Well: Quitting Smoking for Good

Few smokers would claim that it’s easy to quit. The addiction to nicotine is strong and repeatedly reinforced by circumstances that prompt smokers to light up.

Yet the millions who have successfully quit are proof that a smoke-free life is achievable, even by those who have been regular, even heavy, smokers for decades.

Today, 19 percent of American adults smoke, down from more than 42 percent half a century ago, when Luther Terry, the United States surgeon general, formed a committee to produce the first official report on the health effects of smoking. Ever-increasing restrictions on where people can smoke have helped to swell the ranks of former smokers.

Now, however, as we approach the American Cancer Society’s 37th Great American Smokeout on Thursday, the decline in adult smoking has stalled despite the economic downturn and the soaring price of cigarettes.

Currently, 45 million Americans are regular smokers who, if they remain smokers, can on average expect to live 10 fewer years. Half will die of a tobacco-related disease, and many others will suffer for years with smoking-caused illness. Smoking adds $96 billion to the annual cost of medical care in this country, Dr. Nancy A. Rigotti wrote in The Journal of the American Medical Association last month. Even as some adult smokers quit, their ranks are being swelled by the 800,000 teenagers who become regular smokers each year and by young adults who, through advertising and giveaways, are now the prime targets of the tobacco industry.

People ages 18 to 25 now have the nation’s highest smoking rate: 40 percent. I had to hold my breath the other day as dozens of 20-somethings streamed out of art gallery openings and lighted up. Do they not know how easy it is to get hooked on nicotine and how challenging it can be to escape this addiction?

Challenging, yes, but by no means impossible. on the Web you can download a “Guide to Quitting Smoking,” with detailed descriptions of all the tools and tips to help you become an ex-smoker once and for all.

Or consult the new book by Dr. Richard Brunswick, a retired family physician in Northampton, Mass., who says he’s helped hundreds of people escape the clutches of nicotine and smoking. (The printable parts of the book’s provocative title are “Can’t Quit? You Can Stop Smoking.”)

“There is no magic pill or formula for beating back nicotine addiction,” Dr. Brunswick said. “However, with a better understanding of why you smoke and the different tools you can use to control the urge to light up, you can stop being a slave to your cigarettes.”

Addiction and Withdrawal

Nicotine beats a direct path to the brain, where it provides both relaxation and a small energy boost. But few smokers realize that the stress and lethargy they are trying to relieve are a result of nicotine withdrawal, not some underlying distress. Break the addiction, and the ill feelings are likely to dissipate.

Physical withdrawal from nicotine is short-lived. Four days without it and the worst is over, with remaining symptoms gone within a month, Dr. Brunswick said. But emotional and circumstantial tugs to smoke can last much longer.

Depending on when and why you smoke, cues can include needing a break from work, having to focus on a challenging task, drinking coffee or alcohol, being with other people who smoke or in places you associate with smoking, finishing a meal or sexual activity, and feeling depressed or upset.

To break such links, you must first identify them and then replace them with other activities, like taking a walk, chewing sugar-free gum or taking deep breaths. These can help you control cravings until the urge passes.

If you’ve failed at quitting before, try to identify what went wrong and do things differently this time, Dr. Brunswick suggests. Most smokers need several attempts before they can become permanent ex-smokers.

Perhaps most important is to be sure you are serious about quitting; if not, wait until you are. Motivation is half the battle. Also, should you slip and have a cigarette after days or weeks of not smoking, don’t assume you’ve failed and give up. Just go right back to not smoking.

Aids for Quitting

Many if not most smokers need two kinds of assistance to become lasting ex-smokers: psychological support and medicinal aids. Only about 4 percent to 7 percent of people are able to quit smoking on any given attempt without help, the cancer society says.

All 50 states and the District of Columbia have free telephone-based support programs that connect would-be quitters to trained counselors. Together, you can plan a stop-smoking method that suits your smoking pattern and helps you avoid common pitfalls.

Online support groups and Nicotine Anonymous can help as well. To find a group, ask a local hospital or call the cancer society at (800) 227-2345. Consider telling relatives and friends about your intention to quit, and plan to spend time in smoke-free settings.

More than a dozen treatments can help you break the physical addiction to tobacco. Most popular is nicotine replacement therapy, sold both with and without a prescription. The Food and Drug Administration has approved five types: nicotine patches of varying strengths, gums, sprays, inhalers and lozenges that can curb withdrawal symptoms and help you gradually reduce your dependence on nicotine.

