Aging Dads: Incontinence Issues–Part 1 Older Men

incontinence-condition

Wanting to be inclusive, this follows last Saturday’s post about women’s incontinence and the New Guidelines for dealing with it. Interestingly, a current TV ad features a group of women mapping out where bathrooms are located, before presumably going out shopping–or for lunch. Then of course we hear about the product that will make that kind of planning unnecessary.

But what about men?

Although the high rise of incontinence is in women 75 and over, and the rise is less dramatic in men, incontinence–usually temporary (3-6 months)–is common following prostate surgery. Also as men age the sphincter muscle that controls urine outflow can weaken due to more and more years of use. Doctors recommend Kegel exercises for men (with varying degrees of success depending on different factors). I’ve selected informational links from what I consider reputable sources like Mayo Clinic, as this post is intended to provide some background information before speaking with a doctor if there are issues. It should not be construed as giving medical advice, however.

Links:
—Mayo Clinic has instructions for doing Kegel exercises: http://www.mayoclinic.org/healthy-living/mens-health/in-depth/kegel-exercises-for-men/art-20045074
—Webmd weighs in: http://www.webmd.com/urinary-incontinence-oab/kegel-exercises-treating-male-urinary-incontinence
—The NY Times blog also (July 2014)–Here it’s necessary to read to the end of the article to avoid missing important information: http://well.blogs.nytimes.com/2014/07/14/ pelvic-exercises-for-men-too/?_php=true&_type=blogs&_r=0

As we get older and dine out with friends, it’s not unusual to have men get up from the table to use the bathroom. It’s a part of aging. Enlarged prostate as well as prostate cancer become problematic for many older men. That’s why PSA monitoring is important– may be the equivalent of mammograms for women.

Included–as always–in the current US News’ 2014-2015 survey is “Urology,” ranking for the 4 best urology departments in the US (all scoring at least 91.2 to /100) as: Cleveland Clinic, Mayo Clinic-Rochester, Johns Hopkins and UCLA Medical Center respectively. This does not mean they have the best urologists for men’s incontinence; but it does mean these hospitals have excellent departments, if needed. Click for the list

Everyone of a certain age (boomers and older) must know men who have had surgery for prostate cancer. Whether using the DaVinci method or the traditional method, there will be some degree of incontinence for a limited time. An acquaintance is living with the same incontinence situation (following successful prostate surgery for cancer) as the person in Harvard’s Health publication–Prostate Knowledge. He is currently debating the surgery, as was the man in this very good article http://www.harvardprostateknowledge.org/a-patients-story-overcoming-incontinence#… an important read for any man who had prostate surgery and is left with incontinence issues.

We try to help parents age well. While incontinence isn’t usually an ordinary topic of conversation, understandings about it may prove helpful for many.

 

 

 

Aging Parents: Important New Guidelines Could Make it Easier for Those nearing Life’s End

DYING IN AMERICA AND HONORING INDIVIDUAL PREFERENCES NEAR THE END OF LIFE, with recommendations for major changes, was issued last week (9/17/14) by THE NATIONAL ACADEMY OF MEDICINE’S RESEARCH ARM, THE INSTITUTE OF MEDICINE. It suggests an overhaul of current practice at almost every level. (See “Newsworthy” 9/17/14 at right for NY Times report on the report.) 

Palliative Care is mentioned several times as an important aspect of the “overhaul” ideas. While we obviously can’t count on this recommended “overhaul” to take place immediately, it would seem that those not familiar with palliative care, would do well to check out specifics in the “Newsworthy” (right sidebar) 12/16/13 NPR Palliative Care broadcast–as well as “Related” below.

Palliative care is an available option that– if appropriate–could make a significant difference for caregivers and the comfort level of elders as we try to help parents age well….until the end.

Related: Post– Palliative Care and Hospice Both Help Aging Parents: Know the Difference.
                         An Oregon Health Sciences University Prof Weighs in, supporting the new Guidelines

 

 

Aging Women: Incontinence–and Diapers!?*

Just published: The American College of Physicians’ New Guidelines
re: women’s urinary incontinence–see 
Newsworthy at right–
triggers thoughts:

1.  An experience with Mother.
2.  One of this blog’s key thoughts: Is it better for parents or better for us (in this instance the caregiver)?
3.  A prejudice about the word “diapers” used in conjunction with old/older people’s incontinence.

