I had a 12-year relationship with my primary care doctor, which abruptly ended late last year. Why the change? My doctor transitioned to a concierge-style practice that would require me to pay a membership fee of $1,600 per year.
Start by asking family and friends for recommendations and branch out from there. One very underutilized resource are pharmacists, who know a tremendous number of doctors.My doctor transitioned to a concierge-style practice that would require me to pay a membership fee of $1,600 per year.
Since I'm healthy with no chronic conditions, I decided to pass on the membership. But, like many other patients, I didn't want to pay two fees — one for membership in the practice and my insurance premiums.
That decision left me with the challenge of looking for a new provider during a physician shortage, which is becoming increasingly complex, especially when looking for practices that accept Medicare patients.
Supply and Demand
The Association of American Medical Colleges predicts a shortage of up to 124,000 primary care and specialty physicians by 2034. 
The reasons for the shortage are many and complex, ranging from physician retirement and COVID burnout to a shortage of resident physician positions, high medical student debt, primary care doctors reducing their patient load and an aging population that requires more care. 
Additionally, many med students lean toward specialty medicine rather than primary care because the compensation is usually higher.
The U.S. population is getting older. The latest U.S. Census Bureau count shows that by 2034, people aged 65 and older will outnumber children for the first time in the country's history. Those population disparities will put even more strain on health care providers in the future. 
Today, the typical primary care provider (PCP) maintains 2,000 to 3,000 patients, and many spend almost half of their time updating electronic patient records and administering insurance paperwork. 
So it's no wonder they're transitioning to concierge practices, where their patient load is much smaller, but some patients — especially those in rural areas — are left without care.
A Shift to Concierge Medicine
According to a report by Grandview Research, concierge medicine is expected to grow by 10.3% between 2023 and 2030, meaning that, like me, more patients will have to choose between paying a membership fee and insurance premiums or finding a new provider.
"Patients who haven't seen their primary care doctor for a couple of years may be dropped from the practice."
Yet, Ailene Gerhardt, an independent patient advocate and founder of Beacon Patient Solutions in Boston, says that physician practices transitioning to concierge medicine are only one of the reasons patients may be left in a lurch for health care.
"Doctors retire or move out of the area, and patients who haven't seen their primary care doctor for a couple of years may be dropped from the practice," says Gerhardt. 
"There are certainly clinicians who are leaving the traditional model of health care and moving to concierge medicine to reduce the number of patients and paperwork," she adds. "A shift is happening that makes it harder for folks when they learn they have to make a change because they may have to make a financial decision in addition to finding a new physician."
Making The Transition
Dr. Gay Purcell, an MDVIP primary care doctor in Independence, Missouri, switched from a traditional practice to a concierge style after seeing patients for 25 years. 
Concierge medicine is expected to grow by 10.3% between 2023 and 2030.
Rather than labeling her practice as concierge, she considers the care she offers as a personalized wellness program for patients who pay about $140 per month to be a member. As a result, she says her patient load decreased from 3,500 to 600. Purcell accepts patients' insurance, as well as Medicare.
In addition to providing annual insurance-approved exams that include recommended regular screenings, Purcell also offers each patient an additional comprehensive wellness exam each year that is included in their membership fee. 
She explains that her practice focuses on wellness coaching, prevention programs and proactive care for chronic conditions.
"During those exams, we perform specific tests for cardiovascular health, gait speed and balance, muscle and grip strength, vision and hearing, and check for issues like sleep apnea, sexual function, depression and anxiety," says Purcell.
During a 90-minute follow-up appointment, she reviews all the test results, focuses on patient education, and discusses health goals with her patients, which usually include exercise and nutrition guidance.
Purcell says she derives a lot more satisfaction working with her patients since the switch. "I'm able to spend time with my patients now that I didn't have before. The biggest change I see is with the outcomes for the patients and how successful they are. I feel that I'm able to make a bigger difference that counts," Purcell says.
For longtime patient Jana Waits, Purcell's monthly membership fee is worth the extra time and attention she receives. Waits is 66 and admits she doesn't pay for secondary health insurance in addition to her membership fee. 
You need to be clear about what you want in a PCP and don't procrastinate in finding a practice that meets your needs.
She says she's healthy with no chronic conditions, yet as she ages, she likes having a doctor who has the time to listen, go over results and answer questions.
"It's personalized, it's not just that she just hands you a paper with test results, and she'll see you in a year. She gives a lot of thought about you and your lifestyle. Her care has always been high level but now she has the freedom to do more to help her patients," Waits says.
Finding A New Provider
Not all patients can belong to a concierge practice, whether for financial reasons or availability. So how do you find quality health care if you need to switch for any reason?
Gerhardt says that first, you must decide what you're looking for in a health care provider. Then, think about gender and location preferences. Other considerations include ensuring the clinician takes Medicare or your insurance; whether or not they offer telehealth appointments; how they communicate with patients between appointments; and whether there are special language requirements.
"People need to think more broadly about primary care providers. The benefit of primary care is the continuity of care. Are you open to a nurse practitioner or physician assistant? Once you decide, then figure out what sources are available to find a new provider," says Gerhardt.
She says to start by asking family and friends for recommendations and branch out from there. "You should ask any specialists you see for a referral, and one very underutilized resource are pharmacists, who know a tremendous number of doctors," Gerhardt says. 
"Look at your health insurance directory of in-network PCPs. Call the hospitals in your area to ask about new doctors who have signed on for hospital privileges. They may be taking new patients," she notes.
The bottom line: If you need to find a new health care provider for any reason, Gerhardt says you need to be clear about what you want in a PCP and don't procrastinate in finding a practice that meets your needs.


