Agers as Enhancers?

To enhance: augment, boost, enrich, add to

After I wrote the EWA posting on enhancers who were the “wind beneath my wings” (8/29/19), it occurred to me that my enhancers were leading very busy lives. Even so, they were able to augment, boost and enrich my life in significant ways. Encounters with enhancers were positive and intriguing. I began to think about the reality that perhaps agers might be in a very good position to become effective enhancers.

We agers have time to think and reflect upon ourselves and others. Time to see and think about qualities and talents in others to which we respond. Seeing and responding to their capacities and potential may augment, boost and enrich their lives.

I thought about what enhancers have given me and how they’ve done it. They:

noticed specific qualities/capacities in me that I hadn’t seen, acknowledged or used; they responded to them in both behavior and words. At times they’ve identified specific capabilities and ideas in ways I hadn’t considered

showed genuine pleasure in my company.

listened, asked questions, posed ideas that conveyed genuine interest and added to those I’d offered.

Now these things I could do, one way or another.

So I began to ponder more widely on how we agers, each with our own attitudes and capacities, might softly enhance others. We wouldn’t need to be perfect, but we could try, starting in little, safe ways.

My lifetime best friend is almost two years older than me. Her ARCs have taken much from her. Still, she manages to enhance care givers and visitors alike. Care givers as well as family reportedly leave her bedside feeling better than when they came. I don’t know how she does it, but it’s an example that it can be done, even with very limited capacities. It’s led me to think about ways to communicate appreciation of and pleasure in qualities in others, other than just telling them. Eye contact, facial expression, body language, touch where appropriate come to mind. But it all starts with an attitude of genuinely caring, noticing and appreciating specifics in another person.

Another outcome enhancers produced in me is incentive. Many times, even in my advanced years, I’ve felt the need to “live up” to qualities or potential others believed in and shared with me. I’ve had two situations in which encounters resulted in visible incentivizing

During an intake appointment with a physician, I was impressed with a specific question he asked while he was washing his hands that changed my patient-doctor relationship with him in a meaningful way. He asked what I wanted from this first meeting. That immediately changed my participation from cooperation to collaboration in this session and subsequently.   In my next visit I told him how what he’d said had made such a difference. Apparently he hadn’t been aware of its impact and seemed pleased to learn of it, said he’d use it more purposefully .

Remembering his reaction, I decided to give specific feedback to a physical therapist who had: been welcoming of data from me on specific ARCs that were affecting my participation, and created a remarkably useful form to keep track of expectations and activity steps (despite my short term memory ARCs). After giving him this feedback the same collaborative relationship I had with the physician evolved.

As recipients of others’ care and attention, we agers have multiple opportunities to give feedback to care providers when something fosters engagement (and also when it deters it).

As I have thought about my role as enhancer I have (as usual), been my own lab rat. I notice myself enjoying

becoming more aware of qualities and behaviors in others that resonate with me

desiring to respond to them in ways that reflect my appreciation/respect/engagement

aware of my body language, facial expression, eye contact and touch to communicate in appropriate natural ways.

Whether I am a ‘wind beneath the wings’ of others, I may not know—nor does it matter. It does however seem that it may a way for agers to give as well as receive, even as our capacities become more limited and dependencies grow. And for me to remain green and growing.

Gratefulness Changes with Aging

Gratefulness: active, warm appreciation or thankfulness for something

Somehow, active warm appreciation and thankfulness are not words one associates with being old, nor thought of as assets in aging. Yet research suggests that an attitude of gratitude can have a positive effect on both mental and physical wellbeing at any age. Its potential payoff in itself might make gratefulness an attitude and behavior worth exercising and developing.

As I look back on my life, it seems that gratitude has gone through several metamorphoses over the years. From our earliest years, my sister and I were taught and expected to say “please” and “thank you” appropriately. We always ate dinner as a family every evening; and the meal was preceded by saying in unison a short traditional Swedish grace whose words we understood. At the end of the meal, we children would say, “Tack för maten” (thanks for the food) as we were excused from the table. These were rituals that became habits.

The next stage seemed to be thankfulness for things. And a bit later when really positive events happened or there were escapes from potentially bad ones, new dimensions of gratitude emerged. From there it moved on to becoming thankful for special people who were a part of my life and eventually for opportunities and the directions my life was taking that, at times, exceeded expectations.