Incontinence was never a problem for mother. But it was a concern of hers after hospitalization following a stroke that required a catheter. Her first outing after leaving the hospital, other than to a doctor’s appointment, was lunch with me at Marie Callendar’s. She needed to gain weight and loved their pies. All went well until the end of the meal when she said she needed to get to the bathroom fast. While it wasn’t far she was frail, walked cautiously, and as we got through the first door she said she didn’t think she’d make it to the stall. Mind over matter to the rescue?

(I was always fasciated by those people who could walk barefoot over hot coals. It was, I thought, an incredible example of mind over matter. I still think of it when I’m at the doctor’s or dentist’s and anticipate pain. What works for me is asking  her/him to talk to me about anything so my attention/mind is diverted from possible pain thoughts. [Surprising what you learn! I learned one doctor's wife was in my Teachers College counseling program, among other interesting things.])

I tried this diversion tactic with Mother, suggesting that in less than a minute she’d be in the stall, seated and wouldn’t feel embarrassed. Her mind was diverted; the plan worked. Result: she felt liberated–and confident about going out. Her preference to sit near the Ladies Room lasted a few weeks then was no longer an issue….until a year later.

After a bad fall in an unlit movie theater, and resulting hospitalization, Mother came home extremely frail and weak. Although Dad was at home and had a good mind, he was old. Mom needed caregivers 24/7 for an extended period. My only request from the newly-hired, highly-recommended caregiver was that Mother get appropriate exercise, which included walking to the bathroom and back since she had no bathroom issues. I figured Dad could take care of the rest. I came back to NY, confident that things were moving forward nicely.

A month later I flew back at night to see my parents. The night caregiver “tattled.” The day caregiver (who hired the others) was using “diapers” on Mother. Made it easier for this caregiver, but was unnecessary for Mother. Saying I just happened to find  “pull-ups” in the closet, took the night caregiver off the hook and made beginning the conversation I needed to have with the day caregiver easier.

Incontinence is embarrassing enough without having people use the word “diapers” or deciding a person needs them because it means less work for the caregiver.  And wouldn’t “pull-ups” be a more respectful term than “diapers”–simply because it’s not equated with being a helpless infant?

The American College of Physicians’ new guidelines for dealing with female urinary incontinence stress trying normal (pill-free and lifestyle changes) solutions first. Doesn’t maintaining feelings of normalcy help parents–and everyone–age well?
*             *            *

Note: “Urinary incontinence (UI), the involuntary loss of urine, has a prevalence of approximately 25% in young women (aged 14 to 21 years) (1), 44% to 57% in middle-aged and postmenopausal women (aged 40 to 60 years) (2), and 75% in elderly women (aged ≥75 years)” ACP

Related: For the Guidelines as published by the ACP, click this link or link in last paragraph. They’re easily understandable and the helpfulness of the exercises is clear.

The recommended Kegel exercises–courtesy Mayo Clinic (there’s also a link within the Newsworthy article).

 

Aging Parents: 101st birthday

Birthday card from the staff

R reading birthday card from the staff

We stick to our philosophy. We do what aging parents want as long as it doesn’t threaten life and limb and they still have, what Sr. Advisor R calls, “a good head.” R’s birthday was Saturday…her 101st. She didn’t like our original suggestion, thinking our plan of going to La Jolla overnight (which she loved when she was in her ’90’s–she spent summers there in the ’40’s)) would be too strenuous.

Thus, we follow the advice in last year’s post: Celebrating Elders Birthdays: What They Want, Not What We Want. R initially suggested a short drive to the mountains with lunch at a hotel she likes; but she changed her mind saying she didn’t have the energy. Next choice was the club she likes–where she has celebrated past birthdays and the staff knows her. She wanted to make the reservation for just the 3 of us and specify the table she wanted. Plan in place.

The morning of her birthday was not a happy one. Possibly she felt burdened by the responsibility unfolding–the abundance of cards and the phone calls–not to mention things (2 cakes, stew, cookies, flowers), that will require a thank you note. She keeps a list, still thinking she must send a thank you for each one. Old habits die slowly but she decided she would not write notes for local phone calls. She had over 30 remembrances when I spoke to her mid-morning.

Well-wishers’ phone calls made it difficult to get her on the phone. When I finally did, in addition to hearing about the cards and gifts, she had complaints: she’d lost her appetite, nothing was tasting good, she had no energy. When she spoke with her son, my husband (who called from the golf course unbeknownst to me), he heard the same thing. According to him, his response was something like: “you can do whatever you want; whatever you want is fine with us. It’s your birthday and your decision.” 

R was raised to be disciplined. I think that includes “don’t disappoint people” and was the only reason she followed through and was ready when we came to pick her up for dinner.

