a 250-pound linebacker, has a tip for weight watchers: Don't refrigerate butter for toast. At room temperature, you'll use half of what you'd use cold.

Smith knows a thing or two about food, since her specialty is fitness, or more accurately, movement-fluid, balletic movement achieved through stretching her body beyond its normal limits. A classically trained dancer who has been teaching since 1950, Smith wrote the first book on stretch exercise in 1969; and her latest video, a collection of morning exercises called Rise and Shine, hit No. 1 on So take her word for it when this grandmother of seven claims she can do the same number of pushups as the average Marine.

"Look around, and you'll notice that dancers live long, healthy lives in very healthy bodies," says Smith. But she eschews aerobics and traditional weight training. "American exercise has always been based on sports training. It trains you for competition, not to fight obesity." Instead, Smith maintains her svelte shape using a program she developed that incorporates Pilates moves with slow, continuous ballet stretching.

Because it requires no impact or speed, doctors recommend her system for stroke and cardiac rehabilitation. It's got other virtues, too. "I don't limit myself to any food," Smith claims. Junk food is anathema (she's eaten only one MacDonald's hamburger in her life), but she still enjoys eggs, butter, cheese, and the occasional cocktail.

Smith has taught classes for the National Institutes of Health in Washington, and is an ambassador for "55-Plus," a national effort to get aging Americans involved in exercise. Students of all ages flock to her guest appearances at YMCA facilities throughout the country, where she peppers them with phrases like, "If you have time to feed your face, you have time to exercise."

During one appearance at a seniors facility, she ordered the class out of their chairs with the command, "If you could walk to this room, you can stand up to exercise." The room erupted in applause, and the seniors flew off their seats.

"Exercise is a natural body instinct," says Smith. "It's equivalent to eating and sleeping." And while she prefers her physical fitness without the racquetball and treadmills, she understands that some people require more stimuli. "It doesn't matter what you do," says Smith. "As long as you do it every day."

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