“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.

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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

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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.

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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.

Why My EWA Blog Doesn’t Address Pathology or Trauma-Affected Daily Living

Everyone who survives into the latter years of the lifespan experiences progressing, accumulating ARCs (age related changes) that affect all aspects of their daily living. On top of what’s natural and normal, most will also experience pathology and trauma and the demands of its management. These further affect agers’ requirement in daily living and their resources for managing them.

I came to aging well-armed with book-knowledge about and some experience in caring for people with both normal aging and pathology prevalent in aging. I thought I knew what to expect. And, as far as those expectations went, it was useful. But it was not enough! I’ve been one of the fortunate agers whose health seemed to remain intact. My ARCs emerged, progressed and accumulated, just as the books said they would.   What I haven’t experienced is the overlay of pathology or serious trauma.

Given this background, I found that what I hadn’t learned as an outsider was the reality of ever-present ARC impact on so much of my daily living. I began to live with Hyman Rickover’s insight that “the devil is in the details, but so is the salvation”.   My constellation of ARCs (even in my daily living as a healthy, well supported, super-ager), bedevil me and trip me up throughout each day. I struggle to understand, to learn, to adapt, to work over or around them or eliminate what I can’t manage. As an inside-ager, I’m respectfully gaining new working knowledge daily.

I am realizing that my normal ARCs plus the knowledge I have of them and the skills I have developed in dealing with them are all that I or any other ager “bring to the table” when pathology or trauma add new requirements to daily living and alter my capacities and resources for managing them.

Given my own situation, I feel honest in writing about my insider daily-living-with-my- normal ARCS . I know that this is important and will affect actually living with pathology and its management if or when it occurs. I can only speculate how specific pathologies and their management could:

alter specific capacities I now have

increase/modify the requirements in my daily living

change my relationships with my support figures and external assets.

I also have learned that my relationships with family, care providers and friends are more effective when I neutrally and honestly communicate my EWA status and its impact to them. I expect that this same deliberate transparency should apply in my interaction with those who will help me manage my EWAing with the overlay of pathology and it’s management.   And, since there can be a risk of my losing my thinking/community capacities, I’d be wise to prepare my designated care providers to be able to be my voice in communicating with health care providers if I no longer can. I’m actively doing that.

There’s an old saying that “the shoemaker should stick to his last”. I take it to mean that I should know what I can write about, write it well and not go beyond that.

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So, I leave it to fellow-agers who are actually living with normal ARCs and the overlay of pathologies and their management to share the reality-based, specialized working knowledge and arts they have gained in their own blogs.   And of course your comments on my EWA posts that offer insights of application to your different situations can offer EWA readers and me insights that are useful.

After the Fall was Over – Resilience or ???

Resilience: the ability to be happy, successful, etc. again after something difficult or bad has happened  –  Merriam-Webster

 an ability to recover from or adjust easily to misfortune or change – Cambridge Dictionary

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In 1891 Harris wrote a lilting waltz tune about a young man’s disappointment “After the Ball was Over”. The tune came to mind as I was recovering from a recent fall hence the blog title. I haven’t written much about falls, because fortune has favored me with few of them in my decades of aging and none has been more traumatic than leaving me feeling a bit banged up for a time. But I have felt disappointment, even anger, certainly frustration after the fall was over.

My recent fall resulted in minor trauma. But at 97 it was a different experience. By this time my half dozen ARC imps (age related changes) had become my constant companions, poking their noses into many if not most of my daily activities. They seemed to see my fall and slightly banged up state as a great time to create more mischief. My Balance ARC kept me scarily feeling like I might topple over whenever I was upright, particularly when I first rose in the morning. My Strength ARC imp’s tactic was to make it even more difficult for me to rise from sitting to standing and to grasp or manipulate things with my already weakened hands. Stamina’s imp made me head for the recliner after just a small amount of activity and made me feel as if this was the only place to be. My Short Term Memory ARC, as usual (only more so) sneakily bedeviled me with its unpredictability in enabling me to recall information I needed and caused worry that there might be some recall I needed but didn’t even realize. My self-confidence was shaken. And all this with hardly any trauma! My well springs of reserve seemed drained dry and snail-paced at refilling. Now with so much ARC imp mischief, how was I going to be “happy and successful” again, “recover from or adjust easily”?

