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.

“Co” – An Important Prefix to Some Words In Engaging with Aging

Coexist: to live/exist with

Cooperate: to willingly to work with

Collaborate: to actively engage in partnership with

“No man is an island entire of itself” (John Dunne, 1624). Nor do we age in total isolation though it may feel like it at times.

As an ager who lives alone in her home I’m very much an insider within my world of the aging and an outsider to others’ age-related worlds. But I’m not really alone. In varying degrees of closeness I’m relating to others, one way or another. I’m fortunate to have caring, interested people with whom I have face to face contact and many I know only virtually as we share of ourselves via computer and other means. Some relationships are family, friends, or casual encounters. Others are intermittent, time limited professional contacts. So there are many interpersonal options for my “ co-relationships”.

At present I can’t think of any who merely co-exist for me. Perhaps fleeting, focused ones via computer communication. But even casual intermittent contacts with those who primarily relate to me in terms of service tend to turn into momentary enjoyable, mutual encounters. As for the future?   I may yet have to learn how to coexist and tolerate. Will it occur in situations where I have less control over my lifestyle, lose my ability to speak or ?

I can identify some instances where the relationship is one of cooperation. Recently I was meeting a dental hygienist for the first time. Sitting with one’s mouth open suggests necessary cooperation and not much more.   I wondered if I could achieve more than a cooperative relationship. To my surprise and delight, it became possible through snatches of conversation before, during and after. We each learned from the other and looked forward to the next encounter.

It seems that most of my relationships are purposefully collaborative, whatever the encounter. With family and friends in our frequent casual contacts, mutuality and collaboration seem to be central to our enjoying each other as thoroughly as possible. (My need to have everyone “feel at home” and pitch in on any needed activity tends to dispense with formality.) Our interactions offer personal perspectives and often spark ideas that might not have emerged otherwise. In the end it feels as if each one is feeling both more fulfilled and enjoyed.

Even when I met my new doctor for the first time, he opened the door to collaboration by asking what I wanted to achieve in the intake interaction. I was taken aback as no physician had ever asked me that. I surprised him by responding that I wanted to begin to form a working relationship with him. (I wanted one where we each understood the needs and goals of the other.) In my next appointment, once I’d met his needs to update my database, I asked him if he wanted to know the status of my ARCs (age related changes), as they might affect my health care. He did. My concise presentation probably took a couple of minutes. (I’d rehearsed it.) He took notes and asked questions. He had data about me that he wouldn’t have had if I had only cooperated. Based on that collaborative endeavor, months later, I handled a post-fall emergency appointment with a different physician by providing data on my ARC status and daily living demands that were serious deterrents to the proposed treatment. For the first time in my life I rejected the normally accepted treatment— I’m living well with a tiny broken bone in my left hand.

For my part, it would seem that all this may be possible because I still can see, hear (with some assistance) think and react. I have no pain or other manifestations of pathology that interfere with my capacity to interact freely. A time may come when that will change. “To everything there is a season . . .”

Comments from readers who are having different experiences with coexisting, cooperating and collaborating will be enlightening for me and other readers

An Engaging with Aging Logo and Its Interpretation

Recently, the idea came to me that it might be possible to create a logo that would display and encompass Engaging with Aging as presented in this blog. I found that I could identify the elements and their relationships. But translating them into a little logo was totally beyond me. My younger son came to the rescue and offered the talents of a young artist in his company. I shared the ideas. In a month Michael created this logo.

The circular area symbolizes the world of daily living as the ager is experiencing it, seeks to understand and engages with it. This “world” surrounds the aging insider wherever that daily living is occurring. It becomes the basis for the “engaging” activities. Outsiders’ visions of the same experience may or may not be congruent with those of the insider.

The perimeter has multiple openings to permit outsiders’ contributions to enter the ager’s world and the insider to reach out and interact directly or virtually with others’ worlds.

The river of aging wends its way through the countryside of the ager’s daily living and inevitably out to the sea. All rivers of aging have in common: changing currents, obstacles, white water and waterfalls to be navigated.   But each individual’s river of aging is unique in its length, currents, obstacles, white water and waterfalls. The ager has options to go with the flow, or to actively seek to “read the river” and actively navigate it, as capacities allow.

The green leaf symbolizes ongoing “greenness” as new experiences and challenges test capacities and offer opportunities for personal growth, even as capacities are altered by normal age related changes (ARCs) and pathology.

The individual in the center is the engager. The nature of engagement will depend on levels of interest, courage, and cognitive and physical capacities. Others may help out by identifying blind spots, enhancing the engager’s resources, supporting in ways to make engaging possible, easier or more effective. But only the engager can do the engaging.

The sun is the symbol of the life force that makes possible the engaging. Bright or dim, its light and outward rays affect all parts of the engager’s world. Its rays reach out to outsiders as well.

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In this Engaging with Aging blog I’ve applied the ideas of this logo to the elderly. But the reality is that infants begin engaging with aging and daily living from the moment they are born.   So this logo, its elements and relationships are equally usable at any age. Yet-to-be-agers and care providers who are interacting with others of any age can find its elements and the relationships between them a useful perspective for shaping their expectations and interaction.

Creativity, an Essential Element of Engaging with Aging?

Creativity: the use of the imagination or original ideas, especially in production of artistic work.  Inventiveness, imagination, innovation, originality.

When I was an “outsider” to the world of the aged, it never occurred to me that creativity might be a part of it, much less an essential one. I thought of creativity as being associated with the prime of life. Common knowledge seemed to be that aged people are “past their prime”. I also apparently limited creativity to the definition up above. Besides, who linked being old with imagination or originality?

