Boomers Rock

Boomers Rock Radio Podcast

Host: Tom Matt interviews Dr. Deborah Heiser about Motivation and Depression

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The Fountain of Youth?

The Fountain of Youth?

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The Importance of Creativity in Old Age

The Importance of Creativity in Old Age

BLOGGER:  Michael Friedman

“I have two driving forces in my life — to be creative and to be helpful. If I had to choose one, I would choose to be helpful.”

Bernie Kessler — a retired psychologist and an active, avid, very skilled photographer and photography teacher — said this to me recently when we got together during his recovery from heart surgery and the infections and subsequent surgeries that nearly killed him after the original “successful” surgery. Bernie is 84. He knows he will not live forever. But he also said, “I am not depressed. I am grateful to be alive.”

Creative and helpful! An important insight, it seems to me.

Of course, any pair of key components of living well is bound to be too simplistic; there’s always more to it. But sometimes simplistic insights are illuminating. Freud, for example, identified love and work as the fundamental goals of human life. That rings true. But for those of us who are older, particularly for those of us who are aware that death is closing in, finding ways to shape and to express ourselves through artistic and other creative processes, and finding ways to pass on what we know to the generations of our children and our grandchildren, are increasingly important.

It is not that love and work become irrelevant to older people. They do not. But something happens as we become older that changes the nature of intimacy and changes our long-term ambitions. Love and work become a bit less central. Articulating ourselves and leaving a legacy become, or can become, as Bernie put it, our “driving forces.”

Bernie, of course, is an unusual person. He is highly educated, financially successful enough to be able to live comfortably and married to a caring woman for 63 years. He has a daughter who shares his interest in photography and visits regularly, a network of friends who have been there for him during this very difficult time and connections with several arts organizations where he has exhibited and taught regularly. For him, being creative and being helpful are possible.

What about those who may not have creative talents, who may seem to have nothing to teach, who spent their lives doing jobs they hated, who barely have enough to live on, whose families are not intact, who have few friends or who are not connected with community organizations?

If their isolation is extreme, old age is likely to be terrible. But most people have something to contribute to their families and communities, and most people have interests they can cultivate. Yes, some people create and some appreciate, but appreciation of the excellence of others is an opportunity for expertise that is satisfying in itself and can be passed on. Knowing batting averages, the plots and characters of TV shows, which celebrities are doing what with whom, the results of political polls — all of these are opportunities for personal development and to share knowledge. And virtually everyone is able to share their history, which is a great service to younger people smart enough to be interested.

The American society is wonderfully diverse, with a highly-developed sector of organizations that reflect the beliefs and interests of people from a multitude of backgrounds and life experience. Participation in these community groups, whether religious, cultural, recreational or political creates opportunities to cultivate new skills (including creative skills), to make a contribution and to leave a legacy. You don’t have to be a Bernie Kessler — a person of creative brilliance — to find the satisfactions of creativity and helpfulness in old age.

But Bernie is instructive, because even in the aftermath of illnesses that nearly killed him and have left him visibly weakened, he has lifted his art to a new level. While I was visiting with him, he showed me photographs he is readying for a new show. It is called “Silent Places,” and the photographs are simple black and white renditions of furniture in otherwise empty rooms. They are stark, without visual flamboyance, but filled with a sense of transcendent meaning that takes us beyond their visual surface. This work captures, I think, what the philosopher of art Arthur Danto has called “the transfiguration of the commonplace.”

Bernie’s new photographs are mature work that he probably could not have done when he was younger, despite the considerable beauty of the work he has produced over the years. I don’t mean to suggest that young people cannot produce works of transcendent meaning. Obviously they can and do. I only mean to suggest there are new opportunities for creativity and self-definition in old age.

Bernie Kessler is just one illustration of the possibility of new discovery and of the cultivation of a meaningful legacy in the final stage of life.

 

Should I Defrag My SSD?

Video Blogger:  Jacob “The Wizard” Heiser

This video explains why you should not defragment Solid State Drives.  Jacob Heiser talks about how an SSD works and how a defragmentation effects your performance.

Can Caring for Others Affect Depression?