Well, it appeared I was going to have plenty of time to think about it as I lazed in my recliner.   My long term memory (that seems to be working very well) came up with a Bible verse. “The spirit indeed is willing but the flesh is weak. . .” (Matthew 26:41). That’s where I was now. Fortunately, I found that I still had spirit, I had blog ideas just waiting to be written, projects in various states—things to think about, things I could do that didn’t take much physical energy or strength. Some of them, I could do sitting at my desk or even making notes in my recliner.   I wanted and needed to recover in the best way possible. I accepted that it might be frustratingly slow, but at least it seemed doable and highly desirable.

Of course it helped immeasurably that family and nearby friends checked in on me by phone and in person, did the few things I needed but couldn’t do. And provided me with salads, soups and easy to fix food. But pacing myself and being satisfied with small gains would be frustrating. I also realized that falls, like having pneumonia, made one more vulnerable for recurrence.   I needed to keep my wits about me, be careful and no hurrying!!!!!!

Days later I realized that falls actually were learning opportunities. I analyzed this last fall and saw that I had broken two of my EWA commandments:

always keep nose and toes in alignment when turning

stop and center consciously before taking that first step after turning (particularly after rising from sitting).

If I were to avoid high risk falls now, I needed to purposefully follow both of these. I needed to avoid hurrying for any reason. I needed to keep my expectations and plans in alignment with my capacities.

Beyond these, I would work on patience, identify small gains and be grateful for them. I’m still green, still growing.

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Help Has Several Faces

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Throughout my life I’ve been involved in helping and being helped. In earlier times I tended to take help more for granted. As a child I received help, some I wanted, some I didn’t. As a nursing student and RN I learned to offer purposeful specific health related types of help. It was what nurses did. As a teacher I learned ways to help my students. In familial and social relationships, I learned other approaches. From all of them I learned about the give and take of different helping relationships, somewhat as a matter of course.

Then came the time and experience of aging where my prevailing situation has become more often that of being the one in need of help, with only limited capacities and resources for helping others or even reciprocating to those who help me. Engaging with this helping element of aging led me to start looking at the basics of this helping business.

I began to see helping as consisting of three options: doing to, doing for and doing with. I looked for examples of each in my daily and found them.

I thought of those whose help involved doing to me.

I consult and use professionals to manage my physical health, e.g. the dentist, dental hygienist and physician who diagnose and prescribe and at times do to me, the pedicurist who keeps my (now distant) toes and feet in shape. Since I take the initiative in consulting them and the extent to which I follow up on their proposals, I still have some options. But I can readily foresee situations and institutionalizations in which the doing to will be increasingly extensive and out of my control.

The next “doing to” is less obvious. These examples involve those who knowingly or unknowingly communicate words and behavior that “do to” my mental and emotional status for good or ill.   But thus far, I sense that I do have some choices in how I use that input. (See Data are Neutral, My Reactions are Not 4/24/19, and Words Make a Difference 5/29/19)

Real, but even harder to detect, is the doing to by known and unknown people, businesses and institutions whose way of functioning or business model includes sharing information about me or purposefully invading my privacy with or without privacy forms (whose language is often so arcane and obfuscating that it’s hard to know what one is signing). They do to me without my knowledge.

I see doing for me as involving help that takes the place of what I would/might wish to do for myself.

Usually it occurs after learning what I need or want, but occasionally is based on what the helper thinks might be best for me. Sometimes it has been helping me to look at situations through “fresh eyes”.   And then there are people doing for me in ways that go beyond what I might have wished for, or even thought possible. And such thoughtfulness is as much a gift as the gift itself.

Finally, there is doing with.

This involves mutual engagement.   Here each of us has a sense of gains in the helping activity. The result feels greater than the “sum of the parts”. I’ll have to admit this is the most satisfying kind of helping I experience as helper or helped.

I find that each type of helping has its place.   Being an EWA-ing help recipient demands that I:

seek help appropriately in terms of when each type is most useful and desired

recognize the type of help that is being afford and respond accordingly

provide helpers with data and information to enable them offer help in ways that are most effective, efficient and satisfying to us both.

Putting One’s Best Foot Forward In a Different Way

From the time my sister and I were very little, mother taught us by word and deed about the need to “put our best foot forward” when we had guests or were guests (though she didn’t use those words). We were taught how to use eating utensils, table manners, greet people and manners in general. As I look back on it, I remember our home as usually neat and clean, but it needed to be especially so when guests were invited. Mother was a good Swedish cook and knew how to prepare a delicious, attractive meal and serve it well. As my sister and I grew up and started families of our own, we tended to continue what we had been taught and enjoyed doing it. It all was unquestionably friendly, but had a certain degree of formality to it.

