Longevity Secrets from 100-year-old Doctor
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BLOGGER: MICHAEL FRIEDMAN, L.M.S.W
I am afraid of developing dementia, the most common form of which is Alzheimer’s disease. The possibilities are horrifying — the ineluctable loss of memory and other cognitive functions; dependency on others to dress me, to feed me, to change my diapers; slipping into a fog, where I cannot recognize even people I love.
But is dementia inevitably a cruel, distorted end of a human life?
When I was younger, I thought so. I had no doubt that I would prefer death to living in a demented state; that I would want to take my own life; and that, if I missed the timing and could not act on my own, I would want someone else to do it for me. “Just shoot me,” I said to my wife — knowing, of course, that she would not and could not, but hoping that she would act swiftly as my health care proxy to have any kind of life support — including food and water — removed when I was no longer myself.
As I have become old (I am now 68), my thinking has changed. When the time comes, if the time comes, I may want to live — even if I cannot engage in witty conversation; even with the need for someone to help me hobble on a walker to get out for a breath of air; even with the indignity of someone cleaning me after I mess my diapers.
What we expect and want for ourselves changes over time. That is the fundamental insight of developmental psychology. When I was a child, being a child seemed right. When I became a teenager, I fought against being a child. As a grown-up, my adolescence was an embarrassing memory. I am happy now not to be driven to succeed at the work, which largely and happily defined my existence as an adult. The low-stress life I am fortunate to have now feels right to me.
What will feel right when I am very old? Will I care if I can no longer analyze public policy? Will I be deeply distressed if I cannot write or teach? Will I suffer if I cannot tell a joke or have an informed conversation about politics, world events, and the fields of knowledge and activity that have been central to my life?
Or will a visit from someone I like make my day? Will my daughter and grandchildren (if I have them) be a source of constant interest? Will watching world events on the TV with only faint understanding be enough? And when the time comes, if it comes, will the feel of the sun on my face be enough for me to want to live? Will a caring hand on my shoulder, the taste of French fries, the sound of jazz, the sight of a beautiful painting or sunset be enough? I do not know the answer.
I do know that dementia unfolds in stages. Although many people in the early and mid-stages are devastated by the growing loss of important abilities and develop mood or anxiety disorders, others have “full” lives that include the pleasures of friendships, love, and sex; the satisfaction of participation in social and communal activities; and even the discovery of new interests. In fact, some experts on dementia (see, for example, John Zeisel’s book, “I’m Still Here“) maintain that diminished cognitive functions result in the release of capabilities that have been suppressed by the very cognitive abilities that are now in decline — particularly the willingness to take creative risks and the openness to human affection and intimacy.
There are, as we all know, people with dementia who become depressed, frightened or angry — some so angry that they are abusive to people who try to care for them. There are some people with dementia who wonder why they are alive, or wish for death.
But there are also people with dementia who experience pleasure, who feel love, and who are at peace.
So, even though I still fear developing dementia, I no longer say with any sense of certainty, “Just shoot me.”
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Meeting the Mental Health Challenges of the Elder Boom
BLOGGER: MICHAEL FRIEDMAN, LMSW
The elder boom has begun, and our nation is not prepared. Between 2011 and 2030, the number of adults 65 or older will increase from 40 million to 72 million and from 13 percent of the population to 20 percent. This drives growing concerns about the viability of Social Security, the sustainability of Medicare, and the availability of a workforce to provide health and social services.
Despite widespread concern about the physical health of older adults, mental health needs are mostly not on the national radar screen, a serious oversight for five reasons.
First, contrary to the ageist assumptions of our culture, people can live well in old age, but not without mental health.
Second, mental illness has a terrible impact on physical health. People with mental disorders are more likely to have physical disorders, and people with co-occurring physical and mental and/or substance use disorders are at higher risk for disability and premature death and have far higher medical costs than those with physical disorders alone.
Third, approximately 20 percent of older adults have diagnosable mental and/or substance use disorders, including dementia. This increases to over 50 percent of older adults by age 85, mostly dementia, the prevalence of which doubles every five years beginning at age 60. The range of mental health problems also includes:
Fourth, untreated mental disorders contribute to avoidable placement in institutions, such as nursing homes, driving up the costs of long-term care in the U.S. They also contribute to social isolation and high rates of suicide.
Fifth, all older adults face emotional challenges related to social and occupational role changes, diminished — but not lost — physical and mental abilities, losses of family and friends, and the inevitability of death.
Both the public and the private sectors need to take steps to meet the mental health challenges of the elder boom. These include:
In these times of cutback in government spending, addressing the mental health needs of older adults may appear to be an unnecessary frill. But the truth is that failing to address mental health needs will drive costs up in the long run. Ignoring this is very poor policy.
(This article is coauthored by Kimberly Williams, co-founder and Director of the Geriatric Mental Health Alliance of New York.)
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AARP Does an About Face on Social Security Cuts
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On Being Invisible
Blogger: Renee Fisher
Do you ever feel invisible? When my friends and I decided to write a book about women over 50, I asked a lot of women my age what sucked about getting older. I expected to hear the sagging/bagging/dragging thing or maybe the memory thing or maybe even the empty nest thing. I didn’t hear any of that. What I heard over and over was “I feel invisible.” Well, you could have knocked me over with a pair of sensible shoes.