The Challenges of Finding a New Doctor

Sally Benford

If you thought last summer and the holidays combined for nightmare air travel seasons, experts say you can expect more of the same for 2023.
Singapore's legendary Changi Airport "This travel season could be one for the record books, especially at airports," says AAA Senior Vice President Paula Twidale. More Americans are planning trips and booking early, despite inflation, she adds.
Packed or canceled flights, rental car shortages and crowded airports make for weary travelers, but take heart. If you'll pack some patience, you can enjoy novel airport attractions to take the sting out of getting stranded.
Airport as Ambassador
While most large airports have upgraded dining and shopping options, many have taken traveler amenities even further as they pick up the mantle as the first ambassador of their city.
"An airport has a responsibility to represent its community and to promote the uniqueness of that city and state," says Stacey Stegman, senior vice president of communications, marketing and customer experience for Denver International Airport. "What we do sets a tone for someone's experience, and we are very conscious of that."
"An airport has a responsibility to represent its community and to promote the uniqueness of that city and state."
Entertaining and engaging travelers is a big part of airports' portfolios this year, but so is the responsibility to express more about the state's history, culture and aesthetic beauty. Stegman says that it makes sense to provide options for delayed travelers to reduce their stress and create a more enjoyable travel experience.
Alex Poworoznek of Glendale, Arizona, travels both domestically and internationally for work and leisure. Over the last few years, he's racked up plenty of air miles and he says that airports should provide quiet areas for travelers who become stranded or have extended layovers.
"Airports would do a lot of travelers a favor and make traveling more enjoyable if they offered more quiet zones without PA announcements," says Poworoznek. "I'd like to see low-traffic areas and chairs that allow you to kick your legs up — or sleeping pods."
He was stranded recently in two large U.S. airports after severe flight delays and says the experience was a combination of boredom and exhaustion.
Competing to Please
Getting stranded is one issue, but how about travelers who plan long layovers as a strategy to reduce stress or explore a new city for a few hours?
In the past, airport food was expensive but less than inspiring, so airports are enhancing dining options by adding outposts of local restaurants to give travelers a taste of the city's cuisine. During a long layover, travelers can enjoy leisurely dining, rather than snatching a quick bite at the grab-and-go counter.
Stegman says that creating a great food scene is a priority for airports.
"Decades ago, you were lucky to get fast food at the airport and offerings were limited," she says. "Now, you can enjoy some of the best restaurants in Denver, but more important is the ability of an airport to balance national or global brands with fast food, fast casual and sit-down restaurants that have local flavor."
Soak Up Some Culture
At Louis Armstrong New Orleans International Airport, for example, travelers can choose from an abundance of dining options, including the city's famous Creole and Southern fare. Adding to the Big Easy flavor, live music selected in partnership with the New Orleans Jazz & Heritage Festival and Foundation, showcases the city's culture.
Denver International Airport's plaza parkNashville International Airport welcomes travelers with free performances of music ranging from country to jazz nearly every day of the year.
In addition to music venues, airports are adding attractions like butterfly gardens, museums, art galleries, movie theaters, breweries and even malls.
Depending on the season and interests, travelers can find more than a few ways to spend quality time at airports — even if your layover is short.
Light My Flyer
Poworoznek travels often through Detroit Metropolitan Airport and during layovers, he makes it a point to walk through the airport's 700-foot LED Light Tunnel — illuminated glass panels paired with soothing music — which connects the airport concourses.
"Traveling can be stressful and frustrating. I really enjoy the Light Tunnel because it's calming and the tranquil sounds drown out noise, so you can have a moment of solitude before you cram into the next plane," Poworoznek says.
Like Detroit airport's calming Light Tunnel, airport offerings are benefitting travelers around the world.
Terminal Boredom?
So you have a long layover at Chicago's O'Hare International. You can relieve boredom and stress by perfecting your downward dog at the airport's yoga room, Zen out in the aeroponic garden, or indulge in self-care at Terminal Getaway Spa.
If you love to watch planes land and take off, the airport's new outdoor Sky Terrace offers the perfect observation spot.
Atlanta Hartsfield-Jackson International Airport is still the world's busiest, welcoming 93.7 million passengers in 2022, and like passengers passing through O'Hare, travelers in the Atlanta airport can take advantage of a spa experience that includes a massage, facial, manicure or pedicure.
If art is your thing, San Francisco International Airport is home to a variety of exhibits and collections, with unique objects, such as San Francisco Ballet and Opera costumes and airline meal service sets from the 1960s through the '80s. If you love to watch planes land and take off, the airport's new outdoor Sky Terrace offers the perfect observation spot.
Minnesotan Movies
If you have time between flights at the award-winning Minneapolis-St. Paul International Airport, take a seat at the See18 Film Screening Room, where you can enjoy short films about the people and culture of Minnesota, created by Twin Cities PBS (parent company of Next Avenue), or watch TED Talks on a variety of subjects.
Phoenix Sky Harbor International Airport may be the healthiest airport in the country. The airport hosts more than 35 dining options from favorite local restaurants — many offering healthy options. Get some exercise before your flight, along Terminal 4's 1.2-mile Sky Harbor Fitness Trail, which includes the airport's unique terrazzo floors, to view the city skyline and surrounding desert beauty.
The Phoenix Airport Museum within Sky Harbor International Airport has, among its permanent collection, massive terrazzo art works built into the floors of two terminals.Flight canceled at New York's JFK and you have to spend the night? No worries — the airport is home to an adjacent 1960s-themed hotel in the Eero Saarinen-designed TWA Terminal. A Lockheed Constellation L-649A Starliner — one of only four "Connies" that remain — sits outside the hotel and serves as a cocktail lounge. Even if you don't spend the night, you can enjoy the mid-century vibe in the lobby and tour the museum of TWA memorabilia.
Denver's Talking Gargoyle
Games are the name of the, well, game at Denver International Airport. Its main summer attraction — Park on the Plaza — features grass-like turf, lawn games and lounge seating. Inside, on the B and C concourses, travelers can pass the time with cornhole games or view art exhibits. If you have time, check out the hilarious talking gargoyle at the Southwest baggage claim area.
Visits to Paris include world-class museums, but if your Paris itinerary is simply a connection at Charles de Gaulle International Airport, art can still be part of your journey. Famous French museum masterpieces at the airport's Espace Musées take center stage and are organized twice a year.
Cure your ales and get a stein of great German beer at Munich International Airport's Airbrau brewery, home to Europe's largest roofed biergarten.
Cure your ales and get a stein of great German beer at Munich International Airport's Airbrau brewery, home to Europe's largest roofed biergarten. Bavarian food and drink specialties rule, and if you plan ahead, you can take 45-minute brewery tour with the brewmaster.
Golf Among the Runways
Waiting to catch your next flight at London Heathrow and couldn't sleep on the plane? You can hit the ground running at your final destination after you catch some zzzs at Heathrow's short-stay hotels or pay-per-use lounges. Some offer showers to freshen up between flights.
A unique offering at Bangkok's Don Mueang International Airport is the Kantarat Golf Course, an 18-hole course located in green space between two runways. You'll have some amazing views of landing and departing aircraft — assuming the noise doesn't affect your game.
Named the World's Leading Airport by World Travel Awards in 2022, Dubai International Airport is a traveler's dream. Spend your layover at the airport's world-class health club that includes a swimming pool, saunas, steam rooms and even a billiards room.
If All Else Fails, Pet a Dog
Step into the Jewel area at Singapore Changi Airport and you'll never guess you're in an airport. With more than five gardens, the world's highest indoor water fountain, five walking paths, a movie theater, a four-story-high slide, mazes, cycling rentals, a rock-climbing wall and a wealth of shopping and dining, you could spend days at the airport and never get bored.
Seoul Incheon International earns points for its spacious VIP lounges and amenities, including an indoor skating rink, a spa, and a "Cultural Street" with local cuisine and music and dance performances.
Finally, nervous travelers can ease their anxiety at 37 U.S. airports that offer pet therapy. From LA to Philly, you can pet your stress away with a dog, cat, or even a pig or rabbit.


