Still not completely back~however…

 

While “must-do” and “don’t know how to do” have prevented my planned return via “INCHING TOWARDS EIGHTY,” I return here to wish all who are continuing to follow, a very MERRY CHRISTMAS and a HAPPYand hopefully much more stable and peaceful—2019.

Simplifying Helps People Age Better

As we inch towards 80–a new normal for me is attempted, taken from the late Sr. Advisor R’s “SIMPLIFY, SIMPLIFY, SIMPLIFY.”  Admittedly I don’t get an A+. That said, after trauma, overload etc. it makes sense to be conscious of ratcheting down…simplifying.

When on overload, it’s difficult. It involves decisions: what must be done and how to do it efficiently. Reconnecting at holiday time this year— after a 2-year absence since my husband died—topped my to-do list.

I was going away. Armed with address list, boxes of cards and stamps, in addition to the normal necessities, I headed to the DC area. Perhaps the break, getting out of the routine, contributed to clearer thinking. In any event, I take out the address lists, look at the quantity of people, and think “options:”

1. Computer-generated letter: print, fold, sign, address envelope, lick stamp…perhaps more personal and informative than a card, but as time-consuming.

2.  Emailed cards: Subscribers (I’m one at Jacquie Lawson) have loads of choices and the attractive holiday note cards allow for short or long personal messages. Some people prefer a card that can be held and displayed (I’m usually one). But the red and gold e-note-card prevailed. My unexpected reward came via the reply card that accompanies the e-card. I received many notes back—heartwarming and interesting, especially for someone who has been “out of the loop” and that includes so many older people.

Whether snail mail or email connecting at holidays enriches life. Doesn’t that help all ages feel good? And shouldn’t that help parents and us age better–if not–well.

Note: This blog still takes no ads. The link to JL is to get an idea of e-card offerings.

Aging Parents: How One Elder Lived Independently, Alone and Well To 101–Part 1

Aging Alone and Well. Defying the Statistics

“Do you like being alone?”  This question begins A Solitary Life Carries Risk” in the NY Times Well” sectionI’d saved it since March. While it’s aimed at us, based on research following around 3.4 million people over 7 years, it concludes “Although living alone can offer conveniences and advantages for an individual, physical health is not among them.” Indeed the lead researcher says  “Social isolation significantly predicts risk for premature mortality comparable to other well established risk factors.”

If married or with a partner, it’s inevitable one of us will be left alone. How did Sr. Advisor R, who lived alone since being widowed at 50, defy these sobering statistics? A simplistic answer could be that she maintained social connections, which all studies have found is important in aging well. That said, here’s the additional–

 Good genes and a smart, disciplined lifestyle

 At 100 all doctors said R was in amazingly good health for her age. To achieve that she took ownership of her life. This included:

Valuing “Alone.” Making it Work

While emphasizing the mortality risks that accompany living alone, the research recognized that “living alone can offer conveniences and advantages.” R was smart and creative enough (she called it “common sense”) to have both by compensating for age-related losses/changes. Examples:

  • reworking how to do things to save her energy (ie. shaking the salad greens with dressing in a plastic bag, thus not having to wash extra dishes–she didn’t use a dishwasher).
  • leaving note pads in each room with reminders (so she wouldn’t forget what she came in for)
  • putting a to-do list on the desk in her bedroom so she’d see it first thing
  • having a list of important phone numbers (friends, service people) on that desk
  • having 3 conveniently-located phones (bedroom, kitchen, den)
  • having a contractor-friend make adjustments as needed (eg.grab bars) in bathrooms

Combatting Social Isolation

As long as I knew her, R said she enjoyed her own company, treasuring the alone-days (stay-at-home days, she never drove) when she could do as she pleased. Late in life it was her major argument/defense against having any “help” except her cleaning woman in her home for 4 hours once a week. She increased that help to twice a week the last months of her life.