I could relate to these women. I remember certain events in my life vividly: My first kiss. The day John F Kennedy was shot. “Going all the way.” My college graduation. My first wedding. The births of my three children. The day I became invisible. My second wedding. The day my grandson was born.
Whoops, back up. I remember the day, no, the moment, when I became invisible. Walking down the aisle at Safeway. Man coming toward me. Man passing. My brain registering He never saw me. I don’t mean he didn’t oogle me. I mean HE DIDN’T SEE ME. I wasn’t composed of molecules that took up any space in his world. Had someone asked him if he had passed anyone in the aisle, he would have said “No.”
It was a real turning point for me. I never had to think about my visibility before. It was just sort of there. But from that day on, I didn’t take visibility as a given. I made sure I looked people in the eye and smiled when I passed them. I spoke up when sales people started to deal with other customers when I had been there first. I no longer allowed people to cut in front of me in line or to take a parking space I had been waiting for. And I got rid of all the long baggy jumpers I had been wearing, just because they were so comfortable. In other words, I began to think about how I was going to be visible in the world. The result was incredibly energizing.
The conclusion I came to was that being visible had little to do with youth or sex appeal. It came from a feeling of empowerment, and from a belief that I should be noticed. There’s a commercial on TV now that shows a woman all dressed up, coming down the stairs. The voiceover says “It’s (whatever the product is) the difference between ‘I’m here’ and ‘Here I am.’” That pretty much sums it up for me.
All this is not to say that there aren’t times that I choose to be invisible, to fly under the radar. Sometimes, under the right circumstances, that can be liberating and/or comforting. And, at other times, it allows me to get away with things, like standing in line at the checkout, eating the nuts that haven’t been weighed yet (Now Husband Dan hates when I do that.) Visible. Invisible. I simply want the choice.
Note to Safeway Guy: If we ever share the same aisle again, I’ll bet you’ll notice me.
Renee Fisher
Co-author, Saving the Best for Last: Creating Our Lives After 50
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BLOGGER: MARY LANGUIRAND, PHD
There are days when it takes all the self control I possess to be with Carol, a pleasant 87 year old woman with mild age-related cognitive loss. I can empathize with the complaints about the kids who don’t visit often enough, the aide who forgets to put her phone within reach, and the salad with the wilted lettuce. However, I sometimes think that if I hear one more repetition of the story about how her husband bought her a cherished emerald ring in 1973, I may tear out my hair. It’s a long story, it never changes, and I believe I’ve heard it at least twice a month for the past three years.
Short-term memory tends to fade with advanced age, as it is based on such factors as ability to attend to the environment, maintain focused concentration, and track complex information. As illness, diminished energy and perceptual changes erode some of those capacities, the ability to recall recent information diminishes. In contrast, memories from years past strengthen, having been reviewed and repeated (and revised and edited) many times. Caregivers often marvel that Mom can’t remember her upcoming doctor’s appointment, but can tell you what she paid for milk in 1964.
You might think that listening to the same story over and over would be a neutral or—at worst—a mildly boring experience. After all, we hear all sorts of things repeatedly—recorded messages on trains and busses, the music in TV jingles, liturgical passages at religious ceremonies—and many people find the familiar tolerable, and even soothing. Why then, do so many caregivers report that hearing yet again about Dad’s heroic actions in the fields of Korea or Mom’s days as a cheerleader can drive them to drink?
Much of the frustration comes from the fact that this sort of repetition is one of the most inescapable “proofs” that someone has reached a point where they are more comfortable in the past than in the here-and-now, and that this isn’t likely to change. The effort of attending to current realities is too much, and they’ve surrendered to the comfort of the familiar. The content of these repeated tales is also rather telling, as it can give some clues to those events and experiences that impacted the person most profoundly: If a parent’s most cherished memory relates to things that happened long before you were born, what does that say about you?
Repetition apparently isn’t limited to the senior set… When emailing a younger colleague recently, I shared a past experience that I thought resonated with some current events, and was quite chagrined when reminded that I’d already told that story. I felt rather hurt that my misplaced effort at empathy (and the chance to recount how I’d saved the day ‘back in the day’) apparently generated boredom and annoyance, along with the message that I’m forgetful. No kidding—I really don’t remember having told that one before…
Once I moved past the hurt feelings, I began to think about getting my act together and scoring some points in the present, instead of resting on past laurels, which is probably a good thing. I also began to develop a new appreciation for Carol’s experience. I thought about my own response to her oft-told story about the emerald ring, and how I regularly discount her need to re-live a time when she felt loved and special. I just hope profoundly that I don’t communicate my impatience as clearly as my colleague did.
I can’t honestly say that the story took on a new glow when I heard it again, but I did realize that maybe Carol shares it with me because our interactions remind her of that time when she felt valued, and appreciated, with years of life yet to be lived and goals yet to be accomplished. Maybe I need to put more effort into helping her to recapture those feelings in her current relationships.
Realize that when someone relates an experience to you you’re hearing about it for a reason. Don’t just hear, listen.
Mary Languirand and Robert Bornstein are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, published by Newmarket Press. The second edition, revised and updated, was recently released. Here’s the link: http://www.newmarketpress.com/title.asp?id=901
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