Two prescription drugs are also effective: an extended-release form of the antidepressant bupropion (Zyban or Wellbutrin), which reduces nicotine cravings, and varenicline (Chantix), which blocks nicotine receptors in the brain, reducing both the pleasurable effects of smoking and the symptoms of nicotine withdrawal. Combining a nicotine replacement with one of these drugs is often more effective than either approach alone.

Other suggested techniques, like hypnosis and acupuncture, have helped some people quit but lack strong proof of their effectiveness. Tobacco lozenges and pouches and nicotine lollipops and lip balms lack evidence as quitting aids, and no clinical trials have been published showing that electronic cigarettes can help people quit.

The cancer society suggests picking a “quit day”; ridding your home, car and workplace of smoking paraphernalia; choosing a stop-smoking plan, and stocking up on whatever aids you may need.

On the chosen day, keep active; drink lots of water and juices; use a nicotine replacement; change your routine if possible; and avoid alcohol, situations you associate with smoking and people who are smoking.

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Degrees of Debt: Some Parents, Shouldering Student Loans, Fall on Tough Times

Gretchen Ertl for The New York Times

“Jenni feels the guilt and I feel the burden.” Michele Fitzgerald, in debt for the loans she took out for her daughter Jenni’s college education.

When Michele Fitzgerald and her daughter, Jenni, go out for dinner, Jenni pays. When they get haircuts, Jenni pays. When they buy groceries, Jenni pays.

It has been six years since Ms. Fitzgerald — broke, unemployed and in default on the $18,000 in loans she took out for Jenni’s college education — became a boomerang mom, moving into her daughter’s townhouse apartment in Hingham, Mass.

Jenni pays the rent.

For Jenni, 35, the student loans and the education they bought have worked out: she has a good job in public relations and is paying down the loans in her name. But for her mother, 60, the parental debt has been disastrous.

“It’s not easy,” Ms. Fitzgerald said. “Jenni feels the guilt and I feel the burden.”

There are record numbers of student borrowers in financial distress, according to federal data. But millions of parents who have taken out loans to pay for their children’s college education make up a less visible generation in debt. For the most part, these parents did well enough through midlife to take on sizable loans, but some have since fallen on tough times because of the recession, health problems, job loss or lives that took a sudden hard turn.

And unlike the angry students who have recently taken to the streets to protest their indebtedness, most of these parents are too ashamed to draw attention to themselves.

“You don’t want your children, much less your neighbors and friends, knowing that even though you’re living in a nice house, and you’ve been able to hold onto your job, your retirement money’s gone, you can’t pay your debts,” said a woman in Connecticut who took out $57,000 in federal loans. Between tough times at work and a divorce, she is now teetering on default.

In the first three months of this year, the number of borrowers of student loans age 60 and older was 2.2 million, a figure that has tripled since 2005. That makes them the fastest-growing age group for college debt. All told, those borrowers owed $43 billion, up from $8 billion seven years ago, according to the Federal Reserve Bank of New York.

Almost 10 percent of the borrowers over 60 were at least 90 days delinquent on their payments during the first quarter of 2012, compared with 6 percent in 2005. And more and more of those with unpaid federal student debt are losing a portion of their Social Security benefits to the government — nearly 119,000 through September, compared with 60,000 for all of 2007 and 23,996 in 2001, according to the Treasury Department’s Financial Management Service.

The federal government does not track how many of these older borrowers were taking out loans for their own education rather than for that of their children. But financial analysts say that loans for children are the likely source of almost all the debt. Even adjusted for inflation, so-called Parent PLUS loans — one piece of the pie for parents of all ages — have more than doubled to $10.4 billion since 2000. Colleges often encourage parents to get Parent PLUS loans, to make it possible for their children to enroll. But many borrow more than they can afford to pay back — and discover, too late, that the flexibility of income-based repayment is available only to student borrowers.

Many families with good credit turn to private student loans, with parents co-signing for their children. But those private loans also offer little flexibility in repayment.

The consequences of such debt can be dire because borrowers over 60 have less time — and fewer opportunities — than younger borrowers to get their financial lives back on track. Some, like Ms. Fitzgerald, are forced to move in with their children. Others face an unexpectedly pinched retirement. Still others have gone into bankruptcy, after using all their assets to try to pay the student debt, which is difficult to discharge under any circumstances.

The anguish over college debt has put a severe strain on many family relationships. Parents and students alike say parental debt can be the uncomfortable, unmentionable elephant in the room. Many parents feel they have not fulfilled a basic obligation, while others quietly resent that their children’s education has landed the family in such difficult territory.

Soon after borrowing the money for Jenni’s education, Ms. Fitzgerald divorced and lost her corporate job. She worked part-time jobs and subsisted on food stamps and public assistance.