Can Caring for Others Affect Depression – Dr. Drew – CNN

Dementia Caregivers: How to Build Meaningful Relationships

Dementia Caregivers: How to Build Meaningful Relationships in Spite of Memory Loss

BLOGGER: Michael B. Friedman, LMSW and John Zeisel, Ph.D.

Being the caregiver for someone you love who is gradually losing mental capacities is about as tough as it gets in human life outside of wars, disasters and profound poverty. Parents who were once your source of nurturing and knowledge; who worked hard to take care of their family; who had interests in politics, religion, sports, movies, celebrities and more; who had fun with their friends; who may have been among the best in their field. Parents who lose their mastery and become unable to manage their own affairs or to care for themselves in the most basic ways — parents who become dependent on you to take care of these things for them — can be, and often are, a source of great sadness.

Spouses and lovers who were your soul mates, your partners in life, the people with whom you shared your most important, moving, pleasurable and challenging moments — spouses who gradually lose their capacity to be with you as companions and confidantes can also be a source of great sadness.

On top of this, the time, energy and resources that it takes to be the primary caregiver for these people who are so important to you, can sap your own strength. You can feel that it is more than you can stand.

What can help?[1]^{, [2]}

Changing your expectations of the person with declining cognitive capacities can make a big difference, helping you to be less frustrated and irritated by his or her inability to do what they once could and especially to be with you in the way they once were.

Focusing less on the past and on a wished-for future can make it possible to connect emotionally in a new way and to get the most out of the moments you have together. Our relationships are often oriented toward a collective future: retiring together, traveling together, getting old together. It can be daunting to maintain a relationship that does not have the kind of future we always assumed it would.  But it is not impossible to have relationships in the moment that are emotionally satisfying even if we are terribly sad about what they, and we together, have lost.

Understanding that the person we love is still there, despite their inability to access memories without help, can also make a difference. Reminiscing together — even if it is mostly one-sided — can be a gratifying experience, especially when the person’s eyes light up with recognition. Talking about and engaging in old interests, listening to favorite music, going to a baseball game or even getting the feel of it on TV, watching old movies, taking a walk in the old neighborhood — all these can be sources of satisfaction in the moment. Even if the explicit memory of these experiences slips away because of the complex ways in which dementia affects the brain, the emotional connections remain.

Discovering the possibility of being together in silence can be deeply moving and meaningful as well. When we put aside our dashed dreams long enough to be open to the rich emotions alive in that silence, just being together can release an unspoken emotional exchange.

But what about the really difficult times? Dad has wandered away again. Is he safe? Mom says she doesn’t recognize you and yells for the police when you visit. Your wife curses you for cheating on her. Your husband demands sex with the home health aide. Your friend seems lost in himself and does not respond to your presence at all. What can you do?

There is no magic wand guaranteed to make bad times go away. Even if by changing our own behavior we reduce their anxiety and agitation, sometimes the people we care about remain disengaged. Some people’s disappointments and angers run so deep that moments of peaceful, loving exchange seem impossible. Some of us who are caregivers can’t stand another minute.

But these terrible times do not beset all people all the time, not by a long shot. It may seem impossible for the person you care about to get meaningful satisfaction out of a life so different from the life she or he lived before cognitive decline. It may seem impossible to have a meaningful and satisfying relationship with a parent, a spouse, a partner or a friend with whom you can no longer have in-depth conversations. It may seem that they cannot possibly find life worth living.

But a great many can. People with significant cognitive limits can get satisfaction out of life, and it is possible for us to have meaningful relationships with them — if we learn to shift what we want and expect from them, see the person who is still inside, and develop the capacity to live in the emotional moment.

(Michael Friedman is Adjunct Associate Professor at Columbia University’s schools of social work and public health.  John Zeisel, Ph.D., who is Founder and President of The I’m Still Here Foundation and of Hearthstone Alzheimer Care.)

 

Don’t Just Blame Dementia

Don’t Just Blame Dementia

BLOGGER: Michael B. Friedman, LMSW

After a person has been diagnosed with Alzheimer’s disease or other dementia, subsequent emotional, mental, cognitive, and behavioral problems are usually blamed on the disease.  Other possible reasons including behavioral disorders such as depression, anxiety, or substance abuse or ordinary human reactions to tough realities are very often ignored.

