"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.