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Boehner Tells House G.O.P. to Fall in Line

Larry Downing/Reuters

Speaker John Boehner, at a news conference on Friday, says he wants to avoid partisan battles.

WASHINGTON — On a conference call with House Republicans a day after the party’s electoral battering last week, Speaker John A. Boehner dished out some bitter medicine, and for the first time in the 112th Congress, most members took their dose.

Their party lost, badly, Mr. Boehner said, and while Republicans would still control the House and would continue to staunchly oppose tax rate increases as Congress grapples with the impending fiscal battle, they had to avoid the nasty showdowns that marked so much of the last two years.

Members on the call, subdued and dark, murmured words of support — even a few who had been a thorn in the speaker’s side for much of this Congress.

It was a striking contrast to a similar call last year, when Mr. Boehner tried to persuade members to compromise with Democrats on a deal to extend a temporary cut in payroll taxes, only to have them loudly revolt.

With President Obama re-elected and Democrats cementing control of the Senate, Mr. Boehner will need to capitalize on the chastened faction of the House G.O.P. that wants to cut a deal to avert sudden tax increases and across-the-board spending cuts in January that could send the economy back into recession. After spending two years marooned between the will of his loud and fractious members and the Democratic Senate majority, the speaker is trying to assert control, and many members seem to be offering support.

“To have a voice at the bargaining table, John Boehner has to be strong,” said Representative Tom Cole of Oklahoma, one of the speaker’s lieutenants. “Most members were just taught a lesson that you’re not going to get everything that you want. It was that kind of election.”

Aides say this is an altered political landscape that Mr. Boehner did not expect. As a result, whether the nation can avoid the so-called fiscal cliff will depend not only on whether Mr. Boehner can find common cause with a newly re-elected, invigorated president, but also whether he can deliver his own caucus.

“I just believe John will have more leeway than in the past Congress,” said Representative Peter T. King, Republican of New York. “The election will matter.”

The divide between Mr. Obama and Mr. Boehner appears wide. In their Saturday addresses, the president demanded immediate House passage of a bill approved by the Senate that would extend the expiring Bush-era tax cuts for households earning under $250,000, while the speaker said raising tax rates on anyone would be unacceptable.

But beneath the posturing, both men were keeping open avenues of negotiation. Mr. Obama was careful to call for more revenue, not higher tax rates, a demand that could be fulfilled by ending or limiting tax deductions and credits, a path Mr. Boehner has accepted.

The question over what to do about the expiring tax cuts would be swept aside if the parties could reach an agreement before then to overhaul the tax code completely — and render obsolete the current structure of six income tax rates, all of which would rise on Jan. 1.

Even so, some Republicans have issued a stern warning to Mr. Boehner that he cannot expect their votes if he makes a deal with Democrats before seeking their consent.

“What we’ve seen in the past is the speaker goes, negotiates with the president, and just before we vote, he tells us what the deal is and attempts to persuade us to vote for it,” said Representative John Fleming, Republican of Louisiana. “We’re just not very happy with deals being baked, then we’re asked to stay with the team and support the speaker.”

Given those conflicting demands, Mr. Boehner must decide whether he wants to seal his role as an essential player in a grand plan to restructure the nation’s fiscal condition, or continue the status quo of the very gridlock voters appear to detest.

“I don’t want to box myself in, and I don’t want to box anyone else in,” Mr. Boehner told reporters on Friday.

Republican lawmakers and Congressional aides say the situation is not as dire as the conflicts of the past two years, which nearly led to a government default on its debt and included a series of impasses that plunged Congress’s approval rating to its lowest recorded level. Any deal with the president would probably lose 60 to 80 Republican votes, but the president would bring along enough Democrats to get it passed.

“When the president and I have been able to come to an agreement, there has been no problem getting it passed here in the House,” Mr. Boehner assured reporters, alluding to the deal struck with Mr. Obama to extend payroll tax cuts, which took Democratic support.

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Sharp aims for near full-output from display plant – media

TOKYO (Reuters) – Sharp Corp aims to raise the output from its Kameyama No.2 plant to near 100 percent, from a current 30 percent, as early as the end of 2012, by mass producing larger, high definition, power-saving IGZO screens, the Yomiuri newspaper said on Sunday.

The Kameyama plant makes IGZO displays, which consume 10 percent to 20 percent of the power required by conventional panels, for Apple Inc‘s iPad tablet.

The company has won orders for larger 30-inch displays from manufacturers, the report said, without citing sources.

The panels would be used for computed tomography (CT) or game monitors that require clearer definition than conventional high-definition displays, the report added.

