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From Serving Iowa Elders for Over 20 Years

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Who is Old?

I have been searching for the meaning of the term defining “elderly person.” I wanted a consistent, well-defined term to use when discussing issues affecting the elderly in this blog. Instead I found a quagmire of ambiguous words and/or phrases that refer to the state of being “elderly” but do not give a specific enough definition to help clarify whom we as a society (or I as writer of a blog) are referring to when we discuss older people and issues affecting them.

Possible Words and Phrases Used Commonly Are:

Senior Citizen
Elderly Person
Retired Person
Older Adult

This list is problematic in many ways. It contains words and phrases that cannot be precisely defined, are open to many interpretations, and include comparisons to nebulously defined terms. Finally, the words on this list attempt to define being older based upon three extremely different measures: 1.) Comparison to the definitions of other words 2.) References to the individual’s relationship to the workforce 3.) References to the individual’s chronological age. Thus, instead of clarifying what it means to be old, these words and phrases complicate the discussion.

Let’s look at each of these complications to identifying a precise definition for the elderly person:

1. These words and phrases are open to many interpretations.

Most of these words are adjectives, not nouns. Even many of the nouns — Senior Citizen and Elderly Person — contain adjectives. Adjectives, by their nature, are subjective and not precise in nature. For instance, “old” is a relative word….What is “old?” Is it something from your grandmother’s era, from last year’s fashions, or from the Mesozoic Age? Items from all of these times could be called “old” but their true “ numerical age” is vastly different. The subjectivity of these words is in relation to other words. For example, something is “older” because it is “older” than something else. “Older” does not tell you the actual age. To add to the confusion, the “thing” to which “older” is being compared usually is not stated.

2. Some of these words and phrases only refers to a person’s relationship to work.

These are the words “Pensioner,” “Retiree,” and “Retired Persons.” As a society we sometimes make a judgement that being old means not participating in paid employment. Not participating in the work force can be due to positive reasons such as saving enough money to retire at an “acceptable” level of lifestyle. It can be due to negative reasons such as having a medical condition that stops a person from continuing to do his/her previous work. Thus, these words also are ambiguous and non-helpful in defining being “elderly.”

3. Some of these words only refer to an individual’s age.

It seems that when an entity such as a government or an organization defines “elderly,” it uses actual numerical age as the defining factor. Government entities such as the Center for Disease Control and the World Health Organization define “aged” in terms of numerical age when doing research or stating statistics. As numerical age is a well-defined, fixed term, the words and phrases for old based on numerical age should be the answer to our search for a consistent definition of old. But these words are still problematic. This is because different numerical ages for being old are used based upon the country or topic being researched or discussed. These ages range from 50 to age 65 as the cut off between “younger” and “older.”

Many organizations find that their chosen numerical age for being old is not specific enough because it only marks an age when old age starts. They seem to all assume that old age ends at death. This means individuals will vary in how long their “old age” lifespan is. Organizations and governments recognize that there is a huge time span between age 50 and age 116 (the oldest person recorded alive in 2016). Thus some organizations split the “elderly” into two groups depending on their numerical age…the old (being 50, 55, 60, or 65 years and older) and the oldest old (being 80 and over in years). This again complicates the discussion about aging.

A widely accepted numerical age that has been used for many years to distinguish being old from being young in the United States is the year which Americans can draw Social Security checks from the Federal Government. Using this numerical age is problematic also. The United States government originally chose the age 65 as the age the when Americans can draw a Social Security check but as Americans are living longer, the US government decided that this numerical age is too low. The Social Security Administration has administered a complicated step process where the retirement age for Americans rises every so many months depending upon the age in which a person is born. This makes even Social Security eligibility an ambiguous and moving number for the sake of the definition of being “old” in the United States.

What Conclusions Can Be Made:

There is no definitive word that means to be “old” and there is no agreement of when someone becomes “aged.” There are a quagmire of terms and varied numerical ages commonly used. Being older means different things to different people under different circumstances. Fortunately and unfortunately those circumstances are as varied and nebulous as the definition of old age. This helps explain why we have trouble grappling with “elderly” issues. It shows why it so hard to define the needs of the world’s “elderly” “retirees.” We can not even agree to whom we are referring. “Who is old?” is a question with many answers depending upon many variables. This is an unsatisfactory end to my quest for clarity but it appears to be the reality.

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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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Is Honesty Always the Best Policy?

Honesty is a universal value, applicable to the general population and to specific professions.  We all can understand what it means to be an honest person and behave honestly.

