Aging is More than Health

Healthy:   possessing or enjoying good health, a sound and vigorous mind and body; freedom from disease or ailment

Health: a perspective for judging the status of mind and body, or the merits of a presenting situation in terms of being conducive to a sound body and vigorous mind

The way non-aged people view aging and the aged tends to be linked to their background and particular interests. Individuals, relatives, groups, disciplines, professions, businesses, legislators, economists and governmental agencies each view aging and the aged through their own mindsets, value systems and purposes.   Many of them include the health of the aged or their environments in their considerations and actions.

As a nurse, I was taught to view aging from birth to death from the perspective of health, normal versus abnormal.

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I looked at my patients and their environments through the lens of health and I worked for its promotion, maintenance, preservation, treatment and palliation. My viewpoint was wide-ranging even as I aimed for specificity with individual patients. But in my mind (rightly or wrongly), health however applied, tended to involve gradients of healthy and unhealthy.

Now, decades into engaging with my own aging, I find that seeing aging solely, or even primarily, through the lens of health is too confining.

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I sense that it can put blinders and dampers on truly significant facets of my aging experience. That bothers me.

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I don’t question that my health is hugely important to the quality of my life and aging, nor that my behavior and activities are strong influences on my health. I know that my health determines what I can engage with and how I am able to engage.   It’s just that I’m discovering that aging is so much more than health.   For example, nutrition, hydration and exercise are seen as three pillars of healthy aging. Yet the experiences of eating drinking and moving about each day encompass so much more than the health promoting considerations.   I experience the sensory elements, the tastes, textures, aromas.   I recall wonderful associated memories of food-related occasions, both ordinary and grand. The same holds true with movement related experiences. Thinking about the richness of these memories it makes me want to anticipate and enjoy them in present and future activities without having to look at them through the lens of health during the experience.

My aging is filled with intangibles of life and living, with all its richness, its flaws, its details, its marvelous surprises and unexpected pitfalls.   It’s the contemplation of life and death. The experiences of blessed solitude and the warmth of companionship with people who have such wide interests and fresh ideas or different experiences of the past. It’s the seasons and weather in all their dimensions. It’s art and music, comedy and drama.   It’s my vistas of mountains and water; the busy daytime city and the quiet, amber of its nighttime. It’s the ballet and battles of hummingbirds at the feeder and the busyness of mason bees going in and out of their homes outside my kitchen window. It’s the movement in tall evergreens in the invisible winds and their windless stillness. It’s the comfort of a cat on my lap and the warmth of hugs. The aroma of the first cup of coffee and the uncertainty of completing the morning crossword puzzle.   It’s the joy in feeling fulfilled. It’s the mourning with losses. It’s being both needy and yet capable of helping others. It’s knowing and still learning. It’s . . . . . . . . . . . . . . .

I don’t want to feel hemmed in by obligatory calculations of their effect on my health in the midst of these experiences.   I want to freely, profoundly experience all these and more, unalloyed and unexamined.

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I’m not foolish. I want to retain and use my health lens appropriately and creatively. I want and need to securely keep and use it . . . . in its proper place.

 

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“Let there be light”

Genesis 1:3

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These days I’m finding that I need ever more light, for tasks involving my eyes, for navigating safely, reading, writing and for my mood. I know ARCs (age related changes) involving the eyes reduce the amount of light that can enter the brain. Eyelids sag, and the muscles that control the opening the pupil to let in light become weaker.   The number of rods in the back of the eye not only decrease in number, but those that remain become less functional. My brain is receiving less light. The areas of impact in my daily living are multiple, involving not only tasks requiring acuity of vision, but also my balance and mood.

I’m lucky to have wonderful external resources. Our home has lots of big windows, particularly in the kitchen, living-dining room and my office. Whatever light is outside, comes in. Even at night (if it isn’t raining), the amber lights of the city form a lovely night light throughout the living room. Street lights through the drapes offer dim night lighting in the bedroom throughout the night. As for artificial lighting, my husband built in lighting over all the important work areas in addition to the ceiling lights. (Little did he know then, that decades later I would need all of them.) In the central hall that connects all the rooms there are small night lights that are on at all times and lights that turn on automatically when one goes down the stairs.