Love Your Layover

Do optimists live longer? It's a question researchers have been trying to answer for years. But, no doubt, the events of 2020 and beyond have pushed even lifelong optimists to their limits.
The pandemic, partisan politics, gun violence, soured race relations, rising inflation and stock market woes all account for some negative news. But take heart because a new study indicates that positivity pays off, particularly when it comes to living longer.
Results from a recent study found that participants with higher levels of optimism are more likely to live longer — to the age of 90 and beyond. Results from a study published in the Journal of American Geriatrics Society  in 2022 found that participants with higher levels of optimism are more likely to live longer — to the age of 90 and beyond. 
"We defined exceptional longevity as living past the age of 90."
Study author Hayami Koga, MD and PhD candidate at Harvard T.H. Chan Public School of Health, says that because most previous studies on optimism and longevity relied on white participants, she and her colleagues broadened the study to diverse races and ethnicities and concluded that ethnic differences had no impact on longevity. 
In other words, women of every ethnicity studied who faced life optimistically were associated with a 5.4% longer lifespan than those who were the least optimistic.
Optimism Leads To A Healthy Lifestyle and Vice-Versa
Although the study didn't use childhood or culture as factors, the research did consider the participant's way of life.
While optimists have a positive outlook on life, they are also pragmatic.
"One thing we looked at was lifestyle. We followed prior research and designed what we call the lifestyle score. The specific factors we looked at were exercise, diet, smoking, alcohol consumption and BMI (Body Mass Index). We looked at this as a pathway linking optimism to lifestyle, which then goes to a longer life," Koga says. 
"We defined exceptional longevity as living past the age of 90. We initially looked at age 85, but it was common for these women to live past 85 because they were fairly healthy," adds Koga. 
Optimism Is An Opportunity
My mother was the eternal optimist, always looking at the bright side of any issue and encouraging her children to do the same. However, my dad had more of a pessimistic outlook on life in general, and I tend to lean that way. 
But, whenever things look bleak, I can hear my mother telling me to look for the good in all things. While optimists have a positive outlook on life, they also are pragmatic. So when faced with challenges — inevitable life experiences — they tend to look at those issues as learning opportunities, and that's what I try to do.
Koga said that the study shows that optimism leads to a healthy lifestyle, which then leads to longevity.
Good News For All
Koga said that research has found that optimism is not determined by birth, and studies show that optimism and other pathways to psychological well-being can be developed.
"Intervention studies in psychology focus on imagining your best possible future and indulging in that thought. Other things like gratitude and other small interventions can increase levels of optimism, so it is modifiable," Koga says.
For the Eeyores out there, experts say that achieving an optimistic outlook later in life is possible and comes with health benefits. So what are the best ways to gain a positive perspective?
Don't Sweat The Small Stuff
Dr. Carolina Estevez, a licensed psychologist with Infinite Recovery in Austin, Texas, says that looking at life positively can help you be more resilient in the face of difficult times, better manage stress and cope with adversity.
"In keeping a positive mindset, it's critical to avoid sweating the small stuff."
These practices can lower the stress hormone cortisol and blood pressure, regulate heart rate, and even improve our immune systems. Additionally, Estevez says that having a sense of humor provides even more benefits.
"In keeping a positive mindset, it's critical to avoid sweating the small stuff. Try to find humor in the midst of challenges and problems that come your way, and most importantly, learn how to laugh at yourself from time to time," Estevez says.
Celebrity Betty White famously described herself as a "cockeyed optimist." White lived until 99 — just a couple of weeks shy of 100 and had a "glass-half-full" approach to life and a sense of humor.
She once said, "It's your outlook on life that counts. If you take yourself lightly and don't take yourself too seriously, pretty soon you can find the humor in our everyday lives. And sometimes it can be a lifesaver."
Learning To Laugh
It's been said that laughter is the best medicine. Studies show that humor can lower the stress hormone cortisol and lessen anxiety and tension while promoting happiness and well-being.
Optimism can help provide a sense of purpose and meaning to life, something known to be important for living longer.
Can a pessimist develop the ability to laugh — especially at themselves? According to the Mayo Clinic, humor can be learned. In addition, Mayo experts explain that laughter and a sense of humor offer long-term health benefits, including reduced pain, better mood, increased coping skills and improved immune systems.
"Laughter enhances oxygen-rich air, stimulates your heart, lungs and muscles, and increases the endorphins that are released by your brain; positive thoughts can actually release neuropeptides that help fight stress and potentially more-serious illnesses," according to the clinic's website.
Look For Joy
Along with humor and a healthy lifestyle, other ways to increase optimism and longevity include:
Practicing daily gratitude.Focusing on positive self-talk.Maintaining a solid social network.Reframing negative thoughts.Estevez says to look for things that bring you joy. For example, reconnect with old friends or revive a former hobby. Helping others is another way to improve not only your community but your self-esteem, too. 
Many retirees find fulfillment through connecting with those less fortunate. Consider new opportunities to help others that draw on your knowledge and experience.
"Optimism can help provide a sense of purpose and meaning to life, something known to be important for living longer. Optimists tend to focus on the positive aspects of life and look for ways to make it better, which helps them stay engaged in life even as they age," says Estevez.
Focus On The Positive
Above all, aging is inevitable, so optimism is vital to our health. However, the bottom line to a longer, healthier life may rely as much on mindset as a lifestyle.
"Most studies looking at longevity focus on negative factors, such as depression or smoking, so it's also important to look at the positive things like optimism. These attitudes may be assets for health," Koga says.
Koga said that the study's results could reframe how people view the decisions and outlooks that affect their health — and, in turn, their happiness.