“Grandma seems terribly sad.”
“  Of course, she has Alzheimer’s”
“Grandpa has been nasty lately“.
“It’s the Alzheimer’s.
“  Uncle John doesn’t enjoy life anymore.”
“  Who would?  He has dementia.”
“  Mom isn’t eating much or isn’t taking her pills or isn’t getting any exercise.”
“It must be the Alzheimer’s”.

Not necessarily.  In fact, blaming dementia very often gets in the way of understanding what is really going on and doing something about it that will help.

If there were a pill that would reverse, stop, or — better yet — cure Alzheimer’s, it might be useful to understand the emotional and behavioral problems of people with dementia solely in terms of the disease.  But the best pills available now only delay the unavoidable decline in memory and other cognitive functions.  That’s worth doing, of course, for the people for whom the pills work.  But counting on the doctor to come up with medicine that will make a big difference usually is disappointing.

People with dementia experience many of the same emotions as people without dementia, but they are at higher risk than older adults without dementia for diagnosable mood and anxiety disorders, both of which can result in declines in cognitive functioning that are similar to the decline associated with dementia.

Unlike dementia, however, depression and anxiety can be treated effectively; and if they are, the loss of cognitive functioning that is caused by these disorders can be reversed.  To be clear, treating depression and/or anxiety does not reverse dementia and the loss of cognitive functioning caused by dementia.  But effective treatment for mood or anxiety disorders can result in overall improvement of functioning that can make a very big difference in a person’s life.

These days, of course, the first line of response to depression and anxiety is medication.  However wise that is for people without dementia, it is unwise for those with dementia.  Medication can be helpful, but it can also be dangerous.  At the very least, doses must usually be lower than for younger adults.

Better is to begin with interventions that do not rely on medications.  Some formal psychotherapies can be helpful, such as “cognitive-behavior” and “interpersonal” therapy.  Exercise, interesting activities, and social contact with people they enjoy can also be extremely helpful.

Most important is to understand (1) that people with dementia are adults with meaningful life histories, personal interests, individual desires, and a need for dignity and respect and (2) that behavioral “problems” are to a significant extent in the eye of the beholder.  People with greater understanding and tolerance of behavior, that most people find trying, are generally better able to help people with dementia to get the most out of life.

I don’t mean to make this sound easy.  Some people with dementia are so profoundly sad and lost in themselves that they may be impossible to reach.  Some people are “scared to death” by the slightest change in routine.  Some people completely deny that they have any need for help.  Some people are abusive towards anyone who tries to help them, evoking responses in kind from many — if not most — of us.

But many people could be helped to overcome emotional problems that co-occur with, but are not caused by, dementia.

In an ideal world everyone with dementia would be able to get a sophisticated assessment to distinguish between the effects of dementia and other disorders and then to get the treatment that would be most likely to be effective.  But in the real world there is a terrible shortage of physicians who understand the subtle differences between dementia and depression and other disorders.  In the real world there is a terrible shortage of geriatric psychiatrists and other mental health professionals.  And in the real world, paid and family caregivers usually do not get training and support to help them be more skillful with and tolerant of the people they care for.

Our nation needs major changes in policy to address these shortfalls.  In the meantime, however, we need to understand that there are ordinary emotional causes for the sadness, disengagement, and anger experienced by so many people with dementia and that we caregivers can do much to meet human needs often neglected because of a frightening diagnosis.

Grandma is sad?  Grandpa is nasty?  Maybe they are clinically depressed and could benefit from treatment.  Maybe she’s lonely and he feels he’s being treated like a child.  Maybe it’s something else.  But be careful not to jump to the conclusion that it’s because of the dementia.

 

Is Melancholy an Inevitable Outcome of Getting Old?

Elderly Depression: Is Melancholy an Inevitable Outcome of Getting Old?

BLOGGERS: Michael B. Friedman, LMSW and Lisa Furst, LMSW

Depression is dangerous and one of the most significant impediments to aging well.