I can control lighting in my home, but not the seasons and the weather.   Each year autumn inevitably moves on to winter months that seems to inch along like very cold molasses. In addition, our region is characterized by multiple, persistent gray days—with or without rain. By the end of February I’m sagging physically and emotionally. I long for the longer days to become more apparent.

For months, I’ve worked to keep my spirits up. I wear brighter colored clothes to lighten things up—brighter, deeper, richer colors. I put on makeup, even when it’s just me that sees it. I read light entertaining books. Seek out music in major keys.   I light candles (a habit I developed after my times of working in Sweden during their long hours of darkness in autumn and winter).   A son encouraged me to replace the wood fireplace in the living room with a gas one with realistic logs. (It even has remote switches). What a great idea! Its dancing yellow-orange/blue-edged flames and glowing coals now lighten, brighten and warm me and my visitors in both days and evenings. It gives me a sense of companionship.

This year our region is enjoying a warmer, sunnier spring. I’ve gloried in it! While I regularly use my motto of “To everything there is a season. . . .” I’m so glad when those seasons are spring and summer.   I never appreciated that nature’s light could be so important. Just another of the many surprises aging has sprung on me.

 

Words Make a Difference

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I don’t know about you, but at 97, I’m finding that words affect my spirit, my emotions more than they did when I was younger. Both my emotional and physical stability feel more tenuous. I find myself more vulnerable to words/labels that I or others apply to me. Positive words and labels that feel genuine give me a lift. Negative words weigh on me. My immediate reactions even affect being able to sort them out. (When others offer feedback, should I own it? Use it? Discard it?) When I create labels or descriptors on my own, do they point me to useful responses? Deter potentially useful responses?

While on the whole, I’m having a wonderfully rich aging experience, there’s no denying that that some aspects of my ARCs (age related changes), and their impacts on my daily living now are accumulating to the point where even small developments have real impact on what I can do or even experience.   This being true, it seems foolhardy to add the weight of negative, scary words to describe what is happening to me and how it is changing the way I live.

Of course it would be equally foolish and even dangerous to deny or sweep under the rug the effects of my aging. So I asked myself, “OK Doris, what’s the alternative?” Answering that question has taken some thinking. I want to be honest, accurate and I need to be specific. That made me think, “Why not use neutral words to translate feedback others give me, my internal cues of emerging ARCs and their impact?   That frees to decide about their usefulness as a separate step. I’m no Pollyanna, someone who can only see the good in everything. But neither do I want to be a pessimistic, droopy Eeyore.

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Of course, my purposefully using more neutral language, particularly in describing ARCs and reactions to them prior to dealing with them is a work in progress. But, each day gives me plenty of opportunities for practice. It isn’t coming easy. But I rather like the feeling.

I’m also using neutral descriptors when sharing my aging experiences with my near and dear ones. They seem to trust me (or more wisely trust and verify).

Normal aging, for all its richness is not always easy and pleasant, but at least it is normal. And I remind myself that I do have plenty of company in the experience.

Taking a Risk: Should I or Shouldn’t I?

Risk: a situation involving exposure to danger or harm

In retrospect, it seemed that most of my life I tended to skate over the idea of risks in routine daily living.   The idea of risk applied to major, major threats or disruptions, not the minor ones that I apparently took for granted.   As a youngster in the 1920’s there were built-in, run of the mill risks we took for granted, like bumps and bruises, colds, even the childhood diseases that are now avoided through vaccination. Risks had to be something a lot bigger in my mind and apparently in the minds of others around me. As the years went by choices I made never seemed to involve much risk either. Perhaps I was blind to them, or just the cautious type.

Fast forward to today and the day-to-day risks offer an entire reversal. The culture, the environment, global relationships, technology . . . so much has changed. And so have I. In my dotage, my days are literally filled with risk-laden situations where misjudgments on mini-risks can have major misfortunes. Do I bend over and pick up that fallen object or take the extra time to sit on my rollator seat, lock the brakes and then bend over to retrieve it? Do I wait for someone to help lift or move an object I want to use, risk dropping it or having it throw me off balance and land me on the floor? Can I pick up products at the market, or do I need to ask for help?   If I sit in a chair that may seem only a little “low”, do I risk not being able to get up out of it unless I get help? On and on and on it goes.