Optimism May Be the Key to a Long Life

January has always been my least favorite month for several reasons — the letdown after the holidays and the dark, cold days punctuated with piles of snow.
And several years ago, my brother's death from sudden cardiac arrest at 55 on a cold January morning gave me another reason to dread the month.
Cold weather can increase blood pressure. And when you're not exercising regularly, your heart reacts differently to strenuous exercises, such as shoveling snow.I didn't know then, but I've recently learned that heart attacks increase during winter for various reasons, including cold weather, holiday stress, lack of exercise, virus exposure, and eating and drinking habits. 
My brother died from sudden cardiac arrest while outside on a cold morning. 
A 2021 study published in the journal Medicine found that overall, in the U.S., cardiac arrests peak during the early winter months of December and January.
According to the American Heart Association's 2022 Heart Disease and Stroke Statistics, approximately 850,000 Americans have heart attacks yearly, and about 350,000 die from sudden cardiac arrest.
My brother died from sudden cardiac arrest while outside on a cold morning. He had never been diagnosed with heart disease, but that doesn't mean he wasn't at risk.
One study concluded that cold weather is a factor in cardiac events for patients without a previous diagnosis of heart disease, perhaps because they aren't adequately medicated for a cardiac condition.
Pay Attention To Seasonal Challenges
Dr. Norman Lepor, a clinical professor of medicine at the Geffen School of Medicine at UCLA and attending physician at the Cedars-Sinai Heart Institute, says that most people are unaware that the risk of heart attacks and strokes increases in winter.
"The three days of the year that have the highest incidence of heart attacks are Christmas Eve, Christmas, and New Year's Day," says Lepor.
"There are multiple factors involved. For example, around the holidays, people may forget to take their medications, their diet changes, and the season is stressful. These are reasons winter is more dangerous in terms of cardiac disease," he explains. 
How Does Cold Weather Play a Role?
"The cold can cause a narrowing of the blood vessels, which restricts blood flow," says Lepor. As a result, cold weather can increase blood pressure, and your heart rate tends to go faster. And when you're not exercising regularly, your heart reacts differently to strenuous exercises, such as shoveling snow."
The three days of the year that have the highest incidence of heart attacks are Christmas Eve, Christmas, and New Year's Day.
It's also known that as temperatures drop, viruses increase. During winter, we spend more time indoors, so viruses such as colds and flu pass more easily from person to person.
"The flu is associated with a significantly increased risk of heart attack and stroke, which is why it's important to get your flu vaccination," Lepor says.
Cholesterol Spikes During The Holidays
A 2019 study by Danish researchers found that nine out of 10 people had very high levels of low-density lipoprotein — the "bad" cholesterol — in their bloodstream during the first week of January. 
In addition, the analysis suggested that holiday celebration is associated with higher total and LDL cholesterol levels.
Lepor says that cholesterol remains the number one attributable risk for heart disease. Blood tests are a good indicator of cholesterol to assess a patient's risk. Yet, he says other tests are essential.
"Give yourself a holiday gift and ask your doctor for a coronary calcium scan; if it's over zero, you have plaque and need to be treated," Lepor says.
Holiday Heart Is Real
Eating rich and sugary foods and drinking more alcohol can be culprits over the holidays. Excess alcohol consumption at this time of year, known as Holiday Heart Syndrome, is a cause of adverse cardiac events.
"Acute alcohol intake can lead to cardiac rhythm abnormalities, and the most common is atrial fibrillation, which can lead to stroke. However, many people are susceptible to alcohol, so you don't necessarily have to be a heavy drinker to be affected," Lepor says.
Reduce Holiday Stress
Angela Ficken, a licensed psychotherapist in Massachusetts specializing in stress and anxiety disorders, says that the holiday season is a recipe for stress-induced depression and anxiety.
"The cold winter months pack a punch for mental health issues in general — anxiety, depression, sadness and stress. Then take the holiday season and add family and that's a whole other can of worms," notes Ficken.
The best way to reduce holiday stress is to plan. Ficken explains that setting boundaries can lower stress levels, whether with your budget, time, or lifestyle.
"If you know you're going into something hard and your stress level goes up during the holidays, instead of winging it, have a plan," Ficken says. "Think about your budget, the dynamics of family get-togethers, and how you want to spend your time. Planning can help bring down stress levels."
"Also, try to have some self-compassion. It's holiday time, and there's stress, so instead of beating yourself up, focus on what you've learned so that you can do better next time."
Don't Wait to Get to a Hospital
Living in Lakeville, Pennsylvania, Anthony Bombaci, 70, is used to extremely cold weather, but he didn't know his risk of a heart attack increases during the winter months. Then, last winter, Bombaci had a heart attack.
"It can be very cold where we live, and I'm always doing something outside," Bombaci says. So when he began to experience mild chest pain, he decided to go to the hospital.
"It felt like more of a constant discomfort in my chest. People generally wait for severe pain, which I didn't have. So I went to the hospital mainly because of my wife," he says. 
After being evaluated and diagnosed with a heart attack, Bombaci had a stent placed in his coronary artery. He feels good, although he knows he has to be cautious now when out in the cold weather.
"I tell patients that if they have to go outside in winter — particularly to shovel snow — to dress appropriately for the weather, take their time and stay hydrated."
Bombaci's cardiologist, Dr. Bradley Serwer, says taking special care during cold weather is extremely important. Serwer is Chief Medical Officer for CardioSolution, an interventional cardiology practice that specializes in assisting hospitals with their cardiology needs, predominately in rural areas of the U.S.
"We see significant physiologic changes depending on winter temperatures and barometric pressures. Studies on increases in heart attacks during cold weather aren't new, but it's clear that many patients aren't aware of the increased risk," says Serwer.
Outdoor exercise in winter can be particularly tricky. Serwer says that people who exercise regularly are at a lower risk overall than someone who made a "New Year's resolution" and goes out once to exercise. Yet he has seen quite a few heart attacks from shoveling snow.
"Blood pressure goes up, heart rates go up, and you don't have to have a pre-existing cardiac condition to be at risk," Serwer says.
Heart-Healthy Strategies
So what are the best strategies to avoid adverse cardiac events like heart attack, stroke, atrial fibrillation, and sudden cardiac arrest during winter?
"I tell patients that if they have to go outside in winter — particularly to shovel snow — to dress appropriately for the weather, take their time and stay hydrated. I advise them to avoid tobacco and alcohol. Sitting and having a couple of martinis before you go out to shovel snow is not recommended," Serwer says.
Above all, recognize the symptoms of heart attack — chest, jaw, or back pain, lightheadedness, shortness of breath, nausea — and if you're developing any symptoms, call 911 or go to the hospital immediately.