So how does one who values solitude fight becoming “obsolete” (a friend’s description) and remain engaged until the end? It would seem to be accomplished by:

  • the genuine interest and generosity shown towards others during her younger years–repaid by those whose lives she touched, in many thoughtful ways later on.
  • a strong will to stay engaged
  • knowing–or having cultivated friendships with–younger people (beyond family) who understand the importance of doing (and how to do) what’s better for the elder, not what’s easier for them.
  • taking the initiative, inviting others to go out (they drove) to lunch, a movie, lectures etc. R recalled when her husband died. Her social life dwindled. She realized if she didn’t take the initiative she would be sitting home, alone.

Social isolation, so common to many who live decades without a spouse–no problem! Is that incredible since–through choice–R never drove. She was happy to be a passenger. That said, Diane Ackerman’s well-known quoteI don’t want to be a passenger in my own life, seems to have been a guiding principle. R valued being in control of her life. She decided what she wanted to do and how she did it.

To be continued on Saturday with Staying Connected and Our Role in Combatting Social Isolation. We will hopefully be back in NY, having finished the majority of our work here. 

Check out “Newsworthy” (right sidebar). Links to timely tips, information and research from top universities and respected professionals–to help parents age well.

Aging Independently and Well Over Decades–10 How-to’s

“As we live our lives, we write our own destiny” Sr. Advisor R 

Sr. Advisor R,, my mil, was a poster child for aging independently, unselfishly and well. She said, to the extent she could, she’d done everything; helped everyone; and given to those she wanted to give. She was ready to go. It was no secret. And I’ve been thinking–since her timely death last week at 101–about how she managed life so well.

R lived by the following:   

 1.Take care of yourself (or you won’t be able to take care of anything else).
2. Be responsible
3. Don’t abuse yourself. (You get enough from the outside)
4. Know when to say “no.”
5. Simplify (as you age)
6. Don’t assume (you can be wrong; it causes unnecessary problems)
7. Don’t expect anything and you won’t be disappointed
8. Concentrate. (If your hands are doing one thing while your head is thinking another, you forget where you put things.)
9. Remember life is good–it’s the people who mess it up.
10.To bring joy in today’s world there are three things you can count on: animals, flowers, music.

Elaboration

1.  The African proverb “It Takes a Village to Raise a Child” resonates loudest. It may sound like an oxymoron. R was clearly not a child and independence was her highest priority. Making it easier for other family members was a necessity in childhood and became part of her being. She was smart–smart enough to know she couldn’t help others without taking care of herself first. At a very young age she was part of the village. Later the village gave back.

2.  “You’ve got to be responsible,” R vividly remembers her father saying when she was 4. It had a huge impact and she acted accordingly.  She recalled their quarantined home during an epidemic, an older sister’s death, another sibling’s health issues, the Great Depression, WWII, being a caregiver for close family and friends. Everyone knew R was 100% responsable. It was who she was.

3.  R’s home was the buffer for any outside abuse. She made it tranquil, lovely and loved–a place to gain strength and renewal. Widowed at 50, she didn’t indulge in activities that would be bad for her. This doesn’t mean she didn’t overdo in certain areas, but she had the discipline to know when she’d overdone and compensated as appropriate. She treated herself to things that brought joy or made life easier. Her easy-care plants symbolized life and joy thus, she replaced and watered them as needed until the week she died–not easy at 101.

4.  R taught us early there was nothing wrong with saying “no” and “I don’t know.” Simply  because someone asks, doesn’t mean we are obligated give the answer we think they want. (This doesn’t make us selfish. It makes us real–my opinion…and we can be very nice while being real.)

5.  Normal age-related changes slow us down. Simplifying allows us to continue life as we’ve known/enjoyed it. Examples:
–R’s many house plants decreased in number and care requirements as she aged. She gave many away and concentrated on the easy-care ones.
–While she went out every day in her younger years, she reduced to only one activity a day, then going out every other day. The last few months she only went out for doctors’ appointments.
–Still making her own meals, R realized she could save dish-washing by putting Trader Joe’s chopped salad greens along with salad dressing in a zip-lock bag, giving it a good shake, and spilling it out onto the plate with her dinner.

