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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:

Aged
Old
Older
Elder
Elderly
Senior
Senior Citizen
Elderly Person
Older
Pensioner
Retired Person
Retiree
Older Adult
Geriatric
Mature

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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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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Quartet

Quartet

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


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Driving Miss Daisy

Driving Miss Daisy

In my father’s hometown, there is a grand old theater which features a notable film each month preceded by a catered dinner to match the theme of the entertainment.  This month was Southern fried chicken, slow-roasted beef tips, Creole mac & cheese, tomato cucumber salad and various desserts followed by 25 years of relationships in America’s Deep South.

When I saw this film years ago, I focused on the social inequities:  Miss Daisy Werthan’s dismissive rebuffs of her chauffeur Hoke, the various affronts to people in positions of servitude, anti-semitism expressed in a bombing of her synagogue, and law enforcement officers expressing prejudice against both people of color and Jews.

This time around my attention went to the issues of aging.  There have been many “Miss Daisy”s on the Elder Concerns’ client list.  Rather than see her as a difficult snob, I see her as a strong, common sensical, independent woman confronted with the losses that come with age.  In the first scene, she is forced to recognize that she cannot drive her car anymore.  That leads to a world of dependence which she resists vehemently.  When her son hires a chauffeur for her, she is offended by the need for a driver and offended that she is to be seen as someone so affluent as to have a chauffeur.  My heart went out to her. She can’t get around town alone anymore, she can’t drive her friends, and she has a “useless” employee eating her food and taking up space in her kitchen. She complains to her son that she has lost her privacy.  Much of this story seems to be Miss Daisy’s attempt to hang onto her lifelong values in the face of personal losses, all within a larger framework of societal upheaval.

Whereas on my first viewing, I understood that Miss Daisy and Hoke became compatriots by being both of oppressed social groups; now I see them becoming friends in their mutual paths of growing old and needing each other as individuals.  When the household cook dies suddenly, both Miss Daisy and Hoke agree the cook was “lucky” to have died unexpectedly while at her job. Soon Miss Daisy slides into advanced age and Hoke’s eyeglasses thicken. Miss Daisy eventually admits that Hoke is her best friend, something they have each known for years.  Neither loses their sense of humor, nor their sense of humanity.

In the profession of social work, we say that the relationship is everything. This movie is Relationship Building 101 for geriatric social work.  As well as darn good theater.D


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I’ll Be Me

I’ll Be Me is the autobiographical account of musician Glen Campbell’s diagnosis of Alzheimer’s disease and his remarkable final concert tour.  Glen Campbell, his wife, and his musical family has given us a wonderful and generous gift.  This film rings very true to our experiences with early-to-moderate Alzheimer’s disease.  Mr. Campbell allows us to observe his failing memory and inability to concentrate with genuine candor.  The film reminds us of all the marvelous music the Rhinestone Cowboy sang when most of us were focused on the Stones and Beatles.  We are stunned by his ability to continue to perform in top form in major venues while so sufficiently impaired he had to be reminded to stay within the circle drawn for him on stage, lest he wander into the audience to have a chat with someone mid-song.  We can marvel at his professional musicianship despite impairment and how deftly his family and supporters helped him continue to live his life “to the last minute.”   In many forms of dementia, music continues to be a mode of communication when routine speech malfunctions.  Apparently music knowledge and skills are stored in many cerebral locations, allowing people to sing when they can’t speak and sway to the beat when otherwise immobile.  There is nothing sad about this movie, other than illness sucks and life is never long enough.