I’ve also discovered another type of risk associated with becoming very old, not physical, but emotional.   Here the harm is to my ego and self-image. These involve public situations, like invitations to attend functions or trips where my capabilities will be challenged in public and my adaptations or lack of ability to adapt will be obvious to all. The degree of risk seems to be related to the nature of the “public” and the capabilities involved.

On the other hand, I’ve discovered that if I carry on with some degree of aplomb and humor — don’t make a big thing about my constraints, no one else seems to either.   When guests come to my home, the norm is that everyone pitches in when there’s food still to fix or get on the table. And they always help with the clean-up. Not formal but fun.

As I’ve become more limited in my ability to adapt to both predictable and unpredictable conditions away from home, a different kind of risk appears. How much do I deny myself the pleasure of the company and the experience by being too risk averse? Or take a chance and hope for the best?   Those who extend invitations offer all sorts of assurances, but the truth is that there are factors that are beyond their ability to help. The comforts and accommodations of home are increasingly my choice. I think,

“To everything there is a season . . . .”

Data About Me Are Neutral But I’m Not Neutral About Them

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As a nurse, I learned about health-related data. I learned how to collect them appropriately and correctly, how to report them in usable form and how to use them to guide my nursing care. Often they were numbers ( temperatures, pulses, respirations, blood values), reports of surgical procedures and tissue findings. They also involved patients’ and families’ responses to the situations they were facing. I cared about their being accurate. The data themselves were neutral, neither good nor bad, just what they were and what they represented. The diagnoses and other judgments resulting from the data were also neutral to the scrutinizers and decision makers. But for the person generating the data, they all carried emotional weight that was anything but neutral. Data could elate! Data could depress! Data could frighten!

Now as I face daily the reality of my aging and the environment within which it is taking place, once again I am purposefully gathering data. But now I have to remind myself (sometimes forcefully), that indeed the data are still neutral and separate from my reaction to them. It is what it is. I need to keep in mind that my reaction is itself data that I need to use neutrally in order to engage with aging in the most effective way. I am what I am — no more, no less.

A sampling of frequent data these days includes:

I drop things, often. Reaction: frustration !!!!!

A sense of “near-fall” when I bend over to do things or turn without thinking. Reaction: my stomach “drops” and I experience everything but the fall itself. Near-falls leave me shaken and frightened (though massively relieved and grateful that the fall did not occur).

There are numbers on my scale. Reaction: Happy when they are the same or a bit less than yesterday. Reaction: Resolve to eat prudently when they are higher.

More hunger after a meal that should have been satisfying than I had before I started. Reaction: “That’s unfair.” Sometimes I resist giving in and eating more/sometimes I eat more; sometimes I deliberately get busy and distract myself till the hunger passes.

Signals of fatigue before tasks are completed. Reaction: resistance + dissatisfaction. Occasionally leaving task unfinished for the time being.

Recuperative periods characterized by an almost vegetative state when I’ve purposefully or unavoidably exceeded my limits. Reaction: impatience or “It was worth it” or both.

My balance is becoming noticeably tippier, as is my ability to rise from sitting to standing. Reaction:   Concern about how much longer I will be able to manage safely in my highly prized independent lifestyle.

In my intake visit the doctor pronounced me “healthy” and the blood work numbers a week later verified it. Reaction: walking on air. Relieved — “So far, so good.”

Careful comments from my family identifying blind spots or concerns. Reaction: wish they hadn’t been necessary. Sometimes guilt because I should have known better. Always gratitude that they are willing to do it and are so careful about how they do it.

Much as I believe in it, my seeing data as “neutral” is not automatic. I know that data are tools to be used for adaptation and I do use them that way.   But even with these beliefs and experience, seeing data as neutral is still a conscious decision that I have to make almost every time.

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Three Pieces of Lumber, 2+ ARC Challenges Met

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A few weeks ago, an ARC (age related change) that had been rearing its ugly head seemed to have reached a point where I could no longer work around it. For a long time, I’d been having trouble moving from sitting to standing in getting out of bed. (It was just one of my daily living impacted area difficulties in moving from sitting to standing.) In other sitting situations I’ve raised seat levels and provided arm supports on either side so I can push my body from sitting to standing. I even have a foam cushion and a portable “handle” I bring when I ride in a car with low seating.   What I hadn’t done anything about was the level of my bed. Here I would raise my knees to gain momentum and push with both fists on the mattress to stand up. But finally even that wasn’t enough.