The attitude of gratitude that has emerged in my very old age has felt different in its focus and nature from earlier experiences. (Yet another of aging’s surprises.) Here I am, seriously and noticeably losing ground in my capacities, I’m increasingly dependent, yet I experience more and deeper gratitude than I’ve had at any other age. It contains all the aspects of gratefulness of earlier decades plus new, added dimensions.   It feels deeper and richer.

My appreciation of and for family, friends and colleagues increasingly incorporates subtle, specific elements about them that I now notice and respond to. And it’s not just their positive aspects or kindnesses, but also their quirkiness and differing with me. What zest and interest they add to life.

A change that surprised me the most is the gratitude associated with my ARCs (age related changes) as they moved in to become my constant companions. They alter my capacities and make coping more difficult. They constantly invade the nooks and crannies in my everyday life both predictably and unpredictably. They narrow my physical world. I’m grateful that they: are normal, came so late and entered so gently that they give me time to adapt as they grow. And, annoying as they are, they keep me on my toes and certainly never allow me to become bored.

There’s my sturdy body that just keeps hanging in there and even now allows me to take it for granted in many ways. My airway is open. My heart keeps beating regularly. My immune system still keeps me hale and hearty. My mind keeps offering up new ideas, allows me to play with them and (if I hurry and capture them on the computer or in other concrete ways). Each part seems to be trying its best to keep me functioning happily.

The home with its view of the mountains and cityscape that my husband built for us beginning in 1946 still brings his presence. It wraps itself around me and testifies to his artistry, skill and his belief in doing things the right way so they would last. Its layout and planning supports me well in my aging.

My family, friends and other support systems are wonderful as they share my aging and keep me a part of their lives. They fill in the gaps so smoothly. My professional colleagues both challenge and support me, enabling me to reach and stretch even now.   My cat and I are aging together. Initially rather aloof, she’s found that laps and contact are indeed comforting.

The path that gratefulness has taken in the recent decades, has been a surprisingly satisfying experience.   And it’s nice to have discovered that in addition to the experience, it offers the potential side benefits of better health.

Fat Clustered in One’s Middle and Lost in Extremities – Winter Becomes a Different Experience

Reality and research agree that the total amount of fat and its regional distribution changes with age.   Total weight tends to increase as we continue to eat the way we always have, even as our basal metabolic rate for burning calories drops sharply and our activities decrease.

These fat increases relocate themselves to the abdominal area. But at the same time that we agers gain visceral fat, there are decreases in the insulating subcutaneous fat in our arms and legs. The non-scientific fat-in-the-middle explanation, as I’ve heard it, is that it’s there to keep one’s vital organs warm in the winter. Well that sounds as logical an explanation as any.

During recent decades I’ve very slowly lost weight, probably due to loss of muscle mass plus planning my meals to follow the sharp downward curve in my ability to burn calories (basal metabolic rate), and my decreasing activity. I was determined not to think of the needed changes in my way of eating as “dieting”. That felt too negative. And besides, this low metabolism and activity are ongoing.   Was I going to diet for the rest of my life?   I enjoy eating and there’s no way I was going to give up that pleasure. So, I just weigh in every morning and that keeps me shopping, cooking and eating reasonably for that day. I choose foods I like and prepare them in ways that still keep me looking forward to enjoyable meals. The result has been that my weight has come back down to what it was in my late 20’s, but my shape is no way what it was then. Instead my middle is disgustingly “thick” while my limbs have become scrawnier by the year. It’s a sort of a fat scarecrow look. Vanity, vanity!

Strangely enough, I’ve come to think that Mother Nature is at least partly wise. So even as I am disgusted by the fat in my middle, I’m glad it’s keeping my ancient vital organs warm enough that they function as well as they can. But why, I wonder, was it necessary to take away the insulating fat in my arms and legs? After all, they’re vital too! I guess they just carry on, hot or cold.

November is here!   My arms, legs and especially hands and feet, minus their fat layers (and with changed circulation I expect), are predictably and uncomfortably cool to downright cold. My feet feel like ice cubes, and once in bed, I’d prefer to disown them. And they take forever to warm up. Spring and summer seem an eternity away.