6.  Don’t assume. See #6 above. This is so true. Test it!

7.  Don’t expect. See #8 above. Seems jaded, but saves disappointment.

8.  How many times have we forgotten where we put something because our hand did one thing while our mind was on something else? We weren’t concentrating. Shortly after R was widowed she lost something important. She couldn’t remember where she put it. Without anyone to ask for help, R promised herself, from then on, she would never again lose things due to lack of concentration.

9 and 10 above: Life, animals, flowers and music–thoughts R kept front and center as she encountered the challenges of living.

In recent years R acknowledged that she did everything she felt important to do; helped everyone she’d wanted to help, and given what she could to specific charities that served a larger need-base of people and pets. She had significantly contributed to the village.

Since R’s only-child son and I live 2,000 miles away, the village–basically two wonderful neighboring women, Pam and Barb, and a nephew and his wife–made it possible, on a daily basis, for R to continue to live in her own home–with only a cleaning woman working half a day and a gardener. What better “assisted living” could anyone ask for! R had unfailingly done for them over the years and they could never do enough. R was a giver; never wanted to be a taker. In the end, what comes around, goes around.

Check out “Newsworthy” (right sidebar). Links to timely tips, information and research from top universities and respected professionals–to help parents age well.

Aging Parents: Is It Better To Have A Friend Be Your Doctor?

January 20th’s NY Times, Science Section’s “Hard Cases” column, Too Close to a Patient for Comfortmakes the case, based on AMA guidelines and other sources, that objectivity in medical care may be compromised by doctor-friends. “Medical care supplied by a relative — or an old friend, or a trusted employee — just seems so logical. After all, who could care for you more? But that is just the problem…”

The article triggered 2 thoughts and a dilemma:

1. When I was too young to know about medicine, I remember hearing that a doctor could not do surgery on a family member. Might have been true—or not. A playmate was having surgery. She was 9.

2. In graduate school, the professor in “Techniques of Counseling” gave us a practical list of counseling do’s and don’ts followed by his saying something like: “Be forewarned: if you’re trying to counsel a family member, your emotions will dictate and you may forget this.”

If the emotional ties of friendship can interfere with doctors’ objectivity, how do we reconcile this when it comes to helping aging parents, the elders we care about, and ourselves?

Boomers and those older, remember doctors who knew your family, possibly made house calls, and definitely made hospital visits. It was more “warm and fuzzy” then. Today’s efficiencies, however, dictate something entirely different.

I hear people say “It’s not the doctor’s “bedside manner” that matters. Agree. Knowledge and expertise are most important. But it helps if we feel s/he cares about us, doesn’t it?

Three people immediately come to mind. They don’t have friends as their doctors; yet they’re confident in their doctor’s ability to is do what’s best for them and they feel a certain bond–perhaps a professional-type friendship. Another commonality: they make every effort to take care of themselves to the best of their ability. It appears doctors appreciate this.

1. Several weeks ago I reconnected with a friend, living in a large city in the west with excellent healthcare available. I was unaware that she has a serious, unusual vision problem. Asking about her doctor, she related she did the research and now has the best doctor–adding she was concerned that, because she’s now on Medicare, it would be a challenge finding a doctor who would take her. Then she said, laughingly, something like “When we met he told me he isn’t taking new patients, but I’m ‘vibrant’ so he’s making an exception.”

2. Sr. Advisor R, at 101, has obviously had many doctors over the years. This last year a new best ophthalmologist  (taking few new patients) has been doing his best to maintain her sight, which was rapidly worsening.

She was initially concerned that he thought “She’s old, I can’t do much.” R made him realize she takes very good care of herself (corroborated by the lab tests her primary care doctor sent), lives in her home by herself, and will do everything possible to maintain her independence. He, like her other doctors, respects that–and her. For several months there was no improvement. 12 weeks ago there was slight improvement in one eye. I drove her to her last appointment and there was even more improvement in that eye. The doctor was cautiously optimistic; said to be sure to call immediately if she noted any change–not to wait for her next appointment. He wasn’t a friend but he cared. R’s spirits lifted.

