Tag Archives: elderhood

Falls Awareness & Prevention Guide

Falling is the nemesis of older folks. Yes, falls can be an issue for anyone at any age, but for older folks it can mean broken bones – especially hip bones – that take a long time to heal, require physical therapy to be able to resume activity, and are all too often the harbinger of further problems.

The American Academy of Orthopaedic Surgeons and The Orthopaedic Trauma Association have put out a Falls Awareness & Prevention Guide that I recommend for anyone, regardless of age, and absolutely recommend to anyone living on their own, particularly if they are older (and you can take “older” to mean whatever age you feel like having it mean!)

My Mom lived alone for about five years, and in her last year of life she fell several times, the first on New Year’s Day 2010. We were getting ready to leave a family gathering at the home of a relative. Wearing shoes that were like slippers and did not offer much by way of support, she tripped on a towel that was near the front door and meant for wiping wet shoes. The shoes and towel were a nasty combination, causing her to lose her footing and fall to her left. As if it were happening in slow motion, several of us tried to reach out and catch her or lessen the impact of her fall. Alas, a trip to the ER showed a broken left humerus. This would be the first of two shoulder breaks, with the next one happening to her right humerus.

If you look at the Falls Awareness & Prevention Guide, you will notice inadequate footwear and all throw rugs and area rugs that are not properly secured (could just as easily apply to towels on the floor) listed as risk factors. It could have been anyone who fell on that rug, but I suspect my mother’s age also had something to do with it.

So, take a look at the guide and see if it provides some tips for you or for someone you know. Being a little proactive now can mean a lot in terms of later prevention.

And from the National Council on Aging, an info graphic to herald Falls Prevention Awareness Day, which happens to be September 23, 2014.

FPAD14-Infographic_full

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How Elders Will Save the World

With age, comes wisdom.

Attribute to that line whatever you like. I choose to attribute it to the wisdom that comes from having lived a long enough time to be considered living in elderhood, that stage of life following adulthood. William Thomas, author of What are Old People For? How Elders Will Save the World, believes in and advocates for elderhood living environments intentionally designed to promote a sanctuary where elders thrive. These are not merely places where elders survive, but places where they can remain vibrant participants in their own lives and the lives of others, regardless of their physical or cognitive capabilities.

Thomas denotes several “Principles for Elderhood’s Sanctuary”:

  • Warm – radiating human warmth and developing “the practice of doing good deeds without the expectation of return”
  • Small – keep the scale small
  • Flat – keep the hierarchy flat
  • Rooted – have a “deeply rooted belief system”
  • Smart – use of technologies that support the well-being of elders and their care takers
  • Green – sustainable places that provide a “connection with the living world” through gardens

With the above principles in mind, Thomas developed The Green House Project, with implementation support from ncb Capital Impact and the Robert Wood Johnson Foundation. Below is a “documentary short” about the project.

John Zeisel is another author who has created a nursing home alternative. I have read his book, I’m Still Here, and blogged about him a few times, so was pleasantly surprised to see he was referenced by Thomas as a resource when Thomas was researching design possibilities for The Green House Project.

William Thomas goes on to paint a picture of elderhood where each person is able to give and receive loving care. He behooves us to reconsider the lives of the oldest of the old as another developmental phase in the life of a human being:

…to see old age as part of the ongoing miracle of human development. It offers a perspective that connects all elements of the human life span from birth to death.

Mostly what Thomas advocates for is a reenvisioning of the last phase of our lives with a return to respect for old age and the wonders it has to offer, and an acknowledgment that how we craft this last stage (including, but not limited to, physical buildings, guiding principles for care, opportunities for participation, equal respect for the care takers and the cared for) will make all the difference in how it is lived.

What are Old People For? How Elders Will Save the World

William Thomas is the most optimistic advocate for aging I have yet to encounter. He believes in the power of the oldest of the old, and has called that phase of our lives “elderhood”, the natural successor to adulthood.

Old age has richness and complexity that, when appreciated, provide a powerful counterweight to the measurable, progressive, steady decline in bodily functions. In old age, the body instructs the mind in patience and forbearance while the mind tutors the body in creativity and flexibility.

History & Culture of Aging

What Are Old People For? is Thomas’ treatise on old age, beginning with a brief history of the hunter-gatherers and continuing thru to old age’s transformation by modern culture. This was the first time I heard the word “senescence“, defined as “growing into old age”, as compared with adolescence, which is “growing into adulthood”.

The upper limit of longevity may be defined by human genetics, but the experience of living into old age is defined almost exclusively by the customs and mores of one’s culture. An individual’s ability to live a long and bountiful life depends, most of all, on society’s aptitude for making such a life possible.

If you take a look at the various media cultural artifacts (television, magazines, newspapers and the like), you cannot escape the many advertisements for anti-aging products and multiple medications, all being marketed to a very large baby boomer generation that has fully entered adulthood.