The winter wardrobe is back in use with its multiple layering of tops and heavier pants, socks and slippers/shoes. (I don’t go outside much these days.) Fleece and down are “in”. The thermostat is set higher. I’ve moved my recliner inches closer to a gas fireplace that has become the love of my life (and my cat’s too). And my quilts have been changed to the winter version. The electrically heated mattress pad is turned on so the bed is warm when I retire. Still I often feel cool.

But here I am complaining when I have so much that enables me stay warm. I know that in our city we have hundreds who don’t have a predictably warm place to live nor warm clothing and bedding, and even warm food. Time to think about passing along extra bedding and clothes as well as a contribution to an organization whose purpose and business is in helping these folks stay warm and fed. My dad was sponsored and helped by the Salvation Army when he left Sweden and landed with just the clothes on his back on Ellis Island and moved on up to New England to start his new life. That will be my choice.

Engaging with Aging: Accommodate? Adapt? Reconcile?

Accommodate: live with, make room for

Adapt: change to suit altered conditions

Reconcile: live in harmony with status and adaptations

In EWA’s early stages, evidence of age related changes to my appearance and capacities arrived stealthily enough that they really didn’t trigger a conscious need to accommodate nor adapt to them. Slowly, silently, they progressed and accumulated to the point where they invaded and impacted what felt like most of the nooks and crannies of everyday life.

Looking back, it seems that in those early stages I may actually have been casting a blind eye to them, wanting not to see them.   As a result accommodation to them could have been unconscious.

In the same way, early adaptations to my ways of doing things also went fairly unnoticed. But soon changes in capacities and their impact became so obvious that purposefully different approaches were required in order to continue to do the things I needed or wanted to do. Modifications in my clothing, makeup and hairstyle dealt with appearance ARCs. They seemed to allow me to appear close to what I had been—at least in my eyes. Modest adaptations in approaches to tasks permitted me to carry out usual activities without much difficulty. The results left me feeling in control of things, though mildly resentful of the extra effort.   Looking back now, it seems that there must also have been ongoing compromise or accommodation too, though “blindness” to what was happening became more difficult.

As ARC progression and accumulations grew, adaptations became more frequent and dug more deeply and widely into my way of life. Standards and expectations for outcomes became lower. Compromising and accommodating became the necessity, even with adaptations. And then another requirement entered the scene. That of increasingly simplifying the demands I made on myself and my expectations. My physical world became more circumscribed (though my virtual world continues to expand).   Still, even now, the accommodations and adaptations haven’t felt burdensome or painful. Fortunately the people in my life have understood and been accepting.   They’ve stepped in and adapted, right along with me as my needs and lifestyle changed.

Fast forward to the present. Rarely do I find myself “just doin’ what comes naturally”. Instead, there is conscious decision making, anticipatory planning and making adaptations throughout the day. My senses need to be on full alert with any activity. How do I approach each little task? What physical “assists” will be needed to protect myself when: my balance ARC is challenged? my hands can’t pick up or manipulate an object or complete an action? my short term memory decides to be “out of the office” when I need it? There is more compromising as I minimize or avoid tasks and situations that are beyond my capabilities. There also seems to be a growing need to consider and plan ahead for the “what if’s” that could happen. “How do I need to be prepared to respond if . . . . .?”

Reconciliation (living in harmony with) is now the name of the game as activities and experiences are dropped from my life. But it’s also remarkable that sometimes highly satisfying substitutions have come to mind as well. And once again, others step in to become “winds beneath my wings”. Occasionally there are times of grieving. But for the most part the changes are not grudgingly given.

The time may well come, slowly or suddenly, when my precious semi-independent way of life no longer is possible. I think about my earlier blog posting about resilience in aging and how it was different from earlier years (10/31/18). Now resilience means reconciliation—“living in harmony with” a possible lifestyle of greater dependence. I wonder if I’ll find ways to manage that with genuine grace and humor.

I’m able to write this blog posting because I’m a well-supported, healthy female who has benefitted from a long gradual aging experience. Is it different for males?   Do fellow agers who’ve faced sudden, more-demanding aging experiences use different strategies to accommodate, adapt and reconcile? Are yours different?