3. Next I check with my friend of decades, who had polio as a child. In her mid-70’s, she has seen countless doctors who were not friends. “Confidence in them,” she says, is a must or she finds a new doctor. She has made changes over the years, as allowed in her health plan.

And we learn a tip–

She writes thank you notes after each appointment. The notes aren’t a hidden agenda to make them like her, she says, but actually to let them know that she’s very appreciative of their help. In addition, reading her note must make them think about her again after her visit. “It puts you on a level that most patients aren’t on,” she says.

A tip for us personally? And for those we care for and about. .

 

Related: New England Journal of Medicine‘s May 2014: Ethical Challenges in Treating Friends and Family..

Choosing the Best Walker–101-year-old, Aging in Place: Mobility Continues 4 years After Broken Hip Surgery

The “Best” Walker is the Right Walker
(and can change as needs change)

The right cane and the right walker empower elders, enabling them to continue their routines as before. Reduced mobility, on the other hand, is obviously not empowering, creates neediness, and can lead to less contacts with others–not helpful in aging well independently and not helpful to us if we’re caring adult children.

Having the right “tools” makes everything easier–for any situation actually. (Learned this in a “Home Repair” course; found it a truism.) It’s not rocket science that an easy-to-use, dependable walker is the right “tool” to continue mobility and an active life.

But do we realize that the first walker purchased may not be the ultimate walker? Here’s why–

1. We often select quickly (possibly the one used in rehab).
2. We often select the least expensive.
3. Subsequent factors, like balance and aging parent stability may lead to buying a studier walker.

We see many people using light weight walkers with 4 legs, tennis balls or skis on the back legs. Click link to physical therapists’ video before purchasing. It discusses important limitations (ie. light weight compromises stability. It must be picked up every time a step is taken). The research, time and money to purchase a walker that fits needs and gives parents’ confidence is well-spent.

Our first trip to the surgical supply store after R’s release from rehab yielded two walkers: a basic one with front wheels and skis on back legs, and a more expensive, heavier walker with wheels, skis on back legs and a basket/seat (which she never used).

R used the basic walker in the house…until her cane arrived three days later. Basic walker went into the garage. R says once you’ve fallen you need to feel safe when you walk. Ever since rehab, her cane has given her complete confidence to walk…until a year ago. Then serious vision problems began  affecting her balance and confidence. “Bit by bit, then more and more” she used that basic walker from the garage. Last spring she needed a new walker.

Why and how it’s used–

R wanted a tray attached to her walker, but her walker wasn’t compatible with existing ones. Thus, a new walker, with tray, was purchased . According to R it’s less wide (thus more comfortable), very sturdy and weighs less. The skis on the back legs and wheels on the front work fine on carpets. R only uses it in the house. When she goes out she always uses her cane. She feels safe with that.

She switched to her current walker, this Guardian Signature walker plus extras: the front wheels (attachments): $66.75; the back legs’ ski glides: $15; attached fold-down tray: $39.95. 2014 total: $131.80 

While not covered by Medicare, it’s “worth every penny,” according to her. (She still does her own finances.)

The tray is used daily–for moving food from oven to table, refrig to oven, delivered things to kitchen, bedroom etc. Also, R still has easy-care leafy green plants that need watering. She likes taking these plants to the kitchen sink, but holding a cane and carrying a potted plant doesn’t happen! Her current walker with the 2 recessed holes filled a need.

A friend in her 70’s, who had polio as a child, has purchased countless walkers over decades. She now prefers rollators–walkers with 4 wheels, which make them very sturdy and easy to to use inside and outdoors. (I’d never heard the term before speaking with her.)