Sharp, which secured $ 4.6 billion in emergency loans from its banks in September, is looking to IGZO to spark a revival in its fortunes, as it forecasts a 450 billion yen ($ 5.66 billion) net loss for the current business year ending next March.

($ 1 = 79.4500 Japanese yen)

(Reporting by Osamu Tsukimori; Editing by Michael Perry)

Gadgets News Headlines – Yahoo! News

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Mind Faded, Darrell Royal’s Wisdom and Humor Intact Till End

Three days before his death last week at 88, Darrell Royal told his wife, Edith: “We need to go back to Hollis” — in Oklahoma. “Uncle Otis died.”

“Oh, Darrell,” she said, “Uncle Otis didn’t die.”

Royal, a former University of Texas football coach, chuckled and said, “Well, Uncle Otis will be glad to hear that.”

The Royal humor never faded, even as he sank deeper into Alzheimer’s disease. The last three years, I came to understand this as well as anyone. We had known each other for more than 40 years. In the 1970s, Royal was a virile, driven, demanding man with a chip on his shoulder bigger than Bevo, the Longhorns mascot. He rarely raised his voice to players. “But we were scared to death of him,” the former quarterback Bill Bradley said.

Royal won 3 national championships and 167 games before retiring at 52. He was a giant in college football, having stood shoulder to shoulder with the Alabama coach Bear Bryant. Royal’s Longhorns defeated one of Bryant’s greatest teams, with Joe Namath at quarterback, in the 1965 Orange Bowl. Royal went 3-0-1 in games against Bryant.

Royal and I were reunited in the spring of 2010. I barely recognized him. The swagger was gone. His mind had faded. Often he stared aimlessly across the room. I scheduled an interview with him for my book “Courage Beyond the Game: The Freddie Steinmark Story.” Still, I worried that his withering mind could no longer conjure up images of Steinmark, the undersize safety who started 21 straight winning games for the Longhorns in the late 1960s. Steinmark later developed bone cancer that robbed him of his left leg.

When I met with Royal and his wife, I quickly learned that his long-term memory was as clear as a church bell. For two hours, Royal took me back to Steinmark’s recruiting trip to Austin in 1967, through the Big Shootout against Arkansas in 1969, to the moment President Richard M. Nixon handed him the national championship trophy in the cramped locker room in Fayetteville. He recalled the day at M. D. Anderson Hospital in Houston the next week when doctors informed Steinmark that his leg would be amputated if a biopsy revealed cancer. Royal never forgot the determined expression on Steinmark’s face, nor the bravery in his heart.

The next morning, Royal paced the crowded waiting room floor and said: “This just can’t be happening to a good kid like Freddie Steinmark. This just can’t be happening.”

With the love of his coach, Steinmark rose to meet the misfortune. Nineteen days after the amputation, he stood with crutches on the sideline at the Cotton Bowl for the Notre Dame game. After the Longhorns defeated the Fighting Irish, Royal tearfully presented the game ball to Steinmark.

Four decades later, while researching the Steinmark book, I became close to Royal again. As I was leaving his condominium the day of the interview, I said, “Coach, do you still remember me?” He smiled and said, “Now, Jim Dent, how could I ever forget you?” My sense of self-importance lasted about three seconds. Royal chuckled. He pointed across the room to the message board next to the front door that read, “Jim Dent appt. at 10 a.m.”

Edith and his assistant, Colleen Kieke, read parts of my book to him. One day, Royal told me, “It’s really a great book.” But I can’t be certain how much he knew of the story.

Like others, I was troubled to see Royal’s memory loss. He didn’t speak for long stretches. He smiled and posed for photographs. He seemed the happiest around his former players. He would call his longtime friend Tom Campbell, an all-Southwest Conference defensive back from the 1960s, and say, “What are you up to?” That always meant, “Let’s go drink a beer.”

As her husband’s memory wore thin, Edith did not hide him. Instead, she organized his 85th birthday party and invited all of his former players. Quarterback James Street, who engineered the famous 15-14 comeback against Arkansas in 1969, sat by Royal’s side and helped him remember faces and names. The players hugged their coach, then turned away to hide the tears.

In the spring of 2010, I was invited to the annual Mexican lunch for Royal attended by about 75 of his former players. A handful of them were designated to stand up and tell Royal what he meant to them. Royal smiled through each speech as his eyes twinkled. I was mesmerized by a story the former defensive tackle Jerrel Bolton told. He recalled that Royal had supported him after the murder of his wife some 30 year earlier.

“Coach, you told me it was like a big cut on my arm, that the scab would heal, but that the wound would always come back,” Bolton said. “It always did.”

Royal seemed to drink it all in. But everyone knew his mind would soon dim.

