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From Serving Iowa Elders for Over 20 Years

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Toning the Sweep

Toning the Sweep by Angela Johnson

When I picked up this short novel, I didn’t realize it was a book for “young readers.”  If I hadn’t seen the Scholastic Book label as I began to write this blog piece, I wouldn’t have known.  Read it as a gentle, thoughtful story life transitions and impending grief for all ages.

Emily and her mother return to the desert Southwest to close up Grandmama Ola’s house and bring her to Ohio for her final months.  The chapters read like poems to soft desert breezes and cherished family ties.  Odes to friends, family, and connections.  Harmonizing with nature.  Bits of family history in attics and suitcases.  Shared experiences and memories.  All written with the pace of desert life.

I won’t admit how far I was into the book before I realized the characters were African-American.  To me this was about the love and connections within any extended family.  Many hands make light work as they share joy, laugh, and carry on the continuity of life.


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Coach Broyles’ Playbook for Alzheimer’s Caregivers: A Practical Tips Guide Pocket Reference of Tips and Strategies

By Frank Broyles, University of Arkansas, Razorback Athletic Director Emeritus

If you are in the market to understand how to care for someone with Alzheimer’s Disease, this might just be the only book you need.  It is ninety-one pages, wire bound, of plain-spoken direct instructions.  “Do this.”  “Don’t do that.”  In my experience he covers the gamut of caregiving tasks and does it well.  The enclosed pamphlet of Tips and Strategies is a gem of fast reminders.

There are stacks of books on Alzheimer’s disease for every reader out there.  Books full of statistics, understandings of the disease itself, causes, treatments, advancements in science, theories, various common and uncommon behaviors, ad infinitum.  They each serve the reader well.  Broyles’ Playbook is a distillation of just what a caregiver needs to know in order to provide good care.  Nothing more.

As social workers, we often notice that caregivers either “get it” or they don’t.  Frequently, it doesn’t even matter what type of dementia a patient may have; they simply need to be cared for by someone who “gets it.”  Broyles gets it and passes this knowledge on.  This is a very useful resource.

Ah, but I have to be honest and report some comments on the downside.  The booklet itself has some of the worst print I have ever tried to read.  Much of the text is in grey rather than black and is hard on the eyeballs.  The author may know Alzheimers but he doesn’t know vision-impairment.  And the wire binding is just a scooch too tight making the pages hard to turn.

Also, under the category of “political correctness,” Broyles’ frequent mention of support from “church” sticks out to me as slightly offensive.  I am sure he intended to include support from synagogues, temples, and other places of worship and spirituality.  Trouble is he only said “church.”  It seemed either quaintly old-fashioned or accidentally rude.

Boyles also assumed the caregiver, once the patient had moved to facility care, would visit “daily.”  This is an assumption loaded with guilt.  Many people expect close family to visit nursing home patients daily.  It might be a great thing.  Or it might be awful.  My own parents suffered from this assumption.  My mother (and I) had tended my father at home for several years before he had to go to facility care.  My mother, who did not drive anymore, tried to visit my dad daily.  It was difficult getting her there in all sorts of weather.  More tragically, my father did not want to see her daily.  Although my father was an excellent husband, in his dementia, he wanted to flirt with his nurses and aides.  He wanted to have chocolate pudding on his chin.  He definitely did not want his wife wiping his face and telling him to leave the nurses alone.  Visits were challenging for both of them and my mother kept insisting since she felt daily visits were expected of her.  My mother felt deep guilt if she skipped a day.  My father had no particular sense of time so he wasn’t missing her absence.

Boyles wrote this book after years of caregiving for his wife.  There was one issue he did not mention which would be helpful.  It has been my experience that one of the hardest parts of caregiving for a mentally impaired spouse is giving up the spouse as consultant in daily life.  The urge to ask one’s spouse’s opinion on any number of things is a huge barrier to “getting” dementia care.  This book instructs the caregiver to just make the decision for the spouse, or at least reduce the choices to two fully-formed options.  It is far easier for some couples than for others.  We had one Alzheimer’s wife bean her husband with a frying pan when he made a meal decision she didn’t like.  We have seen the caregiving spouse drive his wife to tears trying to get her to decide if he should sell her car.  He stated he had never, nor would he ever, make such a big decision without her input.  Of course, if Boyles had gotten into such variations, his booklet wouldn’t be the simple guide it is.