Be Wary of Winter Heart Attacks

Last fall, while sitting in my family room on a calm Saturday afternoon, I was suddenly hit with a crushing pain in the center of my chest. I was sure that I had twisted some sort of chest muscle, so I sat up straight, hoping that changing position would relieve the pain, but no. Then I leaned forward, still no change. I stood up and walked a few steps, but again, no change. By now, just a few minutes later, the pain had taken my breath away, I was nauseated, and my husband was freaking out. Frankly, so was I.
A few minutes later, after my insistence that he shouldn't, my husband called 911. The paramedics were there within a few minutes. They took an EKG and a blood sample. Turns out, I wasn't having a heart attack, and while I was relieved, the paramedics advised that I should go to the emergency room to find out what was causing the pain.
Pay Attention to Sudden Onset Symptoms
Calling 911 and following up at the emergency room was a good move according to Dr. Nieca Goldberg, medical director of Atria New York City and clinical associate professor of medicine at NYU Grossman School of Medicine. Goldberg says that it's important not to waste time when sudden onset chest pain occurs.
"It's important to get to an ER and you don't want to waste time because you could be diagnosed with a heart attack or other emergency." 
"The most important point is the sudden onset. It's important to get to an ER and you don't want to waste time because you could be diagnosed with a heart attack or other emergency. You can't make the diagnosis about what is causing the symptoms unless you go to an ER where they can do confirmatory testing," says Goldberg.
My symptoms were disturbingly similar to a heart attack, yet, I didn't have a history of heart disease in my family and during my annual checkups, my cholesterol numbers were always excellent.
However, 15 years ago, my older brother died very suddenly, and because there was no autopsy, it was assumed he died of sudden cardiac arrest, but never confirmed. When my pain continued for more than a few minutes, I thought about my brother. If you have a first degree relative who has had a heart attack, you are at higher risk.
So, the question: Is there a way to know if symptoms, such as chest pain and pressure, shortness of breath and nausea are life threatening? The short answer is no — not without further evaluation.
"There is no way of definitively knowing if someone is [or is not] having a heart attack without test results conducted in the ER," Goldberg says.
While the chest pain, shortness of breath and nausea are typical symptoms, Goldberg explains that sometimes women can experience heart attack symptoms differently."Oftentimes, women don't feel the chest discomfort. They can feel it lower and confuse it with stomach issues and some women will have back pain," says Goldberg.
Other Causes of Chest Pain 
Dr. Jim Liu, practicing cardiologist at Ohio State University Wexner Medical Center and assistant professor at the Ohio State University College of Medicine, says that having chest pain doesn't always mean you're having a heart attack and, more commonly, it's related to something other than the heart.
"Usually, I tell my patients when they come in with chest pain that there's a lot in the chest outside of the heart that can cause pain — the lungs, chest muscles, lining of the heart, the esophagus," says Liu.
According to Liu, common examples of heart attack-like conditions include myocarditis, an inflammation of the heart muscle, which can occur from the cold or flu virus. Pericarditis is another inflammation of the lining of the heart which is a very common cause of chest pain. Pneumonia can cause chest pain. Musculoskeletal issues, such as a muscle strain in your chest from working out or a recent trauma, can cause pain, as well as bruised or broken ribs.
"Panic attacks can really mimic a heart attack, and it would be hard to tell based on symptoms alone. If a patient has a history of anxiety or panic attacks, then it could indicate a panic attack. Generally, there isn't nausea with those types of pain, but there may be some shortness of breath," Liu says.
Other issues can cause chest pain; gallstones, pancreatitis, acid reflux, gastritis, collapsed lung, or a rupture of the esophagus are a few that mimic heart attacks and are just as dangerous. Liu says that chest pain happens for a lot of different reasons — including heart attacks — and he explains that personal medical history can play a role in determining what course of action you should take.
"Family history factors, as [does] if the patient smokes or has smoked, high blood pressure, or heart disease in family. If you have a lot of risk factors — think more seriously if you're having chest pains. If it's a heart attack, the pain is not going away on its own. If it's getting worse, the safest thing to do is to seek medical attention," Liu says.
A Visit to the ER
A number of tests are conducted in the ER to determine if a patient is having a heart attack. Initial tests include an EKG and blood work. A blood sample will show if the patient's troponin — an enzyme that only appears in the heart muscle — has risen. When someone is having a heart attack, troponin levels rise.
My troponin level and EKG results were normal. Further tests, including an imaging test, determined that I had gallstones.
Further tests, including an imaging test, determined that I had gallstones. 
Emergency medicine physician Kevin King operates a clinical practice at University Hospital and is an associate professor in emergency medicine at University of Texas Health Science Center San Antonio, Long School of Medicine. I asked him how important it is for patients to visit the ER if they're experiencing symptoms similar to a heart attack.
"Chest pain can represent a lot of things, a heart attack being one. Another thing that we [see is] unstable angina, which is a pre-heart attack syndrome. The heart muscle is hurting because there isn't enough blood flow because one of the vessels is narrowed. If that goes undiagnosed for too long, you'll have a heart attack," King says.
He adds that there are approximately 20 conditions that cause chest pain that are emergencies. He also reiterates that if you have a heart, you can have a heart attack.
"If you're experiencing symptoms that are different and concerning, you should always have that checked out because it's potentially an emergency," King says.
"The bottom line is that we all know what our bodies feel like, and if your body is telling you something is weird, or if you think you're having an emergency, you need to call 911."
I'm glad my husband did just that.