The last time I saw him was June 20 at the County Line, a barbecue restaurant next to Bull Creek in Austin. Because Royal hated wheelchairs and walkers, the former Longhorn Mike Campbell, Tom’s twin, and I helped him down the stairs by wrapping our arms around his waist and gripping the back of his belt. I ordered his lunch, fed him his sandwich and cleaned his face with a napkin. He looked at me and said, “Was I a college player in the 1960s?”

“No, Coach,” I said. “But you were a great player for the Oklahoma Sooners in the late 1940s. You quarterbacked Oklahoma to an 11-0 record and the Sooners’ first national championship in 1949.”

He smiled and said, “Well, I’ll be doggone.”

After lunch, Mike Campbell and I carried him up the stairs. We sat him on a bench outside as Tom Campbell fetched the car. In that moment, the lunch crowd began to spill out of the restaurant. About 20 customers recognized Royal. They took his photograph with camera phones. Royal smiled and welcomed the hugs.

“He didn’t remember a thing about it,” Tom Campbell said later. “But it did his heart a whole lot of good.”

Jim Dent is the author of “The Junction Boys” and eight other books.

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Citing Affair, Petraeus Resigns as C.I.A. Director

WASHINGTON — David H. Petraeus, the director of the Central Intelligence Agency and one of America’s most decorated four-star generals, resigned on Friday after an F.B.I. investigation uncovered evidence that he had been involved in an extramarital affair.

Mr. Petraeus issued a statement acknowledging the affair after President Obama accepted his resignation and it was announced by the C.I.A. The disclosure ended a triumphant re-election week for the president with an unfolding scandal.

Government officials said that the F.B.I. began an investigation into a “potential criminal matter” several months ago that was not focused on Mr. Petraeus. In the course of their inquiry into whether a computer used by Mr. Petraeus had been compromised, agents discovered evidence of the relationship as well as other security concerns. About two weeks ago, F.B.I. agents met with Mr. Petraeus to discuss the investigation.

Administration and Congressional officials identified the woman as Paula Broadwell, the co-author of a biography of Mr. Petraeus. Her book, “All In: The Education of General David Petraeus,” was published this year. Ms. Broadwell could not be reached for comment.

Ms. Broadwell, a graduate of the United States Military Academy at West Point, spent 15 years in the military, according to a biography that had appeared on her Web site. She spent extended periods of time with Mr. Petraeus in Afghanistan, interviewing him for her book, which grew out of a two-year research project for her doctoral dissertation and which she promoted on a high-profile tour that included an appearance on “The Daily Show With Jon Stewart.”

Married with two children, she has described Mr. Petraeus as her mentor.

Senior members of Congress were alerted to Mr. Petraeus’s impending resignation by intelligence officials about six hours before the C.I.A. announced it. One Congressional official who was briefed on the matter said that Mr. Petraeus had been encouraged “to get out in front of the issue” and resign, and that he agreed.

As for how the affair came to light, the Congressional official said that “it was portrayed to us that the F.B.I. was investigating something else and came upon him. My impression is that the F.B.I. stumbled across this.”

The Federal Bureau of Investigation did not inform the Senate and House Intelligence Committees about the inquiry until this week, according to Congressional officials, who noted that by law the panels — and especially their chairmen and ranking members — are supposed to be told about significant developments in the intelligence arena. The Senate committee plans to pursue the question of why it was not told, one official said.

The revelation of a secret inquiry into the head of the nation’s premier spy agency raised urgent questions about Mr. Petraeus’s 14-month tenure at the C.I.A. and the decision by Mr. Obama to elevate him to head the agency after leading the country’s war effort in Afghanistan. White House officials said they did not know about the affair until this week, when Mr. Petraeus informed them.

“After being married for over 37 years, I showed extremely poor judgment by engaging in an extramarital affair,” Mr. Petraeus said in his statement, expressing regret for his abrupt departure. “Such behavior is unacceptable, both as a husband and as the leader of an organization such as ours. This afternoon, the president graciously accepted my resignation.”

Mr. Petraeus’s admission and resignation represent a remarkable fall from grace for one of the most prominent figures in America’s modern military and intelligence community, a commander who helped lead the nation’s wartime activities in the decade after the Sept. 11 attacks and was credited with turning around the failing war effort in Iraq.

Mr. Petraeus almost single-handedly forced a profound evolution in the country’s military thinking and doctrine with his philosophy of counterinsurgency, focused more on protecting the civilian population than on killing enemies. More than most of his flag officer peers, he understood how to navigate Washington politics and news media, helping him rise through the ranks and obtain resources he needed, although fellow Army leaders often resented what they saw as a grasping careerism.