Kudos, Coach Boyles!

Available at http://www.alz.org and Broylesfoundation.com

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New Tricks

I might as well confess.  I am a sitcom junkie.  Love to laugh.  For decades of my life I watched way too many reruns of I Love Lucy, then had to wait until specific nights of the week to watch the funny weekly stuff:  Smothers Brothers, Carol Burnett, Green Acres, Honeymooners, Hawkeye Pierce.  Eventually we got a single channel of daily sitcom reruns so I could watch one lone comedy while making dinner.  The trouble then was that it was one sitcom over and over, ad nauseam.  I knew every punchline.  Then the heavens opened and out popped Hulu and Netflix.  Hallelujah!  Now I can laugh at the best of the past and present anytime I want.  I love these new tricks.

How strange then that the first show I want to recommend from my Hulu obsession is a detective drama.  New tricks.  It was recommended to me since it has a geriatric twist.  It is a long-standing British series about a unit of retired detectives called upon to reinvestigate old murder cases which have been closed without solution.  There is the middle-aged Detective Superintendent Sandra Pullman, who supervises three retired detectives:  Jack, the grief-stricken widower; Brian, the obsessive human data machine; and Gerry, the typical tv-style loose cannon, who still smirks at having to report to a female.  The three Old Dogs are delighted with the New Tricks of DNA detection and database searches, while shocked at the restrictions borne of respect for the rights of the accused.  Their detective years of decades past included secret recordings, sneaky deceptions, and otherwise gathering evidence in whatever way conceivable.  It is a nice reminder of how much has changed in police work and human rights.

My particular recommendation is an episode entitled God’s Waiting Room.  Supervisor Sandra is touring a nursing home with her ailing mother when she hears of an alleged murder.  The victim was found with an overdose of Tramadol, a common painkiller.  The police initially declared the death a suicide.  There are some issues in this episode which are common to our experience in care facilities:  too many keys to the drug cabinets, theft of residents’ personal property, people with drug dependencies hovering around, people doing stupid things with intent to help family/friends, people reluctant to admit that long-term care facilities can be enjoyable, and parent-child frustrations and guilt.

Of particular interest to me is the original police detective’s comment that, at the time of the overdose death, he had to divide his energies between investigating the overdose of this elderly woman and chasing a serial rapist.  He saw the situation as “either-or.”  Later in the show, the same sort of thinking reemerges when the cost of care of the senior was compared to that of a child’s schooling.  “Either-or” thinking.  Competition between generations, favoring youth.  We could favor the more vulnerable.  We could work for more resources.  Like retired detectives.

Postscript:  Try to overlook the low-cut tops worn by the otherwise highly professional Pullman.  Her costumer should be reminded of female super-sleuth, Emma Peel of The Avengers, whose fashion sense kept all eyes on her without resorting to cleavage.

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A Word About Anger

A Word about Anger

The reason I want to write these blog things is that there is some basic knowledge that I want to share with everyone.  Sometimes I think we just need to have a whole childhood class in human behavior and living skills.  So in that vein I offer some thoughts on anger.

