Empowerment versus Control, an Important Difference in Engaging with Aging (EWA)

Empower: make (someone) stronger and more confident,

Control: the power to direct and determine

As life rolls by and we survive into the latter years of the lifespan, normal aging relentlessly changes our appearance and capacities. Gradually, imperceptibly the changes enter our lives. If we think about it at all, we realize that what we see happening is the result of invisible structural changes inside our body, changes that are beyond our control. We can purposefully engage in a lifestyle intended to delay them, but come they will. What we can control, to some degree, is how we acknowledge the changes in our capacities and which areas of our lives they have impact on. We can learn about adaptations to them that, in one way or another, become additions to our ongoing lifestyle.

One would think that all this constant work would be more than enough to expect of any older person. But now here we are . . . being presented with the additional demands of a raging CPVID-19 pandemic with its contagiousness and potentially dire outcomes. And, as if that weren’t enough, we’re surrounded by a wide range of conflicting official, political, social and personal attitudes and behaviors. Do we mask or not? Keep social distance or not? Sanitize or not? And if so, when and how do we correctly do each one? Each of these issues and tasks add major, complex loads to our already demanding ones.

We’ve no control over this presenting situation. The virus, the officials, politicians, businesses, and hordes of people around us control a host of dimensions that surround us.  We know we are at high risk for serious illness and even death should the virus strike us.

What each of us does have is the control (power to direct and determine), how we individually will respond to what’s surrounding and happening to us. And this is where EWA comes in, with its thinking-acting way of looking at both our situations and our personal capacities and assets for dealing with them

 Our existing EWA skills and experience can empower us (make us feel stronger and more confident), as we take stock of the current status of our aging capacities and link them to the specific tasks in daily living they have impact upon. Then we can plan and test the options for dealing with what we’re experiencing.  Sometimes we will start by looking at the task itself and find ways to accomplish it given our capacities and resources. But, as importantly, we’ll also deal with how we feel about the situation and having to make the changes as well as the resultant outcomes that might feel undesirable or uncomfortable to us..

 Our previous experiences in applying EWA to both tasks and our reactions in our lives empower us as we approach these new, complex requirements that have been thrust upon us.

Will we be able to fully achieve the outcomes in task performance or attitude we would wish for? We may not. But what we will gain is hard-earned knowledge about the EWA efforts we’ve undertaken and acceptance of the degree of control and outcomes those efforts are producing.  These well may be results we would not have achieved without our EWA skills.  And, in flexing our creative capacities and testing our adaptive strategies we’re adding to our competencies—bit by bit.  Fully confident?  Perhaps not. But stronger, more confident? Surely! 

We’ve achieved more experience and skills.  And, we’re more empowered to deal with the next challenge that is sure to come.

“Over 60”and Now a High Risk Group in the COVID-19 Era

In November 2019 China began to acknowledge that a previously unknown disease was infecting its citizens in Wuhan.  Information about it was released to the rest of the world in late December. It had proven to be a highly infectious and lethal, a “novel”corona virus with no known treatment or vaccine. 

But COVID -19 (as it came to be named) was a dark cloud on a distant horizon for ordinary people in the rest of the world.

January 21, 2020 began to change that in the USA. A respiratory disease was widely reported to be infecting elderly residents in a nursing home in Washington State. A week later it was killing some. It quickly spread across the region. It had crossed the Pacific Ocean. By March 1, cases showed up in New York. It had spread through the European continent, crossed the Atlantic Ocean and begun infecting and killing hundreds in in New York. Elderly people proved to become sicker and die more often than other age groups wherever the disease struck throughout the world. 

We became a high risk group, at risk ourselves and to others. Acknowledgement was soon being translated into regulations to protect “over-60ers” and their contacts. Within days, health care agencies and practitioners started taking measures to minimize some known risks by limiting on-site appointments and admissions.  

When I broke my forearm on February 29^th I quickly faced these just-emerging changes.

^{Two hours before I was to move from acute to rehab setting, it stopped admissions. Result: 4 expensive days in an acute bed until a rehab space was found. A week later my rehab institution quit admitting.}

^{A hand clinic scheduled an appointment to replace the now-dangerously-loose full-arm splint with a shorter snug one. Hours later a phone call rescheduled it to 5 weeks later, “Due to the Corona Virus”. Fortunately (within days), another hand clinic, using strict social distancing and sanitation methods, did it.}

^{A letter from my dentist recommended deferring routine exams and cleaning but making appointments for more urgent care.} 

^{Sensing an inpatient visit might not be welcomed, I sent my primary care doctor a written report, updating data on all the areas he usually asked about in my annual wellness visits.  His assistant called to say that this took care of it.}

Now this is just one person’s little experiences, but it seems the message has been going out and over-60ers are heeding it.  Nationally, outpatient visits initially dropped by 60% (April 2020), and remain about 1/3 lower than pre-pandemic ones. Caregivers are concerned that patients’ minimization of their symptoms of heart problems, cancer or early signs of strokes and reluctance to seek help are resulting in damage to the organs and disease progression might have been minimized.

