Redefining "senior moments:" Aha!

According to Suzanne Stinnett, culture change student and author of Little Shifts, the healthy aging brain is a lot like new social media: "Adaptive, highly integrated, self-renewing, making use of accumulation of data."

Unfortunately, we tend to look at the older software of the mind the same way we look at older technology. "We view a tech tool that has been around for ten years as a dinosaur – and if it is still useful, smart, and engaging, we’re in awe."

Stinnett makes an argument for more awe, less ugh, and defines a senior moment as:

The moment of “aha” when yet another innovation comes together as a result of our activated brains. When a senior citizen provides an integration of concepts, a brilliant innovation, or makes some connection that no one else could think of. The product of an experienced brain which is functioning at a high level. Only people who have been around the sun fifty times or so are capable of these moments.

Aha!

So long

This is the last entry for this blog as a vehicle of the Milwaukee Aging Consortium. We've had a great time exploring issues on aging in Milwaukee and in general here. We'd hoped that readers would become engaged in creating a discussion, but that didn't happen. So it's time to find a different way to get--and keep--the conversations going.

To those of you who read Aging Maven regularly, thanks so much. And keep the Maven bookmarked: she'll be resurrected as an independent blog.

Deep thanks to the Milwaukee Aging Consortium for trying this experiment. As always, the Consortium continues to find better ways to connect professionals so that together, we can make a real difference in aging.

Aging, changing American demographics: even on the political radar?

Forget McCain's age for a moment. An aging America is nowhere to be seen in either presidential candidate's radar, says Newsweek and syndicated columnist Robert Samuelson (July 6, 2008).

John McCain and Barack Obama are against poverty and fiscal irresponsibility. . . (They) favor “reform.” But beyond these platitudes, they’re mostly mute.

That global aging is “a demographic shift with no parallel in human history” is not exactly a secret or even a disputed issue. So its absence from the discussion table seems curious. Then again, according to Samuelson,

It is one of our fondest political myths that elections allow us collectively to settle the "big issues." The truth is that there's often a bipartisan consensus to avoid the big issues, because they involve unpopular choices and conflicts. Elections become exercises in mass evasion; that certainly applies so far to the 2008 campaign. A case in point is America's population transformation. Few issues matter more for the country's future — and yet, it's mostly ignored.

Samuelson has visited the issue before, specifically focusing on developing bi-partisan think tanks to come up with data and policy solutions to the problems related to government spending on older Americans and immigration issues.

But that’s not enough, according to Encore, an organization devoted to revitalizing later life careers.

. . .Samuelson’s challenge is all to the good, but the framing is too narrow, too Beltway. Rather than merely craft a policy that averts the fiasco, we need a vision that fosters a renewal, both social and individual. Aging boomers are more than liabilities, after all, they are also assets. Changing the starting point of the discussion also changes the end result. Rather than muddle through, why not break through?

Certainly, longer working lives are likely to be a feature of boomers’ encores, but that reality will be much more appealing if work itself is reimagined: encore careers at the intersection of personal meaning, continued income and social impact.

How do we in the community of professionals and “experts” on aging find ways to bring constructive solutions to a table that’s not even set? It seems having faith that whichever candidate we prefer will “do the right thing” is a bit misplaced.

What’s your organization doing locally or nationally to “not muddle through, but break through”? Share your ideas and experiences with us!

Is age an issue in the presidential election?

Last weekend, the New York Times suggested that age was the new "combustible" topic enflaming people's biases and prejudices in the presidential election. The others are race and gender, as we've seen.

Said author Adam Nagourney, the issue is not just candidate John McCain's age but the voters' age as well.

"Many boomers, as we all know, cherish and chase youth, and many of them, not surprisingly, could be found at Mr. Obama’s rallies this fall, the political equivalent of a 50-year-old man wearing a baseball cap backward. Yet, at a time when many Americans live into their 80s and beyond, those who are beginning to contemplate their first Social Security check can simultaneously embrace the belief that they will remain active members of society for years, even decades, to come. For these voters, Mr. McCain may seem as much a barrier-breaker as either Mr. Obama or Mrs. Clinton."

The same day, an article by geriatrician Greg Sachs, MD, professor and scientist for the University of Indiana Center for Aging Research, welcomed the controversy.

"I see this as an opportunity to help encourage greater education of the public about aging, health, and memory issues in particular." And those issues, he pointed out, don't just arise every four years but are with us always.

It's easy to merely dismiss concerns about age affecting performance as "ageist." But Dr. Sachs reminds us that, contrary to the beliefs of a youth-worshipping society, age brings with it greater diversity. It's not all old people who tend to be alike: young people are more similar in health and ability. With older people, you just can't generalize about anything. Especially not health.

Aging carries real concerns. Cancer, heart disease, stroke, diabetes, and kidney disease are found increasingly as people grow older. And so are alterations in brain and cognitive function. The latter is not an easy problem to address, as routine screening for cognitive impairment has yet to be found cost-effective.

Still, Dr. Sachs suggested, "perhaps older people who hold important positions affecting the lives of many others ought to have a more comprehensive evaluation on a regular basis."