 Reporting was contributed by Peter Baker, Helene Cooper, Michael S. Schmidt, Eric Schmitt and Scott Shane.

This article has been revised to reflect the following correction:

Correction: November 9, 2012

An earlier version of this article incorrectly stated that David H. Petraeus was expected to remain in President Obama’s cabinet. The C.I.A. director is not a cabinet member in the Obama administration.

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Justin Bieber and Selena Gomez call it quits

NEW YORK (AP) — Justin Bieber is no longer Selena Gomez's 'Boyfriend,' a source confirms to The Associated Press.

The split happened last week, and distance and their busy schedules were a contributing factor.

Eighteen-year-old Bieber is touring to promote his latest album, while 20-year-old Gomez is filming a "Wizards of Waverly Place" reunion for Disney Channel called "The Wizards Return: Alex versus Alex," that will air next year.

The pair first stepped up publicly in February 2011 at the Vanity Fair Oscar party.

E! News was the first to report the split.

Bieber seems to be doing OK, at least publicly. On the red carpet of Wednesday's Victoria's Secret fashion show he said, "I'd rather be here than anywhere in the world."

___

Online:

http://www.justinbiebermusic.com/

http://www.selenagomez.com/

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The New Old Age Blog: The Emotional Aftermath of Hurricane Sandy

Let’s talk about the emotional aftermath of the storm that left tens of thousands of older people on the East Coast without power, bunkered down in their homes, chilled to the bone and out of touch with the outside world.

Let’s name the feelings they may have experienced. Fear. Despair. Hopelessness. Anxiety. Panic.

Linda Leest and her staff at Services Now for Adult Persons in Queens heard this in the voices of the older people they had been calling every day, people who were homebound and at risk because of medical conditions that compromise their physical functioning.

“They’re afraid of being alone,” she said in a telephone interview a few days after the storm. “They’re worried that if anything happens to them, no one is going to know. They feel that they’ve lost their connection with the world.”

What do we know about how older adults fare, emotionally, in a disaster like that devastating storm, which destroyed homes and businesses and isolated older adults in darkened apartment buildings, walk-ups and houses?

Most do well — emotional resilience is an underappreciated characteristic of older age — but those who are dependent on others, with pre-existing physical and mental disabilities, are especially vulnerable.

Most will recover from the disorienting sense that their world has been turned upside down within a few weeks or months. But some will be thrown into a tailspin and will require professional help. The sooner that help is received, the more likely it is to prevent a significant deterioration in their health.

The best overview comes from a November 2008 position paper from the American Association for Geriatric Psychiatry that reviewed the effects of Hurricane Katrina and other disasters. After Katrina, “the elderly had the highest mortality rates, health decline and suicide rates of any subgroup,” that document notes. “High rates of psychosomatic problems were seen, with worsening health problems and increased mortality and disability.”

This is an important point: Emotional trauma in older adults often is hard to detect, and looks different from what occurs in younger people. Instead of acknowledging anxiety or depression, for instance, older people may complain of having a headache, a bad stomachache or some other physical ailment.

“This age group doesn’t generally feel comfortable talking about their feelings; likely, they’ll mask those emotions or minimize what they’re experiencing,” said Dr. Mark Nathanson, a geriatric psychiatrist at Columbia University Medical Center.

Signs that caregivers should watch out for include greater-than-usual confusion in an older relative, a decline in overall functioning and a disregard for “self care such as bathing, eating, dressing properly and taking medication,” Dr. Nathanson said.

As an example, he mentioned his father-in-law, who had “been sitting in a cold house for days and decided to stop taking his water pill because he felt it was just too much trouble.” Being distraught or distracted and forgetting or neglecting to take pills for chronic conditions like diabetes or heart disease can have immediate harmful effects.

Especially at risk of emotional disturbances are older adults who are frail and advanced in age, those who have cognitive impairments like Alzheimer’s disease, those with serious mental illnesses like schizophrenia or major depression, and those with chronic medical conditions or otherwise in poor physical health, according to the geriatric psychiatry association’s position paper.

A common thread in all of the above is the depletion of physical and emotional reserves, which impairs an older person’s ability to adapt to adverse circumstances.

“In geriatrics, we have this idea of the ‘geriatric cascade’ that refers to how a seemingly minor thing can set in motion a functional, cognitive and psychological downward spiral” in vulnerable older adults, said Dr. Mark Lachs, chief of the division of geriatrics at Weill Cornell Medical College. “Well, the storm was a major thing — a very large disequilibrating event — and its impact is an enormous concern.”

