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?