Anger is not a primary emotion.  By that I mean that there is another emotion hiding behind anger, making anger secondary, a reaction.  For example, your spouse promises to wash the dishes.  You walk into the kitchen to see a pile of dried food on plates and cookware.  You become angry.  Ready to yell at the lazy slob?  Slow down.  Try to see what is beneath your anger.  Chances are your underlying emotion is disappointment; you really believed he would carry out his promise.  He has failed in his commitment and now you have to reschedule your time to wash dishes yourself.  He has disappointed you.  Then you become angry at being disappointed and call him a lazy slob.  Understanding that disappointment is behind your anger does make a significant difference.  You can’t make anything better by calling him names (not for long, anyway) and you can’t get dishes washed simply by being angry.  Anger is just anger — the best it can do is remind you to look for the real emotion that has triggered it.  In this case, disappointment.  You can do something with disappointment.  You can quit expecting your husband to fulfill his promises.  You can readjust your image of him.  Your can examine why he doesn’t perform this or other tasks.  Is he universally lazy?  Is he usually helpful but had some unknown problem today?  Would he be willing to trade dish duty for another chore?  Does he need counseling around his fear of Brillo Pads?  Is he deliberately trying to drive you away?  Is he in the emergency room with a finger severed on a partially washed knife?  If you bypass the anger to look as the primary emotion, you can begin to tease out alternatives that will avoid the anger, deal with the disappointment, and give you data for effective problem-solving.

Anger is most frequently covering up the primary emotions of grief, pain or fear.  It can also be hiding frustration, embarrassment, worry, guilt, disappointment, sadness, and other emotions we’d rather not feel.  It can be very helpful, when you are ready to shout, “You make me so angry!!!!!” to pause a moment to identify the real emotion you are feeling deeper inside.  It will do you more good in the long-run.  Anger management techniques encourage creating a pause before releasing anger.  This is a good time to look for other emotions rumbling around inside.  Also, the pause allows the level of anger to stabilize, making it less of a nuclear explosion when released.

A very important reason to care about lessening the anger response is that anger itself is extremely hazardous to your health.  Explosive anger triples a person’s risk of heart attack.  There is no doubt among medical researchers that anger does damage to your heart and vascular system.  Also, anger releases stress chemicals which can make it harder to think clearly, sometimes for many hours after the conscious feeling of anger has passed.  This hurts the angry person so deeply, it might be worth taking that pause before an explosion to ask oneself how much damage to my body is this outburst worth.  If you add to your thinking that anger isn’t even at the core of the problem, it should make a lot of objective sense to apply the brakes and try to get a better grip on what emotion really needs tending.

“How much more grievous are the consequences of anger than the causes of it.”   Marcus Aurelius

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My Understanding of Anxiety

My Understanding of Anxiety

As vulnerable mortals we have built-in systems to alert us to danger. When we hear an unfamiliar sound, we jump. When we see a sinister shape in the shadows, we cringe or get the urge to run. When we feel water rising around our toes, we spring onto higher ground. It can be essential to our survival to react with alarm. Our bodies automatically ask: Is there danger here? Should I protect myself? Should I run? Should I attack? Ah, no danger after all? It was nothing important. Thank goodness, I can relax. That brief moment between alarm and action contains the feeling of anxiety.

An instant of anxious feelings is an essential part of the quick, yet natural, reactions to the unknown. An unexpected stimulus leads us to alertness, then our recognition and interpretation of the stimulus lets us call off the alarm. Or run for the hills, or gird up for battle. That is how us mammals are supposed to function. When the body’s alarm lasts more than that brief initial moment, when the anxiety response gets stuck or habitual, then there is a problem.

Anxiety, when it lasts more than a brief moment, can be very uncomfortable. It can cause weakness, racing pulse, tightening of the throat, hyperventilating, shaking, sweating, and erratic breathing. Extended anxiety can lead to surges of panic, fears of insanity, and expectation of death. It hurts. And none of these responses are useful when a real danger is present. Anxiety by itself is the essential scanning for danger which runs amuck. The most common response to these unpleasant bodily symptoms of anxiety is to avoid situations that brought them on. Unfortunately that doesn’t fix the problem and often makes it worse.

Anxiety run amok can easily become a cyclical nightmare. When feelings of anxiety cause discomfort, the person dreads feeling that discomfort. Now the person has both anxious feelings plus dread of anxious feelings. Think of a circular pattern: strange noise ==> fear/anxiety response ==> anxiety remains too long ==> miserable feelings ==>anxiety over having more miserable feelings ==> more fear/anxiety response ==> more anxiety ==> so on and on.