Seems like a reasonable suggestion. For all of us, the ability to do the job should be the measure of suitablity, not age, race, gender or other factors.

What do you think about age and ability? Share your thoughts on this or other aging-related topics with us.

Doctor, care manager, gerontologist?

Aging is an interesting field in which to work. But messages about training for professions in the field can be confusing.

An aging population assures a growing “market” for the services of knowledgeable providers of just about anything aging people need. In April the Institute of Medicine predicted an impending crisis and verified what many have already observed: a shortage of geriatricians (medical doctors specializing in aging patients), nurses, and frontline aides skilled in the concerns of aging patients. Meanwhile, the New York Times is touting geriatric care management as “one of the most important professional roles in the whole health services delivery system” over the next 10 years.

At the same time, the March-April 2008 issue of Aging Today raises thoughtful questions in two articles about whether gerontology can continue as an academic discipline. The problem, according to authors Anabel Pelham and Robert Binstock, has to do with lack of formal accreditation programs.

Perhaps the problem also has to do with lack of clarity. Neither article bothers to define gerontology. Wikipedia says it has to do with everything about aging except diseases, which are claimed by the field of geriatrics.

I guess if you’re in the field, you know gerontology “belongs” to the human services side. But it would be a mistake to assume that others share that understanding. Pelham says that “gerontology can synthesize the field’s many realms of knowledge;” it would help the rest of us to know toward what end.

No fewer than four different programs certify geriatric care managers, who don’t have to be social workers, and case managers, who do. And no one has any trouble figuring out what it is that those worthy professionals do: the name is self-explanatory.

Gerontologists, help us clear up some of the mystery that surrounds you. We’d love for you to tell us what you do and what is happening in your field in Milwaukee and beyond!

A jug of red wine and 90 becomes the new 50

Eartha Kitt at 80 sets a tough standard. Image from Wikipedia

Is red wine the fountain of youth? I'm not suggesting that the divine Ms. Kitt relies on that elixer for her youthful appearance. But a handful of articles came across my desk today touting the potential of a resveratrol, a substance found in red wine, to keep people's hearts and bodies young.

All were based on two studies that found resveratrol kept aging mice healthy, middle aged, and slim in much the same way severe calorie restriction, a much less attractive way to maintain youthful vigor, does.

One of those studies came from Madison's LifeGen Technologies and the University of Wisconsin. (Barger JL, Kayo T, Vann JM, Arias EB, Wang J, et al. (2008) A Low Dose of Dietary Resveratrol Partially Mimics Caloric Restriction and Retards Aging Parameters in Mice.)

You'd have to drink a lot of wine to stay as young as the mice--the equivalent of 1,000 bottles a day. I'm thinking that after the first one, you might stop caring much.

The New York Times takes a balanced view, pointing out that the findings are interesting but there never is a panacea; that it's way too soon to understand what the research means for people; and that one reason for the interest is the enormous potential for a pharmaceutical company to clean up on this "longevity elixer."

The Reuters article focuses on potential protection to heart health.

The Atlanta Journal Constitution version homes in on the vanity angle, asking "is 90 the new 50?" and providing photos of well-aged celebrities such as Sean Connery, Kitt, and Sophia Loren. David Sinclair of Harvard Medical School, author of the second lab research report, admits to supplementing his diet with resveratrol. But he reminds readers that the most effective way to improve longevity is exercise.

I wonder what the desire for a magic fountain-of-youth pill that keeps us slim, healthy, and young without really trying does to the way we spend our healthcare dollars. And continuing to raise the bar for expectations of sustained youthfulness seems to serve product manufacturers more than it does the rest of us.

I don't know about you, but I'm having enough trouble keeping up with 50-something being the new 40-something!

Getting ready: continuing the conversation

"Butting heads" by isadoreberg, flickr

A recent blog entry introduced the topic of talking to loved ones about difficult issues in aging. But it's a conversation that needs revisiting often.

One of the most thoughtful writers about Boomer children and their aging parents is David Solie, author of How To Say It to Seniors: Closing the Communication Gap with Our Elders. His most recent blog entry, How do we get them to move? answers bluntly the question so many of us have: we don’t.

“Older adults see where they live as the Alamo and will make their last stand defending it. We advance with logic, manipulations, and threats and they use any means at their disposal to repel us.”

The problem, he says, is that the children see themselves as managers of a situation, while their parents see themselves as preservers. We (the children) want to manage to avoid the inevitable disaster. They (our parents) want to preserve what they know far better than we do will soon enough be lost. Home, health, loved ones, mobility: “Having any of these another day is invaluable victory in the final phase of life.”

So we are left in a holding pattern. What do we do during that time? Put aside persuasion in favor of listening. Celebrate each good day as a gift. And help them—and ourselves—get ready to move when the time comes.

As mentioned in the earlier blog, My way: A workbook for planning and living life your way is an outstanding resource to aid in getting ready and shifting from conflict to partnership. It’s available from the Aging Resource Center of Milwaukee County and was presented at the May member meeting of the Milwaukee Aging Consortium. Another great resource is the 40/70 Rule Guide to Conversations brochure from Home Instead Senior Care.