It was only as my ARCs (age related changes) not only emerged but progressed, accumulated and began to invade the nooks and crannies of my life that the need for creativity became obvious. And it didn’t seem to involve imagination as much as paying attention to: details of what I could no longer take for granted, do easily or at all, and which changes in capacities were snarling things up.   I suppose if I had been content to just ride the river of aging and let things happen, this issue of creativity would not have arisen. But I wasn’t one who was happy with letting things slide. Gradually I began to see a pattern in the changes I was having to make. EWA was born. Eventually I even came up with a shorthand formula for it

Age Related Changes Impacting on Daily Living Activity Leading to Adaptation

or shorter still

ARC →Impact Area→ Adaptation

Now the inventiveness, innovation and even imagination began to come into play. As clumsiness and weaknesses grew, my response was, “OK Doris, now how can you do it differently? more safely? Some things I found I could do early in the day but not later. Sometimes I had to break the activity up or space them out. Sometimes I had to use objects in ways they weren’t intended.

ARC: Weak hands

Impact Area: inability to open dishwasher not only when it was “on the latch”, but even just partially closed. I needed to put dishes in it often during the day.

Adaptation:   I propped the door open with a rolled up terry towel. I also timed my dishwashing to fit with my primary care giver’s visits to open it

Impact Area: inability to open drawers for which my husband had created circular wooden pulls

Adaptation: I found some cord, made a sliding noose that I could slip over the knob and a foot long “tail” to wrap around my hand and pull it open.
Pretty primitive creativity, not the least artistic, but efficient!

I also began planning for what-if’s.

ARC:   Decreased night vision.

Impact Area: What if I needed to call someone during the night.

Adaptation: On the shelf next to the side of the bed where I sleep I placed reading glasses and a flashlight (the light switch was too far away) and my cell phone with a list of speed dial numbers for people who could help.

A colleague taught me about having a “nest” around the seat where I’d spend the most time. It would include all of the items it would be nice or necessary for activities I carried out there plus adequate lighting.

And so it has gone. When my adaptations work, tiny triumphs brighten my day. Failed attempts lead to revision or sometimes making a decision about whether the activity is essential to my well-being. I suspect there will be more of them as my ARC imps invade more nooks and crannies in my life.

There may well come a time when I am no longer able to create and adapt for myself. In preparation for that “what if”, I’m keeping my near and dear ones informed of my preferred approach and strategies. They may well need to be my keeper of the flame.

I’m coming to believe that this creativity in aging is an attitude as well as an approach. I also realize that it takes cognitive abilities as well as physical and emotional energy. Those are not always assured as one ages. Then one can only hope that one’s care givers also see this creative approach to aging as worth pursuing.

100th Blog Posting: A Time to Look Back and Ahead

It’s still hard to believe that I (a social media troglodyte) began writing a blog at the age of 95. I’m so grateful for the two people who made it come to life. The one who believed I had something to write about and the creative expert who generously and dependably takes care of the technical aspects each week.

I know it’s true, but it’s rather mind-boggling to realize that in the two years since that first posting (mid-August, 2017) I’m posting my 100^th blog post. And there are more in varying states in the queue.

What a journey it has been! Such unanticipated impacts on my life! Writing to you has sharpened my own “engaging” skills. It’s one thing to engage with aging casually, harder to do it purposefully, and even harder to put it into words that will make sense and be usable to others. Thinking about this blog has become a red thread in the tapestry of my life as I interweave my ARCed aging capacities with daily living demands and then write about it. I wake in the morning, ideas churning, eager to start the day. The activity has changed and continues to change me. Others have commented that I seem younger and more vibrant at 97 than I was at 95, and it rings true (even as I obviously age).

As I began thinking about writing a blog, I saw myself as a female ager writing from my encounters in engaging with aging as I gain insights. I am definitely not an expert on aging in general, just mine! I am limited in my vision by the reality that I am a remarkably healthy former RN/faculty member/writer and widowed nonagenarian, living alone in a home she owns, with two supportive sons, their wives and three granddaughters (all of whom live within a few miles). I realized that my blog would reflect my blind spots about aging in other circumstances. So there would be no “how to’s”, just vignettes of my own EWA encounters, reactions and insights. We all are being carried down the river of aging, but each of us has our own river to navigate and our own approaches.

With these caveats in mind I decided that I would:

• offer my experiences, insights and ideas as potential points of departure for the reader’s own unique situation and capacities.
• limit my focus to EWAing with normal age-related changes (ARCs) precisely because I didn’t have pathology and its treatment interwoven with my normal ARCs and daily living.   My thinking is that ARC-affected capacities are what any ager brings to living with an overlay of pathology and its management. (Care providers need to know about them too.)
• view the aging experience broadly while giving the health element its necessary place
• focus on the impact of ARCs on the details of everyday living. Again, because I was living with these nasty snags. (Besides outsiders to the world of the aged were researching and writing about ARCs, but it takes an insider to see their personal impact.)
• use a “light” approach in my writing style in line with my belief that data are neutral, including data on one’s emotional-laden responses to aging and its effects
• seek images to enhance the ideas to stretch the reader’s mind

Looking ahead, I foresee postings that reflect my accumulating, progressing ARCs, their effects that are creating increasingly difficult challenges and the constant, conscious adaptations that fill the minutes and hours of my day. I’ll continue to share what I can of my ongoing journey.

When I no longer can, let’s agree that, “To everything there is a season. . . .”

I am so grateful to those of you who join me on my blogging efforts by commenting or otherwise giving me feedback.   I feel like Longfellow’s archer who “ . . . shot an arrow into the air, It fell to earth, I knew not where. . .”.   Your input lets me know where at least some of them land. Beyond that I value your reactions and learn from your comments. Let’s move on together.