Dealing With Distraction

One of the normal ARCs (age relate changes) affecting our cognition is the loss of control over our attention—the ability to focus on a single task and tune out distracting thoughts. Apparently, the circuitry gradually breaks down between two regions of the brain that had worked together to allow a person to attend to a single task and tune out other thoughts. And it too (like so many other) starts in one’s 40’s.

There was a time when I could focus intensely on a task without consciously having to prevent intrusion of other thoughts.   And at that time I also could count on my hands or my body to automatically take care of routine tasks or activities while my mind was free to go wherever it would, or needed to. It all happened so naturally that of course I took it for granted.

Now, a half century later, neither is true.   The most basic tasks my hands and body once could do without thought, now constantly require purposeful awareness and decision making. I’ve had to unlearn automaticity with them.   And at the same time my mind now keeps merrily flitting around to things that have nothing to do with the matter at hand. It’s a double whammy.

I tried reading about the underlying cognitive mechanisms creating this change, but most of the research was in discipline-specific language that was well beyond my ability to understand. However, in my reading I did learn that neurons and connections in the brain do keep on growing in some areas of the brain, even as we age. (But apparently not involved in attention/distraction). Now that‘s both encouraging and discouraging.

I decided to experiment using some of the strategies I’d developed in dealing with other changed capacities. Repeated use of the mantra “NOSE & TOES!” (thought loudly if that is possible), had been improving my balance when I was involved in turning maneuvers. And “CENTER YOURSELF!” worked if I remembered to think it when:

rising from sitting to standing or any bending-over activity and before taking the first step

lifting or carrying objects of any weight

I was about to be hugged.

My new anti-distraction mantras are: “FOCUS! FOCUS!” and “FINISH IT!” I’ve only been using these newly created mantras for a week or so, but they seem to be making a difference.   The tasks where I’ve been testing them are in the kitchen in meal preparation, clean up and all the other sundry tasks that pop up in this area throughout the day. And somehow, both my brain and I seem to be rather proud of the results. Life feels a bit more orderly and certainly the kitchen looks neater.

So far, I’m fortunate that I seem to be able to focus when I am writing or reading. (Here it is my ARCed short term memory that is the culprit creating havoc.)

Somehow my philosophy of “Sufficient unto the day. . .” continues to stand me in good stead. We’re engaging and managing. It is just more complex and challenging.

Balancing Requirement and Resources: One Pragmatic Way to Manage Daily Living

Decades ago I began using the imagery of a balance scale as a concrete way of seeing daily living—my own and that of patients.   I placed what I saw as requirements in daily living on one side and resources (functional capacities and external assets) on the other. I used it to think about:

what it would take to manage the day, week or even longer periods or even just a task or a project

the level of the balance in general and degree of satisfaction with it

I don’t know how others would define requirements and resources and make it work. But here are the ways I define and use them.

On my requirements side I place

• any activity or experience that I see as demanding use of my physical/cognitive/ emotional resources or outside assets.   I find that they include: demands that I make on myself (the “musts” “shoulds” and “doesn’t matters”) but also what I truly want to do. They also include the demands that others make on me, e.g. family, friends, pets, health care providers, government, weather, terrain, etc.

On the resources side I have two sub categories, my internal functional capacities and outside assets.

• my functional resources included any relevant physical, cognitive, emotional capacities in whatever status they are available to me at the time of need. I also include some other elusive resources such as courage, creativity, desire, imagination initiative, perseverance etc.

• my external assets include people in my life (personal, professional et al,) things (tools, equipment etc), services, environmental/natural assets etc.
  Note: Wishful thinking is outlawed. These assets had to be realistically
  • available geographically, physically, monetarily, culturally . . . . .
  • accessible in language I understand, offered in ways I can accept, within my beliefs or values so it was possible for me to engage with them. . . .
  • usable, something I could actually physically, mentally do (e.g., weakened hands prevent me from manipulating dressings in wound care , tiny pills etc.)
  • sustainable, continuing to be available, accessible and usable for the duration of my need for them.

What triggers my thinking about R&R balance?

Again the “devil is in the detail”. I found that changes, increases or decreases in one element of the balance affected other parts. For example: If one of my functional capacities or one of my outside assets changed, it affected specific areas of my requirements, other capacities and the use of my assets. Conversely when something was changed in what I had or wanted to do, or someone else expected me to do it required attention to other specific requirements, capacities or assets. But it was always real, concrete.