When this anxiety response takes over, it can escalate into panic attacks and other acute symptoms, or it can become pervasive and random. Like a bad habit, the feeling of anxiety can pop up all by itself at apparently random triggers. Perhaps there are deep memories in the unconscious that set off the body’s alarm system which make no obvious sense to the person experiencing the anxiety. For example, if being late for appointments triggers an anxiety response, the person can experience an anxiety response in heavy traffic — even when there is no appointment pending. The ever-busy, imaginative brain sets up possible scenarios which trigger more anxiety. This is called Generalized Anxiety. The anxiety response just jumps into action without a clear precipitating danger.

The first helpful understanding in dealing with anxiety is recognizing that it is a normal response mechanism that has become overstimulated. The second helpful understanding is recognizing that prolonged anxiety really doesn’t help. The alarm of possible danger alerts anxious feelings which instruct you to make a fast evaluation of the real risks. The proper function of anxiety is to make a fast logical evaluation: Is there danger here or is there no danger here? Prolonged anxiety gets in the way of answering the question in any immediate, clear-headed way. The normal anxiety response is instantaneous — yes or no. When the answer to this simple question is not immediate, anxiety grows and becomes an issue in itself. Alarm! Danger? No danger? When anxiety lingers, part of the discomfort it brings is keeping the person in a state of indecision when there is still a risk of injury looming.

Sometimes issues of fear, indecision, and procrastination foster the extension of the anxiety response. The person is afraid of making the wrong call. What if he calls off the anxiety alarm and the danger was real after all? That is a big risk. What is the harm in letting the alarm keep ringing, just in case the danger is sneaking around somewhere? What if she is just a chronically bad judge of dangers? What if she believes the world is so fraught with dangers, we all really live in the crime shows that inhabit television? If each storm is reported as the Storm of the Century, how do we know when to turn off our alarms? The media seems to profit from revving up our anxiety alarms. Try to remember that not making a decision is in itself a decision; it is a decision to let anxious feelings permeate the situation. You can be wrong about whether there is danger afoot, but not deciding is not going to protect you. Many people conclude it is safer to decide that every possible alarm is indicative of disaster. That may feel like a safe call but it can’t be sustained very long by the human nervous system. It turns into generalized anxiety, popping up at random. It begins to hurt.

The secret to “unsticking” the extended anxiety reaction is to practice dealing with it logically, without fear or procrastination, so you can move to the post-anxiety step: action. Let’s return to the primitive scenario. You hear an unusual sound and you jump. You start to feel anxious. You think, Is that danger? Here is the prime target. You have to answer that question loud and firmly. You decide right then: danger or no danger. That allows you to take action. If there is danger, run! Or fight. However, if there is no danger, or at least very little risk of danger, have a stern talk with yourself. Say, “Hey, Mr. Anxiety, You! You made me jump at that loud noise. So I jumped. I now conclude that it was most likely a car back-firing, not Armageddon. Fine, you did your job. You can leave now and I can relax in the knowledge that car-back-firings are not harmful to me. Now I am going to actively calm myself and enjoy my superior skills at identifying danger.” Decision leads to action. Indecision and inaction lead to anxiety.

There may still be unpleasant physical sensations afterward, but after toughing them out for awhile, they will diminish. You will begin to teach yourself to not let the anxiety part of your impulses hijack your entire reaction. Your anxiety triggers will return to working properly with effort. You can enjoy the confidence and efficiency of identifying something as dangerous or you can enjoy the peaceful conclusion that there was no danger. You can always tell real danger, when you think in a realistic framework, because you know you need to take some sort of evasive action. Remember that not taking action allows the anxious feelings take over. Be decisive when danger is real, then actively enjoy the relief when the saber-toothed tiger was only a house cat. Practicing this skill and commending yourself for decisive action are critically important to keeping the anxiety alarm brief and functional.