Rollators come with seats, baskets, trays, cup-holders and various other options.  She has one for indoors which has different “amenities” than the collapsable one used for going out. The latter has a fold-up seat, offering a place to sit if needed, but no tray. It’s less heavy, making it easier to lift into/out of the car. (Grandkids love to sit on it, she tells me.) That said, I know adult children who don’t like taking parents out because it entails lifting a collapsable walker. Do they need lessons?

My friend says four wheels plus good brake handles are very important if the walker is to be used out of the house (think uneven pavement and inclines). Over the years she has purchased walkers on line or through catalogs and some at stores like CVS and Walgreens, where they “fit” the walker to your measurements. The right height is extremely important. Note walkers for shorter and taller people when checking “Related” below for rollator options. (Site selected because of the excellent pictures and information.)

Great gift: Family members contribute to the purchase the right walker. For seniors who are trying desperately to maintain their independence and age in place, the right walker helps parents age well. It clearly has for R.

Related: Rollator models
              Very good video, excellence hints by 2 physical therapists: Walkers: Wheeled vs Standard

Check out “Newsworthy” (right sidebar). Links to timely information and research from top universities and respected professionals, plus practical information–to help parents age well.

101-year-old: The Right Cane–Mobility and Aging in Place–4 years after Broken Hip Surgery 1

USING AND CHOOSING CANES WISELY

Because of R’s strong desire to remain in her home of over 65 years and live independently, alone–she may have put more thought into cane selection than many.

IMG_3693The cane she eventually purchased, she first used in rehab. While she used many canes in rehab, this one felt best to her, because of its handle, which is broad. Her palm rests on it, instead of fingers wrapping the usual more rounded handle. Thus, it felt like added support.

To backtrack a bit–

Shortly before her release from rehab a cane salesman visited her in her room. (Don’t know if this is true of most rehab centers.) I happened to be there.

He brought a good supply of canes, but none with the handle R swears by for stability and confidence. She told him what she wanted, which he didn’t have. (No one said she had to purchase his canes…I think it was a “service.”)

The day she signed out of rehab, they let her borrow the cane she liked  best. She took it to the surgical supply store. Not a stock item, It needed to be ordered and would take 2 weeks. R. was eager to get started with it. My husband ordered it through Amazon, where itt was less expensive and arrived at R’s home in 3 days. I can’t remember if Medicare covered it.

A year or so later R saw and ordered the HurryCane. One of its attributes–advertised on TV– was that it stood up by itself. R’s home is carpeted. It did not stand up on carpet. She phoned the company and spoke to “a very nice man” who said she could return it and get full credit (which she did). Although that cane didn’t work for her, she appreciated the ease of return.

She then tried a little rubber gadget that would attach to the bottom of her cane so it would stand up by itself.  But first the existing rubber tip needed to be removed. The rubber gadget didn’t work and R says the original tip could not be put back on her cane–necessitating another purchase of the original cane –with the broad handle.

When R bought the replacement cane, she went back to her rehab place to have them fit the cane so the handle was at the proper height for her. She was told when she left rehab 4 years ago how important it is that the cane is fit properly by someone knowledgeable. She’s convinced that’s why some people who, don’t stand up straight and walk properly with their cane, have problems.

R has always been creative in solving her problems. That’s undoubtedly one reason she has been able to remain independent for so long. Currently her walker, which she loves, provides a place to rest her cane in the standing position.  It’s sort of hooked to one side (see photo). It stands up and ready–always in the kitchen. And when she’s walking to other parts of her one-story home, she can lay the cane on a bed, chair, etc. where it’s easily accessible.

As parents age, inevitable problems arise. Loss of almost all vision in R’s left eye and macular degeneration in her other eye are her current concerns. Mobility isn’t one of them thanks to her cane and a walker (next post).

 
Related: Tips for Choosing and Using Canes Mayo Clinic Slide Presentation

Check out “Newsworthy” (right sidebar). Links to timely information and research from top universities and respected professionals, plus practical information–to help parents age well.

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).