People in our area of human services have some major challenges when it comes to honesty in every situation.  Our peers have called them “geriatric fiblets.”  This “fibbing” is particularly troubling for me.  I value truth and honesty as highly as any personal value.  If you ask my family for the one thing that will set a usually mellow me fuming, they will all tell you “lying” or “dishonesty.”  I find life is challenging enough without being given deliberately misleading information.  Attempts to be truthful are a critical component of communication.  Without it, “Oh, what a tangled web we weave.”*

Yet, we find ourselves recommending judicious dishonesty when dealing with some cognitively impaired clients in some circumstances.  The rationale for lying to a client is easiest to understand by example.  Mr. and Mrs. A had a spectacular marriage of 75 years.  They were always honest with each other, as we expect all good couples to be.  During twenty of those years, Mrs. A’s mother had lived with them.  When Mrs. A began to lose her memory, she would look throughout the house for her aged mother.  She would come to Mr. A often to help her find “Mama.”  Mr. A understood well that his wife was confused and unable to remember many things.  He would try his best to present the truth to her, as he had for 75 years of a close and honest relationship.  He would tell her as gently as he could, “Honey, Mama died in 1998; and she’s in Glendale Cemetery.”  Mrs. A received this “news” by bursting into wracking sobs as if her beloved mother had just died this day.  It broke her heart to hear her mother was no longer with them.  She had the wherewithal to understand death and her personal loss but her memory could not retain the grieving she had completed decades earlier.  Mr. A was unwilling and even unable to lie to her.  His persistent honesty, though with stellar intentions, caused Mrs. A such pain, it bordered on cruelty.

In situations like this, we strongly suggest setting aside one’s impulse to be honest.  Our preference would be to tell Mrs. A that her mother was “fine but not home at the moment.”  If pressed, we would invent something that would pacify her worry but not break her heart.  Perhaps her mother was visiting a friend.  Simply changing the subject can be effective in some situations.  We can try looking for Mama together until Mrs. A can be distracted by some other concern around the house. Direct honesty sometimes has to be weighed against the pain and frustration it can cause.

A completely different situation arises when there is a mistake rather than a lie.  When someone says the day is Friday, while the rest of us know it is Tuesday, s/he isn’t really being dishonest.  Nonetheless, the error is intriguing.  Before simply correcting the mistake and moving on, pause to consider what the error may mean.  Does it mean the person is losing his or her sense of time?  Did she decide it was Friday because she had prematurely taken Wednesday’s and Thursday’s pills?  Is she still waiting for something she expected to happen on Tuesday?  Also, consider the effect of us making a simple correction.  If this person is making frequent factual errors, how will being told she is repeatedly wrong make her feel?  It is certainly hard on the ego and can make the person feel less confident at a time when she may be losing her ability to think clearly anyway.  We once had a client, Ms. D, who insisted her nurse was stealing her stockings.  Ms. D wore garter style stockings with many runs in them.  The nurses were insulted to think they would want such things, much less steal them.  There was no point in correcting Ms. D.  She would only argue more vehemently to protect her ego and her wobbly sense of reality.  When her stockings were missing, she couldn’t tolerate the idea that she was the guilty party herself.  Best to blame others.  Those who got wrongly accused could take comfort in the fact that their egos are less fragile than Ms. D’s.  Ms. D made a mistake about her missing hosiery, but correcting her would be a harmful error on our part.

Honesty is still the best policy for the vast majority of life’s communications, regardless of age and impairment.  However, when someone presents an inability to remember and cope with what the rest of us perceive to be the truth, we are offered an opportunity to step back and ask “why?”  The need to be shielded from some truths can be a consequence of cognitive change.  If the person’s cognitive capacity has become limited, as in the case of Mrs. A, it is up to the rest of us to learn to adapt to her “reality.”  We would not recommend that the death of Mrs. A’s mother be kept secret from her.  However, we do caution that pressing the cognitively impaired person to accept painful information may not be wise or necessary.  Protecting the elder’s emotional health is very much an expression of love and kindness.

*Quote from Sir Walter Scott, Marmion.

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Some thoughts on Ethics.

It seems appropriate that my first blog entry (Mary Alice) should be about ethics. Long ago I began my academic education in the philosophy department, with a particular foci on logic and ethics. Applying ethical principles has been a important value in my life. Now as a licensed social worker, I take several hours of continuing education in ethics biannually.

People don’t discuss ethics as much as they get outraged at the unethical. Unethical behavior makes headlines. We read accusations of dreadful conflicts of interest among financiers and bankers and politicians. There is nearly universal condemnation for being unethical. Yet, there is very little discussion of being ethical. This discussion is how I want to start my blogging adventure.

Merriam-Webster defines ethics as: “Rules of behavior based on ideas about what is morally good and bad.”