Our waitress remembered her (as does everyone, it seems). She said and did all the right things. A birthday card from the staff accompanied her cake (pic above). People at the next table hearing it was her 101st birthday (pic below) began a conversation. First, the man sitting nearest, then one of the women left her seat, and came and asked R her aging secret.

Answer: she eats healthy and equally important exercises every day. She may have disappointed the woman by graciously responding to a second question, saying she never drank much, adding she never really liked the taste.

By the time we left evidently everyone had gotten word of her birthday because she received congratulations from many strangers as she walked by their tables. (FYI: R walks with a cane and took the arm of her son–only uses her walker in the house to move things that could throw her off balance if she carried them [eg. pitcher of water to water her plants]).

R not only regained her appetite, she was energized and (as usual) very talkative. While my husband was outside getting the car, R sat inside on one of the chairs near the door. I had stopped briefly. By the time I reached the entry the new young woman who greets guests had left her position behind a desk and was sitting next to R, having an intense conversation. No surprise. People are drawn to her like a magnet. First by her age, I think; then her wisdom and empathy capture them.

I’ve always thought jump-starts are important for older people and adult children should be proactive in this regard. This small birthday celebration shows what a jump-start can do. We take no credit; R made the decision to stick with the plan. Had we insisted, would the result have been the same?

 


Check out: “Newsworthy” (right sidebar). Links to timely information and research from top universities,

plus some fun stuff–to help parents age well.

 

R’s 101st BIRTHDAY TODAY

We had the small birthday dinner R requested at her favorite place. Early in the day we got the feeling R really didn’t want to go out, Her mood was clearly not upbeat. That said, she has always been a disciplined person and I guess decided she needed to be a good sport and take the time and go to all the trouble of getting dressed up and putting on her make-up–not easy at 101. 101 BIRTHDATShe said her phone rang all day–I can vouch for that having tried to telephone her. She knew she’d need a nap since she tires so easily, and said she stopped answering the phone in the afternoon so she could rest. We were concerned about how the evening would work out. This photo may give a hint. But details must wait until tomorrow….probably after we fly back to New York. Every day we learn more about helping parents age well. Until tomorrow….

Aging Parents: Making Memories for Older People

 

Sharing with SantaMemories are part of our being. They allow us to momentarily recapture ourDad's 90th youth, milestone events, surprises large and small and so much more. If “Time Takes  All But Memories” (see August post) from elders who’ve lost spouses, good health, friends, family etc., can we supply happy memories for them–as well as for aging parents and the older people we care about?

Five suggestions

1. Momentarily recapturing youth: What immediately comes to mind is celebrating a lady’s 100th birthday with lunch at a bar. (She died at 104.) I’m quite certain she never forgot that lunch, nor have I.

What made it memorable? Doing something no longer normal, that was once an enjoyable, normal part of her life.

Going to a bar is a normal occurrence for younger people. Not for the elderly. Normal for us, can be new and invigorating or exciting for the elderly. The fact that two strangers–young guys–sent drinks to our table in honor of her birthday, thrilled her. (I couldn’t have staged that; if I could have, believe me I would have.) Can telling the wait staff how old your guest is produce something extra special?

2. Doing something that’s “today” could be a special event that comes to town; an outing to something contemporary that you go to together; something that elders know about, but may not have experienced, or an ordinary occurrence that wasn’t ordinary in their day.

That said, I remember Sr. Advisor R telling us on the phone (we’re far-away-living adult children) when some younger friends (then in their 40’s and 50’s; R was in her 80’s), took her to a gay bar one night. R has always had a worldly view of life, which includes staying up to date on what’s going on.

Picnic by the ocean: Mother (79) and me

Picnic by the ocean: Mother (79) and me

3.  Family togetherness: may produce the best memories for aging parents. Don’t we, in fact, remember special times with family?

It could be a holiday or a gathering when all children and grandchildren are together. Interestingly we can amass all family members from near and far for the funeral, so why not do it while aging parents/grandparents are able to enjoy it and the memories it leaves?

4.  Reunions and visitations from meaningful people in elders’ lives: Can we provide the occasion for childhood friends, buddies from military service, and old friends to be reconnect, share past memories and possibly create new ones?

5. A collage of photos: Actual photos may be confined to those of Ansel Adams and the like in museums–in another generation. Today, however, we still have photos of special times (often stored in boxes).

Can’t those who do crafts, make a collage of photos and put them in a picture frame as large as an older person’s empty wall permits? It captures memories that can be relived over and over and over.

With hopes that the above contributes towards our goal of helping parents age well until the end.

“Noteworthy” (right sidebar) links to timely information and research from top universities,
plus some fun stuff–to help parents age well.