Fast forward to the present. Aging has not only moved in, but has gradually taken over my capacities to put my best foot forward. My standards and efforts are the same. The friendliness is as present as ever, but formality and execution have flown out the window. I still can set a table, have everything set up and arrange for beverages, but prepare and serve a meal? No way! So guests tend to come bearing food. Once here, everyone pitches in, chaos occasionally reigns.   Service may be buffet style with guests serving themselves from a counter in the kitchen and returning there for “seconds”. And they usually want to help with the cleanup, though I’m still capable of doing the dishes. The casual comradery seems to feel as good to everyone as the genteel service of earlier years.

I don’t go out much for meals, but even at home I may need assistance in serving myself and cutting things into bite size pieces. Once I got over my shyness about this and could accept it neutrally as “this is what it is”, no one else seems to mind at all. As someone once told me, “No use getting your knickers in a knot over it.” So I’m learning to accept who and what I am on any given day, and others do too, thank goodness!

I also look back on my days as a nursing student in a hospital based program where much of our learning took place as we cared for patients for hours each day, and later when I worked as a nurse and head nurse on hospital wards. It seemed to me that patients perked up and tended to want to put their best foot forward when the doctors were making their rounds. And I too on my infrequent doctor visits find myself wanting to do the same.

Still, what’s important for both doctor and patient, or any other care provider and recipient is an honest encounter where accurate data on the actual status becomes available. Putting our best foot forward in this situation now would seem to be preparing ourselves (as our capacities permit) to provide/communicate accurate data on our status in relevant areas rather than try to be seen “at our best”.

In my last checkup visit with the doctor, I had written out a list of my current ARCs so I could quickly, sharply present them (and, in case my short term memory lapses kicked in). After he had asked his questions and done his inspection, I asked if he was interested in the status of my age related changes. He was. I brought out my list, explained why I had one, provided data on each ARC’s status. He asked questions and made notations. He had important data he would not have had if I had not prepared and taken the initiative. I felt I’d put my best foot forward in a new way.

So, I’m learning new best-foot-forward lessons. It’s still fine to try to be the best I can be, but it’s in a new way where it’s truly important to be who and what I currently am, warts and all.

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Attention-Getting ARCs Create Challenges … Quiet Capacities and Assets Await Our Attention

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As my ARCs (age related changes) accumulate and progress, they increasingly resemble the attention-demanding behavior of two year olds. Impossible for me and sometimes others to ignore. On the other hand, my steady, silent capacities and assets just seem to patiently wait their turn to be acknowledged and attended to.   And this seems to be true, not only for me, but for those who help me manage my daily living these days. (Perhaps it’s the same way that more attention is given to our pathology than to our quiet immune systems.)

There’s no question that I need to continue to acknowledge and come to understand each ARC. But (better late than never) I’m seeing the need to pay more attention to acknowledging, understanding and creatively using my capacities and external assets. They are so essential to my well-being. I need to understand them as thoroughly as I do my ARCs. I need to value them. A slight variation on a current chant “Equal pay for equal work” may just need to be my motto as well.   Equal attention for equal work.

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By increasing my underlying knowledge about my capacities and assets in the same way I have my ARCs I may well be able to use them more creatively . In “The Mature Mind” Cohen examines the way agers’ brains change and what is there, available to be used. Some neurons are still growing and so are some connections between areas of the brain.

Obviously I’m at an early stage as I share my thoughts in these areas and plans . What I can share now is that:

I believe I have a responsibility to offer care providers accurate, crisp descriptions of the status of my capacities and assets (strengths and weaknesses as they are relevant to the presenting situation). This way they can anticipate how I will manage what they are asking me to do. e.g. If my physician changes my medication regimen, I need to offer the current status of my short term/working memory. If he were to expect me to change a dressing, I’d need to bring up the status of my clumsy, weak fingers and their potential inability to manipulate tape or dressings.   With my support figures (professional or otherwise) I need to offer data on what I can and cannot do as it is relevant to their desires or expectations.

I’m working on identifying (putting into words) and treasuring specific capacities and assets as they come into play in my adaptations. In my thoughts, I actually talk to them. When they do well in preventing a problem I praise them warmly, put gold stars in their crowns.   I sympathize with them when they try, but have difficulty. When they goof off, I give them black marks of the size and blackness warranted by the degree of failure.

I’m discovering that capacities and assets are like ingredients in my cooking—highly adaptable to be used in multiple ways. All my brain needs to do is figure out how success or lack of it in using them in one situation can be applied to another.  That means I need to know them, well.

As you can see, understanding and using my capacities and assets with greater creativity and effectiveness is a work in progress (like so much of my EWAing has proven to be).

If you readers have any ideas, please comment and share them with me. I can promise you that they will be well received and put to use.