Tell us your experiences with talking, listening, planning, and getting through the changes that come!

Something good about aging

Blissed out in Natalie's Chicken Blog

Things change with aging, and even, sometimes, for the good.

University of Texas sociologists Catherine Ross and John Mirowsky found that around age 60, people begin to report "more feelings of ease and contentment than their younger counterparts." Their study "Age and the balance of emotions" appeared in Social Science and Medicine in May 2008. More about it here.

The researchers also found a shift from "active" emotions such as excitement to "passive ones" like serenity. Talking about that might be a little tricky, since it seems to require some adjusting of a cultural bias that active is good, passive is bad, and excitement trumps all. Adding to the complexity is the need to consider that positive and negative things can happen at the same time. Pub Med's abstract writer puts it this way: "In order to accurately portray the shifts in emotional tone, age may best be considered as simultaneously indicating maturity and decline."

It's not scientific, but I've found that getting older makes it a lot easier not to sweat the small stuff--and to know that most of it is indeed small stuff.

And serenity is definitely something to look forward to.

"We do our best and lean on each other"

The popular press coverage of aging falls mainly into two camps: 1) fight it/beat it and 2) what to do when you can't anymore.

At the May 8 Milwaukee Aging Consortium member meeting, a panel of experts entered the important middle space between resistance and resignation. Critical conversations: helping families and elders get ready for transitions went beyond advance directives for the very end of life to address planning for a longer period of change. Panelists and audience considered the questions:

• How do we think about the time of many transitions during the last developmental stages of life?

• How do we talk to our older clients and relatives about making practical decisions that honor their desire for control?

On the same day as the meeting, Kathleen Merryman told a story in the Tacoma News Tribune that illustrates the problems of unanticipated change. The account of a recent shift in her family's universe begins, "Two months ago, in a Maverick gas station in Bridger, Montana, my dad backed into a post and shattered his sanity."

Merryman's 79-year-old father, who planned to live forever, was returning from a doctor's appointment with the news that he had not only an infection but an aortic aneurysm. The collision with a post marked what Merryman's mother described as "all the bonds of reason in his brain shred(ding) at once."

The collision was not caused by the aneurysm rupturing. The impact caused no physical damage to Merryman's father or mother who was also in the car. The cause of the sudden change was and remains a mystery.

But at least metaphorically, in losing his image of himself, he became someone else mentally and emotionally, someone living in a hell populated by delusions. His wife and children (one lawyer, two nurses, and others) were able to move swiftly through the maze of care options and changing housing and financial needs.

Even with the best of family support, the call for strength in the face of interpersonal friction and fatigue stunned the family. They now know "With aging, we do our best and lean on each other."

No matter how much planning has gone on, a sudden change for the worse is devastating. Unlike this story, the sudden changes in aging often follow a longer period of unrecognized decline. But having deep and honest conversations about what really matters and how to support basic values and desires can go a long way toward easing the pain.

It's probably a good idea to decide that "don't put me in a nursing home, ever" isn't the end of the conversation. It's just the beginning.

Some resources from the meeting to help in starting and sustaining the conversations include My Way, an in-depth planning tool from the Milwaukee County Department on Aging, and two documents developed by Home Instead Senior Care: 40-70 Rule 7 Tips (for conversations between Boomers and their parents), and the 40-70 Rule Guide booklet.

The Grandmother Hypothesis: Creating and saving civilization as we know it

What are you supposed to do you do when you’re not raising kids anymore, anyway? The easy answers to that question aren't always very satisfying, as I was reminded today listening to a Wisconsin Public Radio call in show.

The topic was having children late in life. Author Elizabeth George had only positive things to say about the experience. The women she interviewed for her book, Why Women are Embracing the New Motherhood, didn't seem to be encountering any downsides, either.

One gentleman asked about children becoming caregivers at a younger age. Not a problem, George replied. People are healthier now. And they have better financial plans.

Well. Maybe. Let's hope.

Then caller Molly from Baraboo threw both George and host Joy Cardin off balance with a question about the developmental tasks of aging. The conversation, which I’m recreating loosely from memory, went something like this:

“I had my child at age 39 and then had an early menopause. We thought about having another child but by that time, I found I wasn’t really all that interested in children. I’d heard that you change after menopause, that you are ready start to begin a new life, and I felt like that was happening to me. I was ready to do that, but I couldn’t because I had a three year old. Do other people have that experience?”

You could hear the author frowning. “What do you mean about differences after menopause and being older? Do you mean retirement?”

Host Cardin jumped in and offered some other suggestions for what women do in that “next stage” of life: traveling around the world and self-improving. Lots and lots of self-improving. (Apparently she's not old enough yet to discover that sometimes that's an exercise in futility, not to mention boredom.)

“But with only one child, you can travel around the world easily enough anyway,” said George. The awkward conversation ended with an uneasy dismissal suggesting that Molly’s case might be interesting but didn’t really apply to others: “Early menopause is an anomaly,” George concluded.