Chest Pain Sent Me to the ER, But It Wasn't a Heart Attack

Tere Dillard, of Decatur, Ill., has gotten used to taking her 89-year-old father Jim Lee to what she considers pointless tests ordered by his primary care doctor. One was a CT scan for mild dizziness. As caregiver for her dad and his wife Lenora, who's 88, it's not the only time Dillard has experienced what she calls "over-the-top tests."
Tere Dillard and her parents, Lenore and Jim Lee"When I was in the initial appointment with him, I was surprised the doctor didn't look in his ears or listen to his heart," she says. "He basically asked him a couple of questions and then ordered a CT. And I feel like I have to take him when the doctor orders these tests even though I'm sure they're unnecessary because my dad's scared to death."
The same doctor ordered a CT scan for her mother when she complained of a sore throat — although he saw nothing wrong when he looked at her throat.
Ways Ageism Shows Up in Health Care
Dillard is tired of doctors overtreating her parents for what she believes are minor health issues. "I just feel sometimes doctors order tests because the patient is old, they're impressionable and the doctors know that Medicare will pay for it," she says. 
"We know we live in an age of unconscious bias, and people who work in health care aren't immune to that."
Dillard's experience is just one form of rampant ageism in health care, something the Changing the Narrative initiative is trying to remedy through its Age Friendly Health Care Campaign. (Changing the Narrative is a partnership of NextFifty Initiative — a funder of Next Avenue — and Rose Community Foundation.)
"We know we live in an age of unconscious bias, and people who work in health care aren't immune to that," says Janine Vanderburg, founder and director for Changing the Narrative, which is focused on ending all manner of ageism.
Her new campaign aims to bring ageism in health care to the attention of those who need it most: older patients who experience it and the health care providers who interact with them.
Vandenburg has felt this ageism in health care personally.
During a recent pre-op appointment for cataract surgery, Vanderburg, 68, ignored the receptionist's elderspeak, calling her "dear." But she says she couldn't ignore the wording on the doctor's office form asking why she wanted better eyesight.
Janine Vanderburg heads Changing the Narrative's ageism in health care initiative"The form options ranged from 'I want play to golf, to view scenery/take photographs, play cards, sew, do crossword puzzles, see car dashboard and watch movies,' but nowhere did it have an option for working," she recalls. "So, I crossed out 'view scenery/take photographs' and wrote in 'Working/Facilitating Training Sessions, Workshops."
When she pointed out the omission of working as an option, her doctor said, "Oh, we didn't think about that."
Age Discrimination in Health Care
A study in the Journal of Internal Medicine, Vanderburg notes, found that nearly a third of older adults said they frequently experience age discrimination from doctors or hospitals.
Over- and undertreating older patients, disrespecting or demeaning them, minimizing their symptoms, elderspeak and communicating with a family member instead of the patient are among the ways ageism is showing up in doctors' offices, urgent care centers and hospitals across the country. 
Changing the Narrative and other researchers say ageism has serious impacts on older adults' health and on America's health care system.
Better communication with older patients is one way health care providers can begin to reduce ageist tendencies.
A 2018 study by Yale University Professor Becca R. Levy (a Next Avenue Influencer in Aging) and colleagues found that ageism in health care costs the U.S. $63 billion annually.
The number might be even higher today.
"During the pandemic, there were certainly issues that exacerbated ageism in health care, particularly in the long-term care setting — with the high number of deaths in the first months of the pandemic that were due, in part, to the inadequate protective equipment and inadequate protections given to the workers and the residents," Levy says.
Better communication with older patients is one way health care providers can begin to reduce ageist tendencies.
Alexis Kurland, 66, of El Cerrito, Calif., says she's often called "dear" by the nurse in her doctor's office. "I haven't worked up the nerve to ask her to stop using that term with me, so that's my fault. Yet, every time she says it, I cringe," Kurland says.
Levy says older adults often don't recognize ageism as a real threat to the care they're receiving.  
Not Even Seeing the Ageism
"Part of the reason it's so insidious is that people don't even realize that they're experiencing it and they tend to blame it on themselves instead of discrimination or the larger systemic problem of not getting the best possible health care for older people," she notes.
Alexis Kurland thinks she has heard elderspeak from her doctorsPutting a positive spin on aging, however, can reap rewards. An earlier study by Levy and her peers found that people with a positive self-perception of aging lived, on average, 7.6 years longer than those with a negative view. 
Both Levy and Vanderburg are hopeful for changes in health care ageism at the institutional and government levels.
Doing so, according to a recent Changing the Narrative webinar with experts Kris Geerken and Gilliane Lee, means — among other things — training those working in health care on implicit bias, including older people in clinical trials and exposing health care students to older adults during their professional training,
Levy concedes that these types of changes will probably be slow, however.
"Thinking of it in a big structural way is key," she says. "It's great for patients to advocate for themselves, but the hope is that hospital and office settings will give older people agency and voice."
Vanderburg believes older adults need to address health care ageism when it happens.
"We need to advocate for ourselves, and that's what we're training people to do," she says. "Fill out that patient survey, let the provider know they didn't listen or that there's a problem."
Let doctors and other medical staffers know how you'd like to be treated, Vanderburg adds. "After all, we are the leaders we're looking for," she says.