Of special concern are older people who may be in the early stages of Alzheimer’s disease or other types of dementia who are living alone. For this group, the maintenance of ordinary routines and the sense of a dependable structure in their lives is particularly important, and “a situation like Sandy, which causes so much disruption, can be a tipping point,” Dr. Lachs said.

Also of concern are older people who may have experienced trauma in the past, and who may suffer a reignition of post-traumatic stress symptoms because of the disaster.

Most painful of all, for many older adults, is the sense of profound isolation that can descend on those without working phones, electricity or relatives who can come by to help.

“That isolation, I can’t tell you how disorienting that can be,” said Bobbie Sackman, director of public policy for the Council of Senior Centers and Services of New York City. “They’re scared, but they won’t tell you because they’re too proud and ashamed to ask for help.”

The best remedy, in the short run, is the human touch.

“Now is the time for people to reach out to their neighbors in high-rises or in areas where seniors are clustered, to knock on doors and ask people how they are doing,” said Dr. Gary Kennedy, director of the division of geriatric psychiatry at Montefiore Medical Center in the Bronx.

Don’t make it a one-time thing; let the older person know you’ll call or come by again, and set up a specific time so “there’s something for them to look forward to,” Dr. Kennedy said. So-called naturally occurring retirement communities with large concentrations of older people should be organizing from within to contact residents who may not be connected with social services and find out how they’re doing, he recommended.

In conversations with older adults, offer reassurance and ask open-ended questions like “Are you low on pills?” or “Can I run out and get you something?” rather than trying to get them to open up, experts recommended. Focusing on problem-solving can make people feel that their lives are being put back in order and provide comfort.

Although short-term psychotherapy has positive outcomes for older adults who’ve undergone a disaster, it’s often hard to convince a senior to seek out mental health services because of the perceived stigma associated with psychological conditions. Don’t let that deter you: Keep trying to connect them with services that can be of help.

Be mindful of worrisome signs like unusual listlessness, apathy, unresponsiveness, agitation or confusion. These may signal that an older adult has developed delirium, which can be extremely dangerous if not addressed quickly, Dr. Nathanson said. If you suspect that’s the case, call 911 or make sure you take the person to the nearest hospital emergency room.

This is a safe place to talk about all kinds of issues affecting older adults. Would you be willing to share what kinds of mental health issues you or family members are dealing with since the storm so readers can learn from one another?

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In Syria, Missteps by Rebels Erode Their Support

Asmaa Waguih/Reuters

Rebels firing on a man suspected of being a pro-government fighter in Idlib Province on Oct. 26.

BEIRUT, Lebanon — Syria’s rebel fighters — who have long staked claim to the moral high ground for battling dictatorship — are losing crucial support from a public increasingly disgusted by the actions of some rebels, including poorly planned missions, senseless destruction, criminal behavior and the coldblooded killing of prisoners.

The shift in mood presents more than just a public relations problem for the loosely knit militants of the Free Syrian Army, who rely on their supporters to survive the government’s superior firepower. A dampening of that support undermines the rebels’ ability to fight and win what has become a devastating war of attrition, perpetuating the violence that has left nearly 40,000 dead, hundreds of thousands in refugee camps and more than a million forced from their homes.

The rebel shortcomings have been compounded by changes in the opposition, from a force of civilians and defected soldiers who took up arms after the government used lethal force on peaceful protesters to one that is increasingly seeded with extremist jihadis. That radicalization has divided the fighters’ supporters and made Western nations more reluctant to give rebels the arms that might help break the intensifying deadlock. Instead, foreign leaders are struggling to find indirect ways to help oust Syria’s president, Bashar al-Assad.

And now arrogance and missteps are draining enthusiasm from some of the fighters’ core supporters.

“They were supposed to be the people on whom we depend to build a civil society,” lamented a civilian activist in Saraqib, a northern town where rebels were videotaped executing a group of unarmed Syrian soldiers, an act the United Nations has declared a likely war crime.

An activist in Aleppo, Ahmed, who like some of the others who were interviewed gave only one name for security reasons, said he had begged rebels not to camp in a neighborhood telecommunications office. But they did, and government attacks knocked out phone service.

One fighter shot into the air when customers at a bakery did not let him cut into a long line for bread, Ahmed recalled. Another, he said, was enraged when a man washing his car accidentally splashed him. “He shot at him,” Ahmed said. “But thank God he wasn’t a good shot, so the guy wasn’t hurt.”

Twenty months into what is now a civil war, both supporters and opponents of the government are trapped in a darkening mood of despair, revulsion and fear that neither side can end the conflict. In recent months, both sides adopted more brutal — even desperate — methods to try to break the stalemate, but they achieved merely a new version of deadlock. To many Syrians, the extreme violence seems all the more pointless for the lack of results.