Actually, it’s not. But besides that, I was stunned by the lack of vision of what it might mean to be in the world after menopause, after children.

As an older mom, I knew exactly what Molly was talking about. My friend Kathleen, also an older mom, used to say, “I’d be standing at the refrigerator, my mind drifting off on lofty and spiritual thoughts, thinking about God and peace and ways to save the world, and when that little hand tugged my shirt and asked where the juice was, it took me a few seconds to come back to earth.”

There’s a lot more out there than recreation and holding the line against a widening waistline. Apparently George and Cardin have never heard of the Grandmother Hypothesis. This intriguing idea says that postmenopausal grandmothers (and older men, too) created culture, if not the human race, by helping younger people nurture their children. This not only meant more calories in the family pot, which meant more children surviving, but it meant that everyone had more time to do interesting things like carve spoon handles, compose songs, and create political intrigue.

Time spent lingering in the sun at a table in Turino sounds lovely. But now that my babies are heading for college, I need to add calories in the form of money to both their pot and my own retirement one.

I’m also looking forward to writing books, getting a promotion, and saving some little corner of the world

There’s so much to do, and almost all of it interesting. Even necessary. . .

What are your thoughts about life between kids and the grave? How do you see changes in reproductive norms affecting aging and aging populations?

When things work right: housing and supportive services

My mother died April 1. She was 86, in increasingly poor health, and had long been ready to go.

We encountered some troubling problems with the medical care system at the end. But I'm going to leave those behind and talk about what went right.

When Mom started having more trouble managing in the independent apartment in Oshkosh, Carmel Residence, where she'd lived since 2000, we moved her into the community's assisted living facility, Gabriel's Villa. There was an interlude of illness, skilled nursing, and rehab in between, but that's not really germane to this part of the story.

The apartment was lovely, and Mom quickly made friends with the residents and the aides. The food was superb, and she actually started eating three squares a day. She began walking around her apartment using only her cane, and generally was managing better than she'd been for the past two years.

But things got worse again. She developed pneumonia and digoxin toxicity, the congestive heart failure worsened, the implanted defibrillator started going off frequently despite an increase in potent drugs for arrhythmia. Her mental state became altered.

Gabriel's Villa operates under a residential care apartment complex (RCAC) license. As a result, the staff were able to be very flexible, providing more care as needed for an additional fee. They began administering her medications and checking her every two hours, later every hour.

After we decided to turn off Mom's defibrillator and let nature take its course, her plan all along, Gabriel's Villa agreed to let us bring home hospice into the apartment. No one wanted her to move her again.

Mom died a few hours after we'd returned there, before hospice care could begin. I stayed with her, with much loving attention and help from the aides who were with us, getting her ready for bed, when her big heart went into ventricular fibrillation. A few minutes later, she died, held by my sister and me.

It was as she wanted it-- a good death, I think. For that, we owe much to the dry sounding notion of "elder housing with supportive services."

Honors and awards

Blog entry by Amy Ambrose, executive director, Milwaukee Aging Consortium.

I love a story about gut-intuition that turns out to be right. And I love a story about people investing in services for older people where they are needed most. Last week I had the pleasure of participating in the Milwaukee Awards for Neighborhood Development Innovation (MANDI Awards) celebration, hosted by Local Initiatives Support Corporation (LISC-Milwaukee).

The Milwaukee Aging Consortium sponsored a nomination for Community Care under the category of Building Blocks Award: Large Project. Last year's winner was the Dr. Wesley L. Scott Senior Living Community, developed by our friends (and a sponsor of our April 4 housing conference ) the Gorman and Company and the Milwaukee Urban League.

Community Care, a Milwaukee Aging Consortium member, is a private non-profit organization that provides health, home and community services to low-income frail elderly and adults with disabilities. The organization's mission is to provide the support people need to stay in their homes and communities, where they can continue to enjoy the fellowship of friends and family and play a vital role in their community.

Here's where the intuition gone right part comes in. In order to better meet the needs in Milwaukee, Community Care recently invested $5 million dollars in a property on Vliet Street in the Walnut Hill neighborhood. They turned an old factory building into a state-of-the-art adult day health center that includes examination rooms, a dental clinic, rehabilitation facilities, day center space for social activities and hot meals, and a full-sized commercial kitchen.

The Vliet Street Adult Day Health Center and clinics now serves about 200 participants. Physicians and nurses; physical, occupational and recreational therapists; dietitians, dentists and other health care providers all are part of the caring team.

According to Kirby Shoaf, Community Care founder and president, this choice of location was not met with great enthusiasm at first. Crime in the area is high, and the economy is poor. Security and staff satisfaction were concerns. But Kirby and others reasoned that the organization needed to be centered where the need was greatest.

They reasoned correctly. Now, they have created a gem in the heart of the city that not only serves the basic needs of elders and their families, but also conveys respect for them and their neighborhood. The Community Care Vliet Street location is now a favored place for staff members to work.