Not only are adults impacted by this swath of advertising, but there is a huge trickle down effect, whereupon youngsters and teenagers are inundated with messages about staying young. Modern culture does not embrace the distinctive lines of age – the wrinkles that appear as a banner to living long. There is a huge market for medicine and medical procedures designed to eradicate any banners of aging.

Long-Term Care Environments

From discussing culture, Thomas goes on to describe the “plagues of loneliness, helplessness, and boredom” that accompany oldsters who are relocated, by choice or against their will, to “long-term care environments”. Rather than sit by the sidelines, William Thomas and his wife, Judith Meyers-Thomas, have created an approach to eldercare living called The Eden Alternative. You can read more about it here or listen to this 2002 PBS NewsHour interview: Nursing Home Alternative.

Thomas quotes a passage from Erving Goffman’s 1961 book Asylums, where Goffman lists five traits that define a “total institution”. It is a scathing description that, as Thomas notes, can be equally applied to life in prisons, state psychiatric hospitals and concentration camps. Alas, concludes Thomas, this list is also applicable to our long-term care facilities.

While the intention of these organizations is clearly different from that of penitentiaries, they share a common, rigid division of people into the guardians and the guarded, the therapists and the sick, the staff and the residents.

My Dad lived in assisted living, followed by a nursing home, for a combined seven plus years. My Mom was hospitalized several times within the span of six months, followed by a three week stint in a rehab facility, followed by round-the-clock care at home for several weeks. I know first hand of what Thomas describes.

But all does not have to be glum! The full title of Thomas’ book is What are Old People For? How Elders Will Save the World. Stay tuned for that second part!

for more on William H Thomas:

Elderhood Rising: The Dawn of a New World Age

As I become more involved in the community of aging adults, including my own aging, I am determined to better understand the world of elderhood. From my experience, for the generation of my parents, those born between 1915 and 1930, old age has often been synonymous with illness, nursing homes, hospital stays, and, in too many instances, undignified end-of-life experiences.

William H. Thomas, M.D., has spent his career as a geriatrician trying to educate the world about having a “positive elderhood”, and in the process has helped create Eden Alternative, a living experience for elders that takes a rather different slant to what it means for older folks to live together. I first heard of William Thomas when viewing his TED Talk Elderhood Rising: The Dawn of a New World Age.

Yes, I know he has a semi-syncopated way of talking, but his message is well worth hearing, as he presents important and useful ideas to consider as you age and as your parents age.

 

I have since picked up his 2004 book, What are Old People For? How Elders Will Save the World, and that’s the topic of my next post or two.

Five Wishes (not what you might be expecting)

There is a hearty conversation going on around Michael Wolff’s A Life Worth Ending article in the May 28, 2012 issue of New York magazine. I have already commented once (you can see that in my previous Neurons Firing post) and just this morning added a second comment, which is copied below.

We first heard about Five Wishes from my brother-in-law and his wife, Pat. Pat happens to be a nurse practitioner and clinical coordinator in pediatrics at MIT, and is a former director of nursing at Children’s Hospital Boston. I point out her credentials by way of saying that a medical practitioner gave us our first copy of Five Wishes. I have since purchased additional copies to share with my brother and his wife.

Some form of health care proxy and living will is crucial for family members to have when they find themselves in the position of caring for not only an elderly family member, but for anyone in their family who is of age to be considered an independent adult. Rather than be put off by having conversations about end-of-life care, it is my hope that people will see these conversations as a way to more consciously provide the love, care, respect and dignity that hopefully accompanies the relationships between the cared-for and the caring-for.

—–

I previously commented about my Mom and her use of Compassion & Choices. Now am sharing about the organization Aging With Dignity – http://www.agingwithdignity.org/index.php – which provides a form called Five Wishes. This form helps people begin the conversations about their end-of-life wishes. When filled out, the form provides guidance to family, doctors and other medical personnel as to the wishes of the prospective patient. My husband and I are using this form, and I have ordered copies for my brother and his wife.

Regards, Laurie

Compassion and Courage

Timing is everything! Just yesterday I spent the bulk of the day with my Aunt (my Mom’s sister), and she gave me her May 28, 2012 issue of New York magazine. The cover highlights Michael Wolff’s article, A Life Worth Ending, which prompted me to high tail it to New York magainze’s website and add a comment to the already 370+. You can follow the comment stream here, and I’ve posted my initial comment below.

Oh, and why is timing everything? My Mom’s 83rd birthday would have been this coming Friday, June 8. My comment is a timely tribute to her courage.

—–

My 80 year old Aunt gave me her copy of the May 28 issue of New York magazine expressly so I would read this article. On the cover, my Aunt wrote “Don’t EVER let this happen to me“. She and my Mom have always held the philosophy that when your mind goes, you should go with it. They saw their own mother decline in a nursing home and vowed never, ever, would they follow that route.