How to Make Health Care Less Ageist

The human body needs a certain amount of salt — or rather, the sodium in salt — to maintain bodily functions such as adequate fluid levels, muscle function and proper pH in our blood. Yet for some, consuming salt can cause high blood pressure, especially as we age, putting us at risk for hypertension and heart disease.
We know that reducing sodium intake is good for overall health and now a new study in the New England Journal of Medicine proves that. 
The study found that by reducing salt (sodium) in the diet and replacing it with salt substitutes containing reduced sodium and increased potassium can lower blood pressure. The rates of stroke and major cardiovascular events in participants were also lower with the salt substitute than with regular salt. The study took place over a five-year period in China — a place known for high salt use —  and focused on people 60 and older with high blood pressure.
Americans Love Sodium
"High blood pressure is a well-known cause of developing heart disease and strokes, says Dr. Nachiket Patel, clinical professor of medicine at University of Arizona Medical School in Phoenix and an interventional cardiologist. "Consuming a lot of salt causes water retention and that causes high blood pressure and it can also decrease the beneficial effects of drugs that lower blood pressure."
The average American consumes 3,400 milligrams of sodium per day, well above the 2,300 milligrams — equal to about a teaspoon — recommended by the American Heart Association.
"As we get older, we are more affected by salt in our diets," Patel says. "Salt, by increasing the blood pressure, can lead to uncontrolled high blood pressure, which causes all kinds of negative effects on the heart."
You Are What You Eat
The major culprit of too much sodium in the American diet? Health and nutrition experts place the blame on processed foods.
Dr. Stuart Ruch, a cardiologist with Berkshire Medical Center in Massachusetts, recommends his patients shop on the perimeter of the grocery store and stay away from the interior aisles.
"I've cut out salt, but I've done other things as well, and my doctor says it's working. It's less about elimination and more about moderation."
"You can cut back on sodium, and you need to get potassium from fresh fruit and vegetables. What I tell patients is, 'If it's in a can or a box, you've got to stop that.' ... We've got to find a way to cut down on all the junk we're putting into our bodies," says Ruch. 
He says the reason salt causes problems for some people is that water inevitably follows sodium, and as the volume of this fluid increases, so does the volume of blood. This means the heart must work harder putting more pressure on blood vessels. Over time, this pressure stiffens the blood vessels, which can lead to high blood pressure, heart attack or stroke.
"There's a lot of variability because some people are really sensitive to salt and some people not so much and we don't really know why. Hypertension tends to be diagnosed more in older people. As we age our vessels get stiffer," Ruch says.
More About Salt Moderation
Allen Raines knew he had to make changes when he had an episode of high blood pressure last year. The 54-year-old from Cincinnati has always been naturally thin, so when he had that health scare, his doctor made several recommendations and one was to reduce his salt intake.
"I've cut out salt, but I've done other things as well, and my doctor says it's working. It's less about elimination and more about moderation," Raines says.
He's the cook in the family and stopped using salt that recipes called for. Instead, he lets his family add salt at the table if they choose. Raines tried salt substitutes initially, but his family didn't care for the taste, so he doesn't cook with them.
"I researched salt substitutes and I don't trust the high potassium levels. It felt a little risky and didn't seem like the route I wanted to go," says Raines. "I'm eating more fruit and vegetables now, getting potassium and sodium naturally. I used to like a sandwich for lunch, heavy with mayonnaise. Now I just use a thin layer."
Patel says: "I think salt substitutes are beneficial with the caveat that you have to work with your doctor. Having high levels of potassium in the body can have very bad effects on the heart. Most people can handle the extra potassium they're ingesting in the salt substitute, provided their kidney function is normal; the patients who have abnormal kidney function have to be very careful of those salt substitutes that are using potassium chloride." 
Fresh vs. Frozen vs. Canned
So how do you know what to look for and where to find high- and low-sodium foods? 
Lauri Wright, director of University of North Florida's Center for Nutrition and Food Security, says going fresh is always best, frozen is better than canned and reading nutrition labels and comparing sodium amounts against similar products is most important when buying processed foods. 
She also advises avoiding snack foods that are loaded with salt and notes that condiments often contain hidden sodium.
"Ketchup can be high in sodium — a tablespoon can have a hundred and fifty milligrams. Watch out for soy sauce and some salsas, salad dressings and dips," says Wright. "Anything pickled is very high is sodium."
"Dishes like chicken parmesan with the marinara, cheese and breading on the chicken can contain almost three thousand milligrams of sodium."
For adding extra flavor naturally, Wright suggests using fresh or dried herbs and spices.
"Play with vinegars and plain mustards to add flavor without heavy sauces. Citrus juices are a nice way to add flavor. Look for herbs and herb blends that state no sodium added," Wright says.
Mildred Pascucci has restricted salt on the advice of her doctor after having pacemaker surgery a few years ago. The 86-year-old cooks with what she calls the "big seven"— garlic, onion, red pepper, basil, oregano, thyme and olive oil.
Pascucci and her husband, who live in Hampstead, N.C., follow the Mediterranean diet, eating a lot of fresh vegetables, pasta and healthy proteins. If she buys canned products, she looks for low-sodium versions.
"I used a lot of salt before because that's how I grew up," says Pascucci. "Salt substitutes didn't work for me, so the best way for me was to just cut it [salt] flat out."
What about dining out? Wright says: skip the cream and cheese sauces and gravies, which are usually loaded with salt, and go for roasted or grilled meat without marinades.
"One important thing you can do is check the restaurant's nutrition information. Dishes like chicken parmesan with the marinara, cheese and breading on the chicken can contain almost three thousand milligrams of sodium," Wright says. "The majority of us need to cut back. Even if it's cutting a half a teaspoon of salt from your daily diet, you're going to see a benefit."


Are Salt Substitutes Really Good for Your Health?

(This post originally appeared on Midcentury Modern.)
In the new movie Hello, My Name is Doris,  Sally Field plays a woman in her sixties who falls in love with the new hunk in her office. The hunk, named John, happens to be half her age, and is played by Max Greenfield (Schmidt on TV's New Girl), whose winning smile reminds me of Ken Olin’s portrayal of Michael on Thirtysomething back in the '90s.
Greenfield’s smile is the best thing about this movie, but it’s not enough to save it. The problem is Field’s character  —  an amalgam of every stereotype of the sad spinsterhood rolled up into one vivid grotesquerie.
She lives in Staten Island, she has a cat, she wears her hair up in a big floppy bow, she’s a hoarder, she’s such a Facebook virgin that when she gets a notification chime, she recoils as if a gun went off, she needs two pairs of glasses to look at a computer screen, and her body language says “I wish I could shrink up into a little ball of fuzz and blend into the rug.”
She’s the one who’s going to snag the hottie.
A Certain Age
I saw the film last spring at the Montclair (N.J.) Film Festival. In the Q&A afterwards, between the film festival’s executive director Tom Hall and director/comedian Michael Showalter, there was a fair amount of congratulation and self-congratulation for Showalter making a film with a leading character who’s “a woman of a certain age.”
That phrase was actually repeated onstage several times, and then by someone in the audience asking a question, and the general consensus seemed to be that anybody who throws a bone to an actress over the age of 40 deserves a Nobel Prize.
The problem, though, is that Sally Field’s character is so cringeworthy (and yes I do get it, she grows over the course of the film) and the comedy so broad that the ratio of laughs to winces was, generously speaking, about 1 to 10.
How broad? Consider one of the movie’s peak scenes, in which Doris learns that John’s favorite band is playing in Williamsburg and decides to go so she’ll run into him. Her concert ensemble  —  presented as a huge laugh  —  is a ridiculous mismatched neon jumpsuit, her hair bow temporarily replaced with an oversized visor. Really, just imagine an outfit Richard Simmons discarded in 1979.
No Laughing Matter
And this outfit, Showalter insisted, was proof of how much he loves and respects this character: “She says a lot with what she wears.”
Looked at another way, Doris has made the cataclysmic character leap from milquetoast to eccentric. Hooray!
Yes, it’s a role for a “woman of a certain age.” Yes, there are wrinkles. Congratulations. But when there are so few portrayals of women in their 60s in Hollywood, we choose to make one that depicts an older woman as not just pathetic, but laughably pathetic? Now that’s sad.
We Can Do Better
A friend I spoke with after the screening made an interesting analogy. It would be like  —  she said  —  a director 50 years ago making a movie about an Uncle Tom figure. Sure, the director could argue, “It’s based on a real character. There reallywas a person exactly like this.” And maybe there was. But does he get credit for making movie about the black experience? Or would a lot of people be, justifiably, offended?
When I got home, it struck me: Amos and Andy. We’ve gotten beyond the limp wrist as a hilarious signifier for a gay person, and the shuffle-and-jive as a hilarious signifier for a black person. Director Michael Showalter said that Sally Field’s character was a real archetype. He’s wrong. It was a stereotype. Like so many others, it’s time to let it go.
https://www.youtube.com/watch?time_continue=2&v=L6vBnnryIug