Community Care -- and the community -- "won" in our books, though they did not receive a MANDI award.

But I am proud to say that the winner in the large project category was another Milwaukee Aging Consortium member and sponsor: Manpower. The global headquarters of Manpower, located along the Milwaukee River in the Schlitz Park area, is another example of great investment in our town.

Dozens more innovative companies were honored as a part of the program. If your agency or your company is doing great things for older people, especially by reinvesting in senior services in the city, we’d love to hear about it.

Send your comments to this blog or to cmclaughlin@milwagingconsortium.org.

Did you hear the one about the woman, the black guy, and the Walmart greeter?

Gloria Steinem is 73, Robert Redford and John McCain 71. McCain's mother Roberta, who just renewed her driver's license, is 96. Do they seem "out to pasture," doddering, or foolish to you?

In humor, you have to tread carefully. Unless you are going after "old folks," that is. Much has been said in this year's presidential campaign about sexism and racism. But there's another "ism" that seems to be taken for granted: ageism.

David Letterman calls presidential candidate John McCain a "Walmart greeter" and a "mall walker," according to Julie Bosman in the New York Times. She asks "Has ageism run rampant in mainstream discourse because America exalts youth?. . .is the oldster an archetype so ingrained in the American comic sensibility--a la 'Grumpy Old Men' and 'Golden Girls'--that it trumps identity in politics?"

Great question--although in fairness, ageist humor may be milder now than it used to be. When Bob Dole was running for office, Letterman said “Bob Dole is so old his Social Security number is 2. He’s so old that when he was a teenager, his cologne was New Spice. He’s so old, his Secret Service code name is The Clapper.”

Even McCain gets on board with 'the joke': "Usually, people watch my performance to see if I need a drool cup, or stumble around, or anything like that."

In Politico, Roger Simon points out that John F. Kennedy, for all his appearance of youthful vigor, was frail and ill much of his time in the office he entered at age 43. Youth alone is no guarantee of physical health, mental acuity, or fitness for office.

I'll admit that I'm not ready to give up jokes about old people myself. But I'm making a vow to find jokes where the older person comes out on top of the humor. Because what we say and how we say it makes a difference in how we see--and create--aging.

What do you think about old-age stereotypes? Age-related humor?

A place that makes you wish you were old

"We know what helps people. What helps them age in place is not covered by insurers at this point," said Laura Gitlin, director of the Center for Applied Research on Aging and Health at Thomas Jefferson University in Philadelphia.

She was referring to healthcare and a study showing that periodic visits to independently living seniors by therapists can catch small difficulties before they turn into large ones.

But healthcare isn't all people need to age in place. To have a sense of wellness, we need purpose. Something to look forward to the next day. Ways to actively engage in the world.

Imagine if, instead of watching TV, you were broadcasting it. That was the idea behind the Burbank Senior Artists Colony. It's a 141-unit senior apartment community featuring 24-hour art studios, a film lab, performance space for its theater group, a resident-run internal cable TV station, and much more.

"You walk through this building and you never hear anybody talk about their aches and pains or how many medications they're on. They're just constantly talking about what they're going to do next," said Tim Carpenter of EngAge, a nonprofit organization that brings "whole person" creative programs to affordable senior housing.

The mission: "It's our vision to make aging a beginning. By providing life-enhancing programs to low-and moderate-income seniors living in affordable apartment communities, they will be given the opportunity to continue to grow intellectually, creatively, and emotionally. Programming will focus on the combination of mind, body and spirit to promote active engagement and independent living, and to provide seniors with a purpose."

Resident Suzanne Knode, who wrote her first screenplay after moving in, said "I never thought that I would be able to find something else that's new inside of me. You know that same feeling when you got out of school and the whole world was open for you? Now, all over again, the whole world is open to me and I have no idea what it's going to bring."

Everyone there is an artist, but many never called themselves that before entering a place where creativity is the air they breathe.

Six hundred people were on the waiting list before construction began, and 2,000 artistic souls are on the waiting list for the 43 affordable units that rent for $500 a month (market rate units start at $1400).

Burbank may be the home of Disney and Warner Brothers Studios. But you don't have to be in the entertainment industry to imagine creating senior communities as places anyone would want to live.

The question is, what would it take to do it here in Milwaukee? We'd love to hear your creative ideas.

Slow medicine for the old

Time to "rescue the elderly from standard medical care"? Geriatrician Dennis McCullough says it is in his new book, My Mother, Your Mother. Embracing "Slow Medicine," the Compassionate Approach to Caring for Your Aging Loved Ones. I haven't read the book but the New York Times review makes me want to.

The book is aimed at children and relatives who, McCullough says, are the best medicine--along with a slower, simpler, less expensive, family based approach to medical care. In interacting with the medical system, frail older people need an advocacy team of friends and relatives for protection and moral support.

Among the changes to consider for people at advanced ages: manual breast exams instead of mammography, stool tests for blood instead of colonoscopy, revisiting hypertension medication that works differently in the very old, companionship instead of antidepressants.

Reviewer Abigail Zuger, also a physician, calls the book valuable, "chilling and comforting in equal measure."