People with depression[i] usually experience a profound sadness and sense of hopelessness that goes far beyond ordinary unhappiness.  They often experience terrible psychic pain, which some people report is harder to bear than severe physical pain.

People with depression often experience a profound disinterest in life.  What has made them happy and kept them vibrant no longer does.  Life may have no meaning for them.

People with depression often find it difficult to carry on ordinary life functions.  They may have trouble sleeping or sleep too much.  They may have no interest in food or may stuff themselves in futile efforts to counter their bad mood.  They may find it difficult to concentrate on work, day-to-day tasks, or social interaction.  They may ruminate about relatively minor matters and be unable to make a decision or forgive themselves for errors or discourtesies.  They may feel that doing anything takes too great an effort.  They may always expect the worst and give up without trying.  They may be angry much of the time, easily irritated by small aggravations.  They may often think about death, even about taking their own lives.

People with depression have lower life expectancy than those without.  The combination of depression and a serious, chronic physical illness, such as diabetes and heart disease, results in greater risks for disability and premature death than for people with the same physical conditions without depression.[ii]

People with depression are also more likely to be socially isolated and caught in a vicious cycle in which depression feeds isolation and isolation feeds depression[iii].

Most people who complete suicide are depressed.[iv] And the sense of hopelessness inherent in depression makes many people reluctant to seek or accept help.

Obviously, depression makes it hard to live well at any age, including old age.

The good news for older adults is that, contrary to common belief, depression is not a normal or inevitable outcome of aging.  But the ageist expectation that it is frequently results in failure to take steps to overcome it.  ”There’s nothing to be done.  They’re just old.”  This attitude too often robs older people of opportunities to enjoy life.

In fact, each year major depressive disorder affects fewer than 5 percent of adults 65 or older who live in the community.[v] The rate is higher among older adults with serious chronic health conditions, those who need home health care and those who are institutionalized.

A much higher proportion of older adults who live in the community — perhaps 20 percent — experience symptoms and forms of mood disorders, such as dysthymia or sub-syndromal depression[vi], that are not as severe as major depressive disorder but may have nearly as much negative impact[vii].

So, a significant proportion of older adults suffers from depression.  But, it is important to note, 75 to 80 percent of older adults do not experience depression in any given year.  Depression — to say it again — is not normal in old age, an encouraging fact for those who may feel hopeless about their lives.

Depression often can be treated effectively or overcome through other means such as meaningful relationships, activities, or spiritual experience.  Unfortunately, it often goes unrecognized.

One reason for this is that it may not look like “depression”.  Frequently, it is expressed through physical symptoms such as headaches, “stomach” problems, aches and pains, fatigue or insomnia.

Depression also can be hard to recognize because it does not necessarily involve having a depressed mood.  There are two “cardinal” symptoms of major depressive disorder — profound sadness for two weeks or more and loss of interest and pleasure in activities that have had the greatest personal meaning.  It is necessary to have one, but not both, of these symptoms to be diagnosed with major depression.  It may seem strange, but there is depression without sadness[viii].

In older adults, depression may be missed because it involves cognitive difficulties that get diagnosed as dementia.  This common misdiagnosis is terribly unfortunate because successful treatment of depression can restore cognitive capacities that have been lost due to depression — even in people with dementia.[ix]

Finally, depression can be hard to spot because many people with depression are able to hide it.  From the outside they may seem unchanged, even though they may be suffering terribly on the inside.

So depression is dangerous, and it often goes unrecognized and untreated, depriving older adults of opportunities to get the most out of life.  What can be done about this?  We will address this question in our next post.

In the meantime, if you or someone you care about needs help, call 1-800-273-TALK.

And to find a geriatric psychiatrist in your area, refer to the website of the Geriatric Mental Health Foundation, http://www.gmhfonline.org/gmhf/find.asp.

This article was co-authored with Lisa Furst, L.M.S.W., Director of the Training and Technical Assistance Center of The Geriatric Mental Health Alliance of New York and co-author of  Depressed Older Adults: Education and Screening

75 Year-Old Woman Gets Breast Implants

 

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