The Trouble With the New Sally Field Movie

Debbie Galant

Legendary Washington Post Editor Ben Bradlee rose to prominence for exposing the Watergate scandal, for publishing the Pentagon Papers and for guiding the paper to 23 Pulitzer Prizes during his tenure. He died Tuesday at age 93 in his Washington, D.C. home. He had Alzheimer’s disease.
 
In September, Bradlee’s wife, Sally Quinn, spoke to C-SPAN’s Brian Lamb about her husband’s health and her own transitions as a caregiver. She moved from thinking his dementia wouldn’t be so hard, to witnessing its ravages, to facing it realistically and ultimately finding peace with the disease and her role.
(MORE: 11 Inspiring Quotes for Caregivers)
 
“A certain peace has come over me,” she said. “Caretaking has become almost sacred… I don’t think we have ever been as loving with each other as we are now.”


Sally Quinn on Ben Bradlee’s Final Days

Sue Campbell

Divorce is always sad, but when it turns ugly, it’s terrible. You may remember The War of the Roses, the dark comedy where Kathleen Turner and Michael Douglas start out as a perfect couple and end up destroying their possessions — including their luxurious house and cars — because they can’t agree on who gets what. That movie is unfortunately hitting home for plenty of boomers and Gen X’ers. According to a recent survey by Allianz Life Insurance, two thirds of divorced women feel their divorce created a financial crisis.
Many of my friends have gone to divorce war, but unlike Turner and Douglas, they destroyed their finances (by paying steep legal fees), not their possessions. Divorce doesn’t have to be as financially painful as it so often is, though.
Why Divorce Turns Into War
What drives divorce wars? My hunch is that many are driven by very different assessments by spouses of the impact of their proposed settlements. For example, a husband may think his settlement proposal is incredibly generous while his wife thinks it’s miserably cheap. Without a neutral measurement stick, their fight — with the lawyers' meters running — can go on and on.
As an economist, I’d say that this is where economics can help couples. Its math and computer algorithms can figure out precisely how much each spouse will get to spend now and in the future under any given divorce settlement. And this analysis can take into account all relevant factors, including the division of assets, alimony and child support, child custody and the disposition of the marital home.
How do I know? My company recently released a software tool designed to limit divorce wars (full disclosure: I derive no income from my company). It calculates each spouse’s living standard under any proposed divorce settlement.
John and Sally's Equitable Divorce
Let me illustrate this new technology:
Take John and Sally Doe, both 50, who are untying the knot after 25 years. John earns $200,000; Sally earns $40,000. John and his employer both contribute $6,000 a year to his 401(k). Sally and her employer both contribute $3,000 to hers. John and Sally plan to retire at 65. The couple has one child, Sam, 10. Sam will spend 80 percent of his time with Sally and 20 percent with John. John will cover Sam’s college expenses. The couple own a $450,000 house with a $90,000 mortgage. John proposes that Sally live in their house for eight years, while he picks up three-quarters of the housing cost. Meanwhile, John will buy a condo for $200,000. Sally will buy the same-priced condo when they sell their house, sharing the proceeds 50/50. John also proposes dividing the couple’s $200,000 in regular assets and $1 million in retirement assets in proportion to their labor earnings.
John wants to be fair. He figures that paying for most of Sally’s and Sam’s housing for the next eight years, covering Sam’s college expenses and housing and feeding Sam one-fifth of the time is highly generous. He also believes his and Sally’s living standards will be pretty similar once his much higher tax payments are factored in. So John proposes no alimony or child support.
Is John right? Will he and Sally be able to spend roughly the same amount over the rest of their days?
No, he's wrong. But by playing around with the numbers and the software they can arrive at an agreement that works for both of them.
John’s proposed settlement lets him spend $83,215 annually and Sally spend $23,353 annually (measured in today's dollars) after covering all housing costs and taxes. There are lots of reasons for this big differential, including John’s higher salary, his large asset share and his receipt of higher Social Security benefits.
When Sally points out the large spending (living standard) difference, John offers to split all assets 50/50. Now John’s and Sally’s annual spending amounts become $73,891 and $35,757, respectively.
Sally, who sacrificed her career to put John through law school and raise Sam, digs in her heels. “John, you need to pay alimony and child support,” she says. John agrees to $25,000-a-year in child support until Sam goes to college. Sally runs the computer program again and finds that John’s annual spending would now be $68,783 and hers would be $41,158.
Sally says, “John, sorry, but you wouldn’t be making five times my salary if it weren’t for me. There is no reason I should have a lower living standard going forward. If you pay me $20,555 each year in alimony and agree to the other things you offered, we’ll both get to spend the same amount each year: $54,836.”
John thinks this over and then counters with a $10,000 annual alimony payment, pointing out that his job is far more demanding than Sally’s. Sally, upon reflection, decides this is reasonable and the two hire a single attorney for one hour to draw up the agreement. Sally and John used economics to save their divorce.
How to Divorce Fairly
Couples don’t have to use our software to come up with equitable divorce agreements. You can also get a rough handle on your relative spending levels by comparing each spouse’s disposable lifetime resources.
To arrive at this number, you'd start by calculating your lifetime resources (the present value (how much a future sum of money is worth today) of your future labor, Social Security and other income including alimony and child support plus your current net worth. Next, you'd subtract the present value of your projected taxes, housing costs, expenditures on children and other expenses including alimony and child support payments. The difference is your spendable resources.
Do this for your spouse, too, and then divide by each spouse's maximum remaining lifespan. This is a rough calculation primarily because you'll need to guesstimate your taxes and may misestimate your Social Security benefits, since they may be different in the future than what you expect today.
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