The topic is especially timely as we think about our July member meeting. We'll be building on the dialog with discharge planners in January. This time, we'll be considering how family members can talk about "advance directives" that go beyond end of life hospitalization. As McCullough says, hard conversations about topics like when to stop driving and what to do when you can't manage at home anymore need to start early, while the parent is still vital and lively.

It's about anticipatory guidance. The Library Journal's review says that the book will help readers:

—form an early and strong partnership with your parents and siblings;
—strategize on connecting with doctors and other care providers;
—navigate medical crises;
—create a committed Advocacy Team;
—reach out with greater empathy and awareness; and
—face the end-of-life time with confidence and skill

Please let us know your experiences and thoughts about how professionals in aging might help families talk about and plan for all of the transitions from fully independent to needing a wide circle of concern and care!

Ageism and drug safety

The Need for Drug Safety-the Older Person and Ageism grabbed me when it came across my desk through the Badgeraginglist. The listserv is a wonderful source of information for professionals in aging, and the source of many reports the Milwaukee Aging Consortium describes in our newsreel or information links.

Drug safety is not just an abstract good idea to me: it’s personal.

At Christmastime, my 87-year-old mother’s slow deterioration accelerated. It turns out that one of the prime causes was prescription medication toxicity. Another was electrolyte imbalance, a medication side-effect.

I haven’t looked at the bill yet to see what this episode cost in dollars. I won’t try to figure in the days lost from work and from our children for my sister and me. But I have a good sense of what it cost in pain and suffering, not just for my mother but for all of us.

The issue brief from the International Longevity Center-USA points to problems resulting from rapid approval of new medications and the lack of long-term “postmarketing surveillance”—research on what happens to 30,000 users, not just the 3,000 studied before release to the market. In 2007, the report says, the pharmaceutical industry “conducted only 7% of the studies they had promised.”

Drug problems affect older people disproportionately. Only 12% of the population, they use 40% of all prescription medicine. Physiologically, older people process drugs differently. They have the most problems with drug interactions. And yet there is no requirement that older people be included in clinical drug studies.

Report author Robert Butler, MD, uses some strong language: “Because medicines in the United States are disproportionately used by older persons, we must conclude that failures in drug safety are due in part to the belief that older persons, having lived their lives, are expendable. This is a manifestation of ageism.”

The brief calls for significantly increasing FDA funding and power to monitor drugs on the market and in older adults. The up-front cost, Butler says, “will likely save time, energy, and money, not to mention lengthening and improving the quality of lives.”

After a couple months of emergency rooms, hospitalization, skilled nursing facility stays, and rehabilitation, Mom's doing beautifully in an assisted living facility. In fact, she’s doing better than before. I wonder if, had her primary physician been monitoring her better, she could have stayed in independent living. But that’s a moot point now.

We’d love to hear your responses, ideas, experiences. Please comment here or send a message to cmclaughlin@milwagingconsortium.org.

Everybody's doing it: Caregiver help sites

You may have noticed a proliferation of all kinds of websites for caregivers. According to Mass High Tech: The Journal of New England Technology, the surge is partly a response to need--and partly a response to commercial opportunity.

“All of a sudden, it’s like caregivers have money,” said Gail Hunt of the National Alliance for Caregiving. “The baby boomers have to care for their parents, and there’s money to be made.”

Some of the sites, in other words, are all about the advertising.

But folks who run “altruistic” sites with no profit motive can learn some lessons from the often young entrepreneurs who understand social networking. Chief among these: the term “caregiver” doesn’t resonate with Boomers. We don’t see ourselves as caregivers but as family members—or even “baby sitters.” Caregiving is a market with more than one niche.

Realizing that, some sites are including services for the other side of the Boomer sandwich: childcare and tutoring, for example.

One site is called Lotsa Helping Hands. Developed in cooperation with the National Alliance for Caregiving, it has “created 6,000 ‘communities’ for users, mostly networks focused on a specific patient’s circle of caregivers,” according to article author Christopher Calnan.

Sites that list providers often offer a free basic service and charge monthly rates for “premium” services as well as using advertising.

Hunt warns that most of these businesses will disappear like the dot.coms – unless they develop the “Holy Grail:” comprehensive information combined with a database of local resources for users.

In Milwaukee, the Family Caregiver Support Network offers diverse help and information and a social support network for caregivers--for free.

Other excellent noncommercial sites include the Family Caregiver Alliance, and Hunt's organization's website Caregiving.org.

Strength for Caring is a great site owned by a commercial enterprise, Johnson & Johnson.

We’d love to hear about the best websites for caregivers—and what’s needed but not there. Comments and guest blog entries are most welcome!

What's your priority for making communities elder-friendly?

In the newsletter Connections, American Society on Aging (ASA) members identified as their top three policy priorities to make communities more elder friendly:

• 59% Public transportation improvements
• 25% Universal design requirements in building codes
• 10% Walkability mandates in urban planning

Public transportation improvement has been a chronic need for older people in this community since the days of the Older Adult Service Providers Consortium, the Milwaukee Aging Consortium's predecessor organization.