The greatest bed-related challenges came when I needed to get up during the night. I was apparently less coordinated and half-asleep still. Four o’clock on this morning when I needed to get up I thought about it a while, forced my lagging eyelids to open and moved to a sitting position on the edge of the bed. As I pushed on my hands and tried to rise, nothing happened. I wasn’t budging! On the third try I finally made it, unsteadily! When I returned to bed I spent what was left of the night thinking about how to raise the bed.

I finally wondered if thin mattresses were available to solve the problem. I could insert it between the box springs and the mattress.   I went on line and found them in several thicknesses. “Just the thing,” I thought. When my son arrived for his quickie morning visit, I proudly told him of my “solution”. He came up with an even better, cheaper one for this built-in bed—three 4×6” pieces of lumber laid lengthwise on the existing floor-based wooden frame! Within a couple of hours my bed was 4” higher. (And, the supports can be “turned” to offer an additional 2”should it becomes necessary.)

And this is not the only ARC challenge the lumber met. It also addressed difficulties I was having with the element of my balance ARC that makes tasks requiring me to bend over feel precarious and scary!   With the bed 4” higher, I don’t have to bend over as much and the task of “making my bed” feels less risky.

I have a third ARC that also affects bed-making. It is my weak-hands-ARC that doesn’t allow me to tightly grasp and pull covers straight and tight. But even that is not so hard if I’m not worrying about tipping over at the same time.

Fully “fixing” two out of three difficulties in one morning is a reason to cheer. I can live easily with an “un-tight” looking bed.   Each night now I go to bed with peace of mind, knowing I can safely get up. And each night and again in the morning I call down blessings on the one who was both willing and able to make this possible for me.

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“Acceptance” of Aging Is a Moving State

“Acceptance” is often identified as one of the developmental tasks of aging, or at least aging well. There are articles aimed at the pre-aged, telling them how to prepare for this acceptance, how to make it easier. And that would seem to be a healthy thing to do. Certainly spending years studying and writing about aging as well as encountering aged folks offered me plenty of preparation. I knew what to expect. In fact I found myself being curious as to what would require acceptance and how I would respond. Well, the School of Aging has been teaching me. Perhaps all the preparation “helps,” but once one’s aging rubber meets the gravelly road of aging, acceptance becomes an ongoing learning process and activity.

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What I (not surprisingly) discovered is that ARCs (Age-Related-Changes), don’t wait to be invited in. As in the story of the camel and the Arab in the cold Arabian Desert, ARCs like the camel “nose” their way in. Nor do they confine themselves to being polite guests, but gradually take over.

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For me, acceptance of aging divided itself into two very different areas, presenting me with distinctly different challenges. The first was accepting that “I am old.” I was in no hurry to get there, but didn’t find it difficult when it arrived (and it had nothing to do with falling into the “over 65” official age category). In fact, when I decided I had become “old” I also realized what an unexpected quality of richness in my life it was offering me.

The second area has been more difficult to accept. It is the loss of competencies for managing my daily living.  My choice to take an active “Engaging with Aging” approach rules out passively and meekly living with whatever ARCs emerge and progress.  I find that even my acceptance has needed to be an active, even proactive process.

So far, I’ve been fortunate in that my ARCs have arrived gradually, giving me time to adapt. My support system has been non-intrusive, incredibly available and generous.   And so far, the only cognitive abilities I’m aware that ARCs have afflicted are my short term memory and decision making. This leaves me able to identify ARC–impacted areas in daily living and create adaptive strategies.   Nor have I found it difficult to accept lowering my expectations and simplifying my lifestyle (setting my ideal balance between daily living requirements and resources at regularly lowering levels).

But my ARCs are now accumulating to the point where even tiny progressions genuinely stretch and threaten my adaptive skills, my support systems, my control, and my equanimity. Maintaining a balance between my requirements and my resources is becoming increasingly precarious even at basic levels of what I need and want to do.

I regularly remind myself and truly believe that, “To everything there is a season. . .” Ecclesiastes 3:1.  The net result is that I’m still “accepting” (sort of), but it’s getting harder. I wonder, “Is it possible to strengthen one’s acceptance capacities?” I may well find out.

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