Initially I tended to use this image in situations where either a new demand was made or some capacity or resource changed. Then I realized there were times when I had more capacities than I was using or shrunken capacities improved—I could require more. Or someone else saw capacities I was under- utilizing, such as the time when someone convinced me to write this blog. Or someone stepped into a situation and offered to help me to do more or differently.

The balance is not a steady state in degree or overall level

For me, the degree of balance can vary from day to day. But there’s usually been a general sense of it. The level of balance also varies.   For me, some days it feels high; my resources allow me to do everything I want to do; other times it can be much lower.

Satisfaction with the level of one’s balance

Each person has their own degree of satisfaction with the general level of their balance. I’ve seen patients who were dissatisfied with what I saw as a high level of balance given their circumstances, and others who seemed content with their balance at precariously low levels.   Satisfaction is in the eye of the beholder.   Outside groups have researched and defined what constitutes “ideal” or “healthy” balance in aging.   Individual agers’ own satisfying/unsatisfying balances may or may not conform.

ARCed Balance is More Multidimensional Than I Thought

Through most of my life my idea of balance was a general notion of being able to be upright and steady. In a physiology course I learned that the organ that enabled balance was a complex vestibular body located in the inner ear. The other day, a physical therapist taught me that it is three pronged: vestibular, vision and proprioception.   ARCs (age related changes) affecting balance tended to begin in one’s 40’s. And through it all balance seemed to me to be a generic, unitary function—being securely upright.

As the balance ARC crept silently into my life, I became increasingly aware of reaching out to put my hand on a solid surface to “steady myself”. But if I thought about it at all, it still was about uprightness and steadiness and found myself being curious about how it would manifest itself as the ARC progressed.

Well, that curiosity is now being satisfied. And (as with so many other realities of aging), it brought its surprises. It proved to be not just one entity. No, it was far more complex than that. It manifested itself in separate capacities which impacted specific daily activities linked to high risk locales. Different adaptive strategies were needed for each.

Six risk activities appeared to be altered by my Balance ARC, turning, centering, bending, dealing with darkness instability when moving about and now, even when standing.

Turning: when my head and body/feet faced in different directions and the difference was greater than 90° “tippiness” and physiological “near-fall“ sensations (an instant nasty gut reaction without the subsequent fall). The highest risk area proved to be my kitchen with work areas on all four sides. Adaptation: Say/think “Nose&Toes!” to remind me to keep face and feet pointing in the same direction. (blog 11/16/17) To move objects about, slide them on nearby/adjoining surfaces. With 180° or greater turns, find intermittent surfaces to allow for reorienting one’s feet.

Centering was essential when moving from sitting to standing, after turning, when picking up or carrying items, or being hugged. (9/5/18) Adaptations: Say/think/do “Center yourself!” before engaging in the affecting behavior. Brace the body before lifting an object large/heavy enough to pull one off-center. Hold objects close to the body when moving. Alert huggers to the risks of pulling one off center or brace part of the body against something solid before hugs. Most recently, even merely standing triggers teetering. Now that’s really scary for the increasing risks it portends.

Bending:  during any activity below waist level, e.g. bed making, picking up/dealing with objects on low shelves or the floor. Adaptations: Brace one hand or body part against a solid object during the activity (e.g. lower legs resting against mattress in bed making, sit on walker to deal with things on lower shelves or picking up objects from the floor). Last resort: ask someone else to do the job.

Dealing with darkness: this challenge to balance occurs most for me in the living room where evenings are spent. Adaptation: Get up and turn on the wall switch before turning off the lamp. Turn on/off lights upon entering/leaving a room. Turn on night lights before retiring. Keep a working flashlight on the bedside stand in case of a blackout.

Needing hand contact with my walker or body contact with a solid surface in order to feel secure. Riskiest when getting up during the night and when moving about open space in the kitchen. Adaptation: Keep the walker within arm’s reach at all times. When both hands are needed for an activity, lean lower body on available solid objects (e.g. counters). Use a tray on the walker seat to transport objects about in open spaces. (4/26/18)

Being constantly mindful of my balance when I’m just standing still, even in the midst of everything or anything else, is a new reality that’s demanding adaptation. Hopefully an upcoming new physical therapy regimen will at least slow this ARC, perhaps even reverse it a bit.