The most significant shift is among the rebels’ supporters, who chant slogans not only condemning the government but also criticizing the rebels.

“The people want the reform of the Free Syrian Army,” crowds have called out. “We love you. Correct your path.”

Small acts of petty humiliation and atrocities like executions have led many more Syrians to believe that some rebels are as depraved as the government they fight. The activist from Saraqib said he saw rebels force government soldiers from a milk factory, then destroy it, even though residents needed the milk and had good relations with the owner.

“They shelled the factory and stole everything,” the activist said. “Those are repulsive acts.”

Even some of the uprising’s staunchest supporters are beginning to fear that Syria’s sufferings — lost lives, fraying social fabric, destroyed heritage — are for naught.

“We thought freedom was so near,” said a fighter calling himself Abu Ahmed, his voice catching with grief as he spoke via Skype last month from Maarat al-Noaman, a strategic town on the Aleppo-Damascus highway. Hours earlier, a rebel victory there ended in disaster, as government airstrikes pulverized civilians returning to what they thought was safety.

“This shows it was a big lie,” Abu Ahmed said of the dream of self-government that he said had inspired him to lead a small rebel fighting group from his nearby village, Sinbol. “We cannot reach it. We can’t even think of democracy — we will be sad for years. We are losing victims from both sides.”

A chain of calamities has fueled disgust and frustration on all sides, dozens of interviews with Syrians show.

In July, a rebel bombing killed four senior officials in a heavily guarded Damascus building, bringing new insecurity to government supporters. The rebels’ growing use of large bombs that kill bystanders spurred concerns on both sides.

Poorly executed rebel offensives brought harsh consequences. In September, rebels launched an offensive in Syria’s largest city, Aleppo, an ancient town that stood for centuries as the proud legacy of all Syrians. The fighting failed to achieve the turning point the rebels had promised.

Hala Droubi contributed reporting from Beirut, and an employee of The New York Times from Aleppo and Damascus, Syria.

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Roger Waters plays with band of wounded veterans

NEW YORK (AP) — Roger Waters honored wounded veterans in New York by performing with them at the annual Stand Up for Heroes benefit, Thursday night.

The founding member of Pink Floyd took to the stage of the Beacon Theater with 14 wounded soldiers he met recently at the Walter Reed Army Medical Center in Washington, D.C. He rehearsed with them at the hospital, and for the past few days in New York.

The event benefited the Bob Woodruff Foundation, which helps returning veterans and their families, and featured Waters, Bruce Springsteen, Ricky Gervais, Robin Williams, and others.

Before the show, Waters chatted with veterans and called the experience "fantastic." He says he's "looking forward to pulling for the rest of these guys with their comrades" during the healing process.

He says that he shares "enormous empathy with the men."

"I lost my grandfather in 1916 and my father in 1944, so I've been around the sense of loss and what loss from war can do to people," Waters said.

"I never talk about the politics because it's not relevant to me. I'm not interested in it," he said. "What I am interested in is the burdens these guys bear and would never question motive or even dream of talking about any of the politics."

He added: "If any of us have a responsibility in our lives it is to tear down the walls of indifference and miscommunication between ourselves and our fellow men."

Waters said he rehearsed with many of the soldiers at the hospital in between their medical procedures. Before the show, he walked the red carpet with Staff Sgt. Robert Henline, who was not in the band. In 2007, Henline was the sole survivor of a roadside bombing north of Baghdad. As a result, he suffered burns over 38 percent of his body and his head was burned to the skull.

Henline, who fought for his life after the attack, has endured more than 40 surgeries.

Still, he maintains a sense of humor. On the open red carpet on a chilly night, Waters pushed closer to Henline for warmth.

"Get next to the burn guy. I'm good. I'm heated up," Henline joked.

No surprise. The retired soldier says he's been doing stand-up comedy for the past year and a half.

Waters performed three songs with the veterans, including the Pink Floyd classic, "Wish You Were Here."

Waters said he didn't think there would be a reunion with his former band.

"I think David (Gilmour) is retired by and large. I shouldn't speak for him. But that's the impression I get."

Waters then added: "Hey whatever. All good things come to an end."

While his mammoth tour of "The Wall" ended this summer, Waters promised the theatrical version would hit the Broadway stage in the near future.

The Bob Woodruff Foundation has supported more than 1 million veterans, service members, and their families since it began in 2008.

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John Carucci covers entertainment for The Associated Press. Follow him at —http://www.twitter.com/jcarucci_ap

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