One would think that being ethical is pretty easy. People assume they know what is the “right” thing to do. We learn right from wrong as children. We learn The Golden Rule. We are taught, “Don’t poke your sister with a stick.” How hard can it be to continue to do “right” and avoid doing “wrong?” Hopefully, we adults have all stopped poking people with sticks.

The challenges for ethical behavior arise when life presents choices which are not so simple. “To poke or not to poke” becomes “which poke is less painful?” There are times when there are no “good” choices at all. Even more complications arise when people disagree on what is really good, sort of good, a little good, not very good, not too bad, etc. Is “sort of bad” better than “not too good?” What do we choose when your good is bad for me? When we start to look closely at real life situations, the right thing isn’t always so obvious.

Thanks to all the philosophers and ethicists over the centuries, we have some guidance on how to make the complicated choices. Like the dictionary says, ethics involves “rules” of behavior. Even in complicated situations, the Great thinkers guide us with rules and their reasonings about those rules. Some are aimed at humanity in general and some are developed for specific areas of human interaction.

As licensed social workers we are guided by the Code of Ethics of the National Association of Social Workers. This includes the principles that we profess as social workers and which underlie our approach to human interactions. As care managers, we have an overlapping Code of Ethics developed by The National Association of Geriatric Care Managers. You can read these in their entirely at http://www.socialworkers.org and http://www.caremanager.org.

These codes of ethics both include many obvious “rules,” like respect people, keep confidentiality, make good records, know our limitations, etc. However, there are a few “rules” that pose some interesting challenges for our style of practice. These will be the subject of my next few blog entries. Stay tuned.

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What Does It Mean to Be a Senior Citizen?

As geriatric social workers, we notice that there are certain times in a person’s life when he/she begins to contemplate this question:

*When one is approaching a significant birthday
*When someone feels ill and/or disabled
*When a person assumes the care of a senior citizen
*When one’s own parents, grandparents, aunts, uncles, and/or neighbors become senior citizens
*When a student has an assignment for school about senior citizens
*When someone gets a job working with seniors
*When someone approaches retirement

So, what is the definition of a senior citizen? Who is a senior?

These two questions are easily answered by an unhelpful but true statement, “It depends.”

It depends upon how you as an individual define it or how your employer defines it or how your government defines it or how a business defines it, etc. Thus, the answer to “Who is a senior?” is as varied as the individuals and/or entities asking and defining the answers. This begs another set of questions that need to be explored in this discussion of what it means to be a senior citizen:

Who is defining this period of time in our life, how are they defining it, and why are they defining it?

Who? The answer to this question is huge and probably never-ending. A few entities and individuals come to mind, including:

*American Association of Retired People
*Life Insurance Companies
*Health Insurance Companies
*The World Health Organization
*The US Department of Health and Human Services
*The Department of Medicare/Medicaid
*Retirement Communities
*Travel Agencies/Cruise Lines
*Car Insurance Companies
*Our employers
*Financial Institutions
*US Department of Revenue
*Our children
*Our religious institutions
*Physicians and other medical providers
*Our neighbors
*Our extended family members

How is senior citizen defined?

Is it defined by age? Is it defined by our work history or retirement? It is defined by our physical ability or disability? Is it defined by our monetary worth as an employee? Is it defined as our productive worth as an employee? Is it defined by our relationship to others that are younger in our family and/or community? Is it defined by our mental abilities or disabilities?

Asking, “How is senior citizen defined?” really starts to get at the “meat” of the definition of being a senior citizen and accentuates the problem with defining this period of life. We, as social workers working primarily with senior citizens, find that definitions of being a senior citizen change throughout their lives. This definition changes depending upon the age of the person, the physical and/or mental capabilities of the person, the employment status of the person, the mental health of the person, the life experiences of the person, and the expectations of life for the future of each individual.

Why is senior citizenship being defined? Is it being defined in order to classify a group of people for a study? Is the definition used to exclude or include certain people for housing, government programs, or reduced rates at businesses? Is the definition used to determine rates for insurance? Is the definition used by an individual to access whether he/she should be capable of doing certain activities? There are many reasons why the image of “senior years” is defined. It is important to understand the reasons why the definition is being created while considering the definition.

As discussed today, the definition of being a senior citizen is complex and varied. As expected there is no one right answer to this question. The answers are as varied as the reasons for asking the question. We hope that this discussion will stimulate you, our readers, to think about your own definition of what it means to be a senior. Please feel free to share your thoughts about this subject and your personal definition of senior citizenship in our comments section. This discussion will start out fairly academic but quickly morph into talking about how “academic” and “official” definitions of being a senior citizen affects our personal expectations, stereotypes, fears, concerns, and planning for this period in our life.

In the next blog, we will explore some of the definitions of senior citizen that exist currently.