My Aunt is still going strong, though not without bits and pieces of her body falling apart. My Mom died in October, 2010. And this is the part I hope readers of this article and these comments will take note of. Dying does not have to be an agonized, drawn out, horrific experience like the one that Van and her family is experiencing.

My Mom had a stroke in August, 2010, that left her paralyzed on her dominant right side. Unable to play her treasured piano (she had a masters in music composition), unable to use her valued computer to communicate with the world, and unable to care for herself with the basics of dressing and toileting, she invoked what she always said she would do if such a circumstance occurred. She contacted Compassion and Choices. http://www.compassionandchoicesofny.org/ Compassion and Choices is a phenomenal organization that exists to help people make quality of life decisions by offering them choices. My Mom opted for VSED, voluntarily stopping eating and drinking. She made this decision while perfectly competent, but even had she not been able to make this decision, it is one which she had shared with her family over and over for years, so we would have known what to do had she not been able to do it for herself.

VSED requires the participation of a doctor who will prescribe palliative care, which means medicine to alleviate pain and discomfort, and morphine towards the last day or two, and a round-the-clock aide to assist with diaper changing and other functions of care, but not of feeding, as no food or water are taken in during this time. It is a special person, indeed, who opts to provide aide care during this time – who can soothe and calm, clean and comfort. We had the benefit of such a person, thanks to a recommendation from our contact at Compassion and Choices.

My Mom had a soothing, almost spiritual final 11 days, filled with sunshine in her ground floor apartment, loving children around her and a compassionate aide to care for her. She died peacefully, on her own terms, in her own apartment, in her own way.

Respectfully,
Laurie B.

Successful Aging

Oh dear, yet another large print book. I have nothing against the concept of large print, ideally this makes it easier to read for people with vision issues. However, I wish the publishers did a better job with layout and leading, the latter essentially being the spacing between lines. Lines of large type clumped on a page does not, actually, make for easier reading (for me).

John W Rose, MD, and Rober L Kahn, PhD, compiled the results of a MacArthur Foundation Study on aging and the result is the 1998 book, Successful Aging. Given that this book was published 14 years ago, there was nothing new in it that I had not already seen in some other format.

There were, however, two items that did particularly strike me. The first was the wonderful optimism the authors exude in describing both the results of the long term study and what the findings could mean for the future. While they break down the study and discuss multiple aspects of aging, I think the book’s message can be summed up quite simply. To paraphrase Carol Dweck’s findings about mindsets, those with growth mindsets will find it easier to deal with aging and, as such, will likely have a positive impact on their own aging process. Those who have a fixed mindset will find that when the going gets tough, they may be less flexible in managing repercussions, which will likely have a less positive – and perhaps negative – impact on their own aging process.

The idea of mindsets holds true, as well, for younger peoples’ perceptions of older people. As a teacher, I have always believed that students rise or fall to the level of expectations held for them. Similarly, if younger people can have a positive mindset about older people and the process of aging, this is more likely to have a beneficial impact on their interactions with older people and on their own aging process.

Due to the date of the book, 1998, I tended to question some of the statistics the authors noted, especially regarding the prevalence of Alzheimer’s in the aging population. I am reasonably confident that the numbers of people with, and expected to exhibit some form of dementia or Alzheimer’s is far greater than what they forecast back in 1998. You can read more about the Latest Alzheimer’s Statistics in the United States in this article on the Texas Alzheimer’s Research and Care Consortium site. In any case, both resources note that dementia and Alzheimer’s are not part of the normal aging process.

Similar to what I have gleaned from other books on aging, and from attendance at various Learning & the Brain conferences, Rose and Kahn note there are several factors a person can engage with to help their brains and bodies age normally. Turns out we do have  some control over how we age, it’s not all in the genes.

  • engage in physical activity – good for the body and for the brain, as exercise helps stimulate BDNF, brain-derived neurotrophic factor
  • fertilize your social network – showing care for and an interest in others, and allowing them to do the same for you makes for a strong support system
  • believe that you can manage whatever comes your way – while this may not always be the case, having a “cup half full” approach to aging can help you handle the blips

According to research, focusing on the above three elements will help an individual age successfully. Essentially, this approach translates to preventive care, and preventive care can aid with (in the words of the authors) “avoiding disease, maintaining high cognitive and physical function, and engagement with life.” Alternatively,

Disability in older people results from three key factors: 1) the impact of disease, or more commonly, many diseases at once; 2) lifestyle factors, such as exercise and diet, which directly influence physical fitness and risk of disease; and 3) the biological changes that occur with advancing age – formally known as senescence.

For more on healthy aging, here are some of my prior posts plus an article by Elkhonon Goldberg.