In communities where mitigation regulations have been seriously enforced, the message is out. Close personal contacts for the over-60er and for the businesses that serve them is dangerous. The result has been that grocery stores, retail stores and restaurants have seen drops in business and closures.

Many retailers found safer ways to meet the needs of their elderly customers, e.g. grocery stores and markets set aside early-in-the-day hours where only “over-60’s” are admitted.  Pre-ordering, curbside pick-ups and home delivery are alternatives for a fee.

All these restrictions to protect us “over-60-ers” are understandable. But it can cause a feeling that we have become a pariah.

New for those who hadn’t felt class discrimination before and a double whammy for those who already had.

Still, in the USA COVID-19 looks to be a big part of our lives for the foreseeable future. It is what it is. Time for us over-60ers to pull up our socks put on our creative hats and find ways to meet our needs as the “special” group of people that we are.

We didn’t get to be this old without learning some tricks to manage our needs, even when it meant scrambling over obstacles.  And, we’ve found helping hands before.

We’ll try. We’ll engage. We’ll manage, somehow.

Agers and Healthcare Providers, We Each Need Data on the Other

It’s a given that those who give care to agers need data on us in order to deliver services that’re just right. What seems less obvious is that we need data on them in order to use their services effectively and comfortably. We’re each outsiders to the relevant lived-in-experience of the other.

At every level, care providers’ education/ training have a specific focus for knowledge, skills and values. And even within a discipline there can be sub-specialization. As they offer their expertise they bring that specific focus to both : data gathering and service offered. They also may bring a personal “bent” that shapes their care .

In most interactions, our care providers guide the focus and approaches. But it’s as important that we seek data on the their perspective /expertise before we meet and during our interaction, e.g.

In an intake interview with a new primary care physician, (when I handed him my POLST form), he asked if I would be willing to share my end-of- life care wishes. I did. But then, in turn, I acknowledged some limits of the system I knew existed and asked if he could provide my desired end of life care. He could. For a 95 year old and my family, this was timely information.) As importantly, it also set a tone for mutual information sharing and collaboration that shaped subsequent appointments.

Several factors influence the interaction between those who offer us care and we who receive it

Many if not most healthcare service encounters are intermittent and time-limited.

Even when care is more continuous  we agers are constantly engaging with our aging when the caregivers are present and when they are not.

Our healthcare providers are usually outsiders to “being old”. We agers are usually outsiders to their lived-in professional /care giving experience. For each the view is different.

When we can choose our care provider, we match person and their availability to our needs.  Think dentist,  primary care physician/ nurse practitioner, surgeon, psychiatrist, physical or occupational therapist etc.

But some situations arise when we have no choice, e.g.

Recently (in a span of three weeks), I had to learn the data desired by:

the emergency medical technicians, (± an hour)

the orthopedist in the emergency room, ( a few hours)

two assigned internists  an occupational and a physical therapist in, nurses and nursing assistants (acute care 7 days)

 a geriatrician, an adult nurse practitioner, two occupational therapists, three physical therapists, a speech therapist, a social worker, a nutritionist, a case manager, nurses and nursing assistants. (rehab 14 days)

2  case managers, 3 Visiting Angels, 2 hand specialists  (when COVID-19 and my age limited availability of the first one) my prmary physician,  dentist, dental hygienist. (home. . . . . )) 

Each looked at the same old lady with a fractured right forearm.  Most had access to data collected and treatment instituted by the earlier practitioners. Even within the same discipline, each turned out to have apparent, different interest, and priorities

  I learned I needed increase my skills in:

 communicating my values/goals, age related changes (ARCs) their impact areas and my adaptations in my daily living, e.g.

 identifying concrete, specific areas

using specific words

speaking in a concise and neutral way. ( None of this happens automatically.  It takes preparation.)

setting myself to look for provider data on the  :

perspective they bring to assessment and treatment to see how they fit with my needs, (e.g.one 3 -day assigned internist’s  total focus on laboratory values, not me)

specific areas where I need to provide relevant data on my ARC (age related change) capacities that should affect their clinical judgements on my:

status during the assessment, diagnostic workups and treatment planning , capacities to carry out prescribed treatment

At 98 it also seems prudent to accept that there may come a time when I can’t speak for myself.  So, I’m trying to keep those who would have to speak for me up to date.

Does this ring a bell with your experiences?

What’s different?