Creative tasks can be helpful to get your anxiety trigger to be less sensitive. We can’t be fearful and anxious at the same time as we are having fun. If your anxiety trigger makes you jumpy, try jumping. Up and down. Literally. Once you discover that the water rising around your feet isn’t really a deadly tsunami, splash in the puddle. Wiggle your toes. If your anxiety sneaks up on you, sneak up on it: schedule an appointment with Mr. Anxiety. For example, let your anxious feelings run wild for 5 minutes every mid-day, then tell Mr. Anxiety to get lost until his next appointment. When CNN tells you the sky is falling, and it doesn’t fall, tell that Idiotbox not to scare people for ratings anymore, and turn to the funny animal videos. These exercises can convince your deep-dark brain to remind Mr. Anxiety to do his basic job and no more.

What of those anxiety triggers that are more subtle? Swimsuit shopping, nasty employers, IRS audits, creepy landlords, unexpected expenses, ad infinitum. There are situations in which our system to detect danger is more challenging. Anxiety is rightly triggered but the decision of whether there is imminent danger is not easy to determine. This is life in the modern world which is creating more global anxiety among us all. The alarm systems of our primitive brains aren’t built for this level of complexity. It is helpful to discover the issue that the functional anxiety alarm is attempting to point out. Remember to focus on the issue, not the anxiety reaction. Have a dialog with yourself about what your anxiety is trying to tell you. Define the danger precisely. For example, if being summoned to your supervisor brings worry, sweat, and desire to dive under a chair, have a heart-to-heart with your feelings. Ask yourself: What is so alarming here? Is the boss a nasty human being in every possible way? How much power does the boss really hold over you? Am I afraid he will discover I goof off too much? Is the larger issue with his personality or his authority or the job itself? Get specific about where the danger seems to be and where it is not. An alarm has sounded, but rather than responding with anxiety, you can respond with investigation and clarification. If you understand anxiety as too much “treading water” or “revving the engine in neutral,” think of clarifying the related issues as part of the action which needs to take place. Swimsuit shopping anxiety is best addressed with action on nutrition and exercise and self-acceptance, not avoiding anxiety in the stores. IRS audit anxiety requires sorting receipts and finding documentation, not stuffing papers in a drawer and worrying. Cautiously, getting to know the creepy neighbors is best before deciding who is dangerous and who is just unusual. Action is less effort than worry. Sometimes chronic anxiety is telling you important things need your attention. Try to use the best anxiety has to offer, and work at addressing dangers head-on.

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Remember those old Mickey Rooney & Judy Garland movies of the1930’s and 40’s? They solved their community problem by staging a “show.” They sang and danced into a happy, if improbable, ending. Quartet has a similar simple, feel-good, magical, happily-ever-after plot. Only with a geriatric twist.

The setting is stately retirement home in the English countryside needing an influx of funds for its survival. The residents are former operatic and classical musicians. The “harmonious” balance in relationships among the residents is disrupted by the arrival of a former opera diva, who has issues with her own aging and an ex-husband also residing there. Let’s get Diva to join our gala event so we can raise enough money to rescue our Victorian home. In the process, Diva learns her remaining life lessons.

My reaction to this film is unfairly sarcastic. If you are looking for a great story, you should pass this by. However, it is just the right film for a cold, rainy day and a cup of hot cocoa. The scenery is delightful and the pacing is measured and, for the most part, calm. Diva is played by Maggie Smith who can’t be on screen without riveting your attention. All the characters are very credible and enjoyable, particularly the flirtatious Irish tenor and Cissy, the occasionally disoriented. I loved the phrase: “Cissy’s gone walkabout.”

From a geriatric perspective, an important message is stated early in the film, when staff points out a fellow resident, a famous conductor, and Diva sniffs “I know who he was.” These characters have lost their identities as royalty in their field. As many work-focused retirees discover, work place identity fades. Retirement provides the opportunity to define oneself in more universal terms. The characters in Quartet conclude that they have no time left for regrets, quarrels, or competition. They learn to give of themselves and to enjoy each other in whatever time they have.Q