Are those the priorities you'd list, too? What could we do to fix the problems of getting around? We'd love to hear from you.

Some good news about aging societies

There’s an upside to aging societies that most of us haven’t much thought about. According to new information from The Gerontological Society of America published January 25 in ScienceDaily, as a society ages, it loses the taste--and the opportunity--for political violence. (World's Aging Population to Defuse War on Terrorism)

If you look at the Mideast, Iraq, Pakistan, and Saudi Arabia, you’ll see what happens with “youth bulges” in which there are proportionately more young people than usual. The youth bulge creates lots of people with “strong grievances against current political conditions and little stake in society.”

Population age cycles. In about 20 years, an aging, invested population creates political stability and economic development. Think about the US during—and 20 years after—the Vietnam war. You get the picture.

When the population continues to age and stops working, the period of economic development can slow or stop. Then a developed country will likely have to choose between accepting a high level of poverty among the old—or diverting money from military spending to avoid that poverty.

I will leave you to draw your own inferences. But I for one prefer the second option.

Author Mark Haas of Duquesne University says that the aging trend is starting to affect all the most powerful nations. By 2050, Russia’s working age population will shrink by 34%, and China’s median age will be almost 45. Will they choose impoverished old people or reduced military spending?

Apparently, the US will be less affected than China, Russia, Britain, France, Germany, and Japan. “In 2050, this country’s median age will be the lowest of any of the great powers,” ScienceDaily reports. At the same time, “the working age population in the US is expected to increase by 31%.”

While the article doesn’t mention it, I bet that the “youthing” of the US depends partly on immigration.

Makes you look at politics, the future, the economy, and aging a little differently.

Can we please talk about this?

If it’s sex or giving up driving, Mom doesn’t want the conversation.

Death, on the other hand, is okay to talk about, according to a recent Canadian study, The 40-70 Rule, by Home Instead Senior Care.

The title refers to the report’s suggestion that by the time you are 40 or your parents are 70 (whichever comes first), it’s time to start talking—and keep talking--about the hard subjects.

The 40-70 study found that the easiest topics to discuss were end-of-life wishes, living will, health concerns, and legacy. The hardest topics for Boomer children and their parents were independence (when Mom needs to move out of her home), personal hygiene, money, and when it’s time to quit – working, driving, and so forth.

Aside from parents refusing to talk, the main block to the conversation seems to be unprepared and fearful children.

Just how hard those conversations can be, and how little skilled most of us are in having them, is a message we keep hearing.

• At our January Member Meeting, Dialog with Discharge Planners, it became clear that no matter how good a job we do at discussing options at the end of life for advance directives, we haven’t really begun to talk about the shifts before the end. “Don’t resuscitate me” might be a much easier decision than what to do when Mom needs more help. We’ll pursue this topic further at our July 10 Consortium member meeting on Advance Directives. Check the calendar at our website.
  

• Yesterday (January 22), at WALA’s Aging In Place. . . Prepare for Evolution conference with Jim Moore, it was clear that senior housing operators also need to have clearer conversations with residents and family about changes in functioning that call for changes in housing or service.

David Solie’s blog entry, No Easy Way Out, has a wonderful discussion of the conversation problem. Solie is author of How To Say It to Seniors: Closing the Communication Gap with Our Elders.

As my mother approached 90 and despite increasing frailty and her super human responsibilities for my special needs brother, she simply refused any assistance. Every approach was rejected. The best we could do was build support scaffolding around both of them for when “the bottom fell out.”

This went on for years. Airline flights, phone conversations, involvement of other family members, protracted conversations with our family lawyer, meetings with my brother’s case worker, and endless strategy sessions with my wife all ended with the same outcome. It was my mother’s way or the highway.

So we shored up the situation the best we could. Despite my mother’s derogatory objections, we purchased long term care insurance when she was in her late seventies. We petitioned the court so she and I could have co-guardianship of my brother. We got her to sign a Medical Power of Attorney. Then we waited.

His recommendations?

1. Advance as far as you can go based on the personality and the nature of your relationship with the parent.

2. Retest the boundaries of that advance periodically even if they appear initally absolute. You never know when there is some give in the system.

3. Build the best scaffolding you can with what you have.

4. Keep asking yourself this question: What am I responsible for?

5. Draft a “When The Bottom Falls Out” list of the items that will require your management. Print it out and then start making weekly annotations. Your brain works better with a “starter” document. I think just “pre-thinking” about the house, the Medicare forms, the Power of Attorney steps, and so on will give you greater stability in the midst of the actual chaos.

6. Rethink what you know about the final mission of life. Most of what we are seeing in our aging parents is a need to maintain control in a world where all control is being taken away. Nothing is going to change that. It is not a rational need; it is simply a developmental task. We have all lived them in our own lives. The problem with the last one is how deeply it is connected to our family systems. However, knowing its true magnitude reduces the guilt over trying to craft a perfect ending or trying to control things that beyond our capabilities.

* * *

We'd love to hear your comments, as always.

