weekly blog--one for the ages
Admittedly, I was a bit squeamish walking into the Newton Senior Community Center for the first time last Friday. To think that I was now age-appropriate to participate in one of the Center’s many activities. But in truth, the current center-goers I saw in this antiquated red-brick building that once served as the Newtonville library, were mostly in their early-to-mid-70's, and seemingly worlds apart in terms of interests, needs and probably expectations. I asked the Center’s director what it would take to get Baby Boomers like myself to go. She said that the activities themselves would eventually draw us in. I wasn’t so sure; even the word “Senior” in the name was a turnoff.
When I got home, I headed straight to the computer to do more research. I wasn’t alone in thinking that the word “Senior” was a generational turnoff. So what might work? I found a study that presented 5 models that focused on wellness, lifelong learning, entrepreneur and volunteerism, and even a restaurant that could be open to people of all ages, but hosted activities and programs to enhance the well being of older adults.
The bottom line on all of this was a community’s need to create an age-friendly environment to meet the growing demands of an aging population, which led me to the World Health Organization (WHO) and AARP, which recently established a worldwide network for communities to share their ideas. The group has also created a checklist of community characteristics geared toward the needs of elders who prefer to age in place. Boston, Brookline and Newton are among a number of communities in Massachusetts that have joined. The checklist covers outdoor spaces and buildings, transportation, housing, social participation, respect and social inclusion, civic participation and employment, communication and information, and community and health services.
Fortunately, 60 is the new 40, or so they say, leaving me with plenty of time to ponder my future before crossing the Senior Community Center threshold again.
This week’s topic is a little touchy: end-of-life care. I was supposed to go to a seminar at Harvard Medical School on the subject, but instead ended up going to the wake for a friend’s father whose in-home end-of-life care was left in the hands of his two devoted sons and their families. The takeaway on all of this…although dying is a fact of life, few people want to think about it. But one group that has no choice is the people with advanced illnesses, such as cancer, who are told they have just a few months to live. Then it becomes a matter of creating a situation that maintains the quality-of-life leading to a good death.
Essential in this paradigm is the communication between patient, family members and physician. Yet to my surprise, the end-of-life conversation has historically been especially difficult for physicians because of a natural reluctance to broach the subject, or because it conflicts with their problem-solving, hope-giving image. The good news is that there is movement within the profession to change that.
Currently, there are several programs being developed that focus on teaching physicians how to encourage patients to talk about their end-of-life wishes, and then document those wishes in the patient’s electronic medical record so that any physician in the patient’s care continuum can access it.
What helps a patient end their days as peacefully as possible? According to a number of surveys: being at home instead of in the hospital; not undergoing chemotherapy or other active treatments; not having a feeding tube; talking with a chaplain or other minister; spending time in private religious activity; having a good relationship with the health care team; and not being anxious.
One interesting survey finding: during their final days, religious people in their belief that God is the only entity that can decide when a life begins or ends, often wish for more aggressive care, which frequently entails a lower quality of life.
Readings from the Harvard Medical School seminar.
This week’s ConfrontingAging site updates of note: Perspectives/2000s &Technology--Telemedicine/Virtual Consults; End of Life Options--Online Memorials.
Last Saturday night I went to see playwright August Wilson’s one-man show where he (through an actor) shares stories about his first few jobs, a stint in jail, his lifelong friends, and his encounters with racism, music, and love as a young poet in Pittsburgh’s Hill District. Its title, How I Learned What I Learned, seems applicable to how the ConfrontingAging website has evolved. Nearly every day since the site was launched I’ve read an article or met someone that has expanded my understanding of the aging process, or reinforced something that I had already documented.
Last week I came across an article on volunteering which made the point that you really have to do your homework on selecting the organization and assignment. The wrong experience can prove to be unrewarding and demoralizing. You could also say that about life in general. But keeping a positive frame of mind regardless of the situation is a great way to offset the disappointments, reduce stress, and age successfully.
I also read about an emerging company beta-testing a website called Cake that was developed by MIT students to help people document and share their end-of-life wishes. It’s probably one of the more important aging issues that you can control, and one of the easiest to put-off doing until it is too late.
When I was managing my mother’s care during the last year of her life, I often wondered what would have happened if no one was around to do the managing. Kodokushi or 'lonely death' refers to a Japanese phenomenon of people dying alone and remaining undiscovered for a long period of time.
Kodokushi has become an increasing problem that has been attributed to the country’s economic troubles, a growing elderly population, a shortage of workers and family members to take care of them, and the social isolation that elderly people often experience as they reach the last stage of life. If nothing else, the phenomenon of Kodokushi increases the pressure on government, family members and local communities to ensure that the elderly don’t fall through the cracks and become forgotten.
In that regard, 18 states have enacted legislation that would allow a patient to name a family caregiver to help legitimize the role family members’ play in the health care system, and prevent hospitals from releasing patients without the caregiver being notified.
Meanwhile, technology in the form of robots is on its way. In recent years, Japanese researchers have designed robots that can play games and dance with the elderly, keep their minds active with trivia, and listen and respond to problems. One company recently introduced a humanoid creature with the power to read and respond to human emotions. They made 1,000 robots, costing $1,600 each, and sold them all in less than one minute, according to a recent Boston Globe article on robots.
In the works are robots that can assist with walking and gently lift a patient of up to 176 pounds and carry them around. More promising are limited-use robots which can wash people’s hair or watch for breathing or movement, and exoskeleton bodysuits that an elderly person can wear to enhance mobility.
For better or worse, the experts say that we are about 10 years away from seeing a socialized, multi-tasking robot that can replace the human caregiver.
Super Tuesday is done, and after 2.5 months so too is our kitchen renovation. I only bring this up because it leads to the inevitable series of questions that aging home owners face: how much longer should we live in our house....when is the optimal time to downsize and capitalize on our investment...and if we do downsize, where should we live.
For some people the choice is simple--sell the house as soon as the kids move out, and then buy or rent a property in an area with a lower cost of living. For others, like my wife and I, the pressure of taking care of an elderly parent close to home has clouded the picture.
Given our circumstances, Aging in Place seems like the best option for the foreseeable future, especially with more and more support resources becoming available. But the decision would not be complete without at least going through the motions of downsizing. And to that end, it means getting rid of stuff you no longer need, organizing your financial portfolio and preparing the appropriate legal documents to protect your assets, and maybe the most important of all, sharing the information and your thoughts on the future with the ones that will be most involved in managing your life when you no longer can.
Some downsizing stats:
Product of the Week: MedCottage, an intriguing solution if you are concerned about the living options for an elderly parent.