Make sure you can get there from here

A service and support program is only as good as the ability to access it. This concern was raised at the January 16 meeting of the Make It Work Milwaukee Coalition of health and human service providers. Cutting funding for intake and other staff—or not increase staff along with increasing caseloads—can put people in jeopardy. It also can waste the money poured into the program itself.

The Milwaukee County Department on Aging has built some economic support positions into its own budget to make sure that older adults get into and through “the system” without the delays and frustrations that others may encounter.

Milwaukee Journal Sentinel editorial cartoonist Stuart Carlson weighed in on the subject with this cartoon January 15. We’d love to hear from you about your solutions to intake and access problems you’ve encountered!

Beauty matters

With more than half of the “aging alerts” that come across my desk dealing with physical appearance, it doesn’t seem right to overlook the important topic of beauty and aging.

Nearly everyone agrees that Boomers are driving the exploding beauty business. We were the generation that would never grow old, that would just “fix” whatever we didn't like, including aging. By 2001, more than half of all beauty products claimed to have anti-aging properties. Plastic surgery and injections promising rejuvenation have become ubiquitous, and eating disorders in older women are growing.

Care in appearance is part of feeling good. I knew that my mother, who’s now in a nursing home for rehabilitation, was doing better when she asked my daughter to pluck her eyebrows and complained that I’d brought her the wrong lipstick.

But those who are battling against aging instead of exploring a new territory of a different kind of beauty are sure to encounter despair.

A new website, Beauty Paradox, promises some interesting guidance for women who are growing older. Its authors, Vivian Diller, PhD, and Jill Muir-Kukenick, PhD, are both psychotherapists—and former models. They’ve written a book by the same name in which they propose to offer a “psychological map through which a woman can explore the role beauty plays in her life as she ages.”

The goal is to redefine beauty on our own terms, not the media’s.

There’s not much on the site yet, but what’s there is promising. The first entry is a keeper. If you pass these thoughts along to others, please remember to credit the authors for them!

10 Beauty Thoughts to Hold onto as Aging Takes Hold of Your Beauty,
by Vivian Diller and Jill Muir-Kukenick.

1. Beauty is not just a physical experience, but a psychological one as well. Although we can't stop the physical changes of aging, we can effect change psychologically.
   
2. While aging is unconquerable, inevitable and irreversible, self-image is not. Self-image can be fluid and timeless.
3. Aging is not a battle of time, but with one’s image of oneself.
4. Chronological age does note have to define you. You can define yourself at your chronological age.
5. Put your beauty in your identity, not your identity in your beauty.
6. Take an honest look at who you are, not what you look like.
7. Rob beauty of its power over you. Take back that power and you will feel more beautiful.
8. Learn about the psychological forces of beauty you can’t see and those you can’t hide from.
9. Fear of aging interferes with aging attractively. Fear is unattractive. Aging confidently is not.
10. Beauty matters to all women, but to women who age beautifully, beauty matters not too much nor too little.

A place to live—and a little bit of grace

From Sarah Polley’s screenplay Away from Her:

Grant and Fiona are a comfortable, long-married couple who live in an old rambling house by a lake in Ontario. When Fiona’s memory begins to slip—“I seem to be disappearing bit by bit,” she says—they face a difficult decision.

(Fiona) picks up some forms from the dining room table.

Fiona What are these, Grant?

Grant They’re the. . . the forms to fill out. If you decide to go to Meadowlake

She looks frustrated.

Fiona But that is exactly what I have decided. You were to go and sign these forms. And leave them there.
. . .
Grant I don’t think I like the place.

Fiona I don’t think we should be looking for something we like here, Grant. I don’t think we’ll ever find that. I think all we can aspire to in this situation is a little bit of grace.

It seems like yesterday that I wrote about moving my mother into assisted living. But so much happened in the last week and a half. The Friday before the move, she became listless and delusional and was admitted to the hospital. A week later, after treating an infection and medication toxicity, straightening out her electrolytes, and getting the congestive heart failure under control, the hospitalist sent her off to a skilled nursing facility.

Like Grant, I don’t think I like the place. Not because there’s anything wrong with it: there isn’t. Because it doesn’t suit my image of how and where Mom should live.

But as Fiona said, in this situation, we’re aspiring to a little bit of grace. Here, she will be safer, and with grace, recover enough strength and independence to go to the original assisted living destination. If not, we’ll be grateful for the grace and care provided by a good skilled nursing facility.

Of course, we all want to be part of creating living and care situations people will like. I’m especially excited about a new event the Milwaukee Aging Consortium will present Friday, April 4, with the cooperation of LISC (Local Initiative Support Company) and hosted by Direct Supply. Linking Housing & Service Solutions for Bottom Line and Best Practice is a day-long seminar on bringing services to aging residents in Milwaukee area congregate living.

This seminar includes breakout sessions to stimulate working partnerships. Housing operators, developers and architects, home health and medical providers, and others won’t want to miss this! For more information and to learn about sponsorship opportunities, contact Tracy Straub, 414-289-0890.

More about this later!