Automaticity, How I Miss It! But . . .

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As the old saying goes, “You don’t know what you had until it’s gone.” I‘d had no idea how much I had been able to take for granted, nor how much I’ve been able to do on auto pilot. If I was going to make breakfast, all I thought about was what I would eat. Then my automaticity took over. It knew where the items were and how to put them together. To dress, I had to decide what to wear, but the rest of the process followed without purposeful thought about how to put the pieces on. And so it would go through much of the day. All this automaticity freed me to address issues, ideas and activities that required purposeful thought and effort. (I read recently that it took only one side of my brain then, but takes two sides now.)

Then ARCs (age related changes) sneakily but surely began taking automaticity away from me. I found myself having to think about how to lift a glass or a jar, depending on its diameter and weight—one hand or two–grasp around the sides or with one hand underneath? For a while, I had to think about how to tie shoelaces until one morning I couldn’t tie them at all. Time for slip-on’s. My comb flipped out of my hand when it encountered a snarl. Adopt a simpler haircut. Stairs required me to rely heavily on a railing or wall in order to climb them and knees threatened to buckle when I descended. My family, standing behind me, finally couldn’t stand watching me and a son proposed (pushed for), a lift that now gets me safely from the house to street level and back. Supportive arms on either side help me manage stairs when no lift or ramps are available. A granddaughter took over the laundry tasks that had to be done in the basement (reached by a circular stairway with no railing). I now live on one floor of my home. A son noticed my difficulty in rising from my recliner, he placed 4” risers under it and later added another 2”. One day while on vacation with my family, I discovered for myself that putting my hands on the back of a wheelchair made me steadier in my walking. I ordered a walker that enabled me to take long walks for years and now keeps me steady here at home. I found that a shopping cart in the market served the same purpose for quite a while until recently that too became unsafe and a neighbor offered to take over the shopping.

And so it has gone from year to year, month to month and recently sometimes day to day. My capacities change and so do my adaptations. Sometimes I’ve been able to see and manage them on my own. Sometimes times others have noticed and stepped in (with my acceptance!) to help me manage.

And there have been times when certain activities simply are no longer possible automatically, intentionally or with adaptations. Then it has been time to simplify my life. I’ve enjoyed baking orange rye bread and Swedish cardamom rolls for me and my family. First I reduced the size of the recipe to weights and size I could handle. Recently that too was beyond me. Fortunately, I’d taught the next two generations how to do it. Now the time had come to pass the tradition on.

Do I miss the things I no longer can do or automaticity? Of course. Still, in the grand scheme of things I’m grateful for all that’s still possible, for family, friends and colleagues who support me and offer adventures within their view of my capabilities (often far more than I can see in myself). When all else fails I call on my mantras of “Sufficient unto the day. . . .” and “To everything there is a season.” And, so far, I’m feeling content with what I still have.

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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.

 

We Agers Are Experts On Our Own Aging Experience

With that expertise come responsibilities

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Many of the people who study old people, theorize and write about us, take care of us, or relate to us are not “old’ themselves. They experience old age second handedly. Earlier in my life as a nurse I often had older patients. As a daughter I shared my parents’ aging. In my 50’s I blithely participated in three editions of a nursing book about caring for the elderly without taking note of myself as the “outsider.”

Now I feel as If I had been a pilot flying over the city of aging, assuming I knew how the residents lived. What an illusion!   It’s not that what I knew, used or wrote about elderly people was inaccurate. But it paid only narrow attention to the significant ways normal aging was changing agers’ capacities to manage their ever-present tasks and relationships. I had looked at them narrowly as they related to a particular issue, pathology or health status. Also, somehow, at some level, I gained a vague notion that aging made people less credible whether it was reporting about themselves or their opinions. Dumb!

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Now, I’m the insider. I‘m aware of my hard-won knowledge on normal aging in general and my specialist knowledge on my own aging.   I notice when my insider-knowledge and perceptions (not necessarily right or wrong), are just different from those who are not old.

I see myself as a practical person. I realize that health care providers and others have focused areas of interest and expertise and limitations on their time. Health care providers of all stripes and levels are, in particular, intermittent, time-regulated resources. And even my near and dear ones, friends and neighbors have very full, demanding lives of their own. (But given the nature of our relationships they tend to be more familiar with how I experience and manage both the pesky ordinary parts of my daily living snarled by my aging and the richness of my life.) Each of these people (professional or other), play an important naturally limited role in my life, as I do in theirs.

So, what is my responsibility in enabling them to see my aged world as I need them to and they may wish to? I tell myself, “Doris, they are not mind-readers! They know what they see, hear and what you tell them!” I see how they tend to use what they discover and how it fits with their specific role relationship with me, e.g. professional health care provider, relative, friend, neighbor etc.

I’m accepting that I as an aged “ insider” have responsibilities to them. Instead of taking it for granted, I owe it to them to appropriately :

  1. notice what they might need or want to know about me that satisfies us both
  2. share myself in ways and language that is natural to them and the situation (it’s different for professionals and personal relationships and situations)
  3. give/seek feedback on ways they might participate in my aging and daily living that are comfortable to them and me, given their roles
  4. share with them and include them in the joys and richness of my days

I realize that a lot of this is what has been going on intuitively. It’s just that now with this insider-outsider perspective I see a greater need to become more sensitive and skilled at it.

Downsizing Involves More than Things – Decreasing Capacities Downsize Lifestyle Too

Initially I thought of downsizing as relating to material possessions and environment, externals. Even there I recognized that not only the concrete things were involved. As important was my attachment to them. How precious were they to me? What would giving them up mean to me? How would my life change without them?

I found it easier to downsize in small steps. I’m finding happy homes for things that have deep meaning to me. Now others can cherish them.   Clothing, linens, household items go in small batches to our local volunteer recycling group. I‘ve gone through stages in my reactions: first a sense of loss and then feelings of relief, as if my load had been lightened.

As years rolled by and my ARCs (age-related changes) progressed, I awakened to the reality that my downsizing involved not only things, but activities and choices in my lifestyle, significant ones. Of course as a non-aged “outsider” I had watched it taking place in others as they aged. Now I was no longer a watcher, I was the “insider”. It was my self-image, my control, my privacy that were being changed in my own eyes and in the eyes of others. Downsizing took on a different color and meaning.

Now I was dealing with closely held values, goals, my contentment. I knew that self-sufficiency and feeling competent were both important to me and would be major deterrents to adapting to this kind of downsizing (even as they would serve me well in the process). For example, it took more than a few risky experiences involving close calls with my decreasing balance, or hand grip to convince me some activities risked unacceptable dangers.   Sometimes it has required others to point out how my “making do” was creating intolerable risks.   It was time to acknowledge that this kind of pride was foolhardy.

So I purposefully began to look for ways in which I could be deal with new dependencies as they occurred, and to plan ahead for them where they were predictable. Ongoing contentment and pleasure in daily living was my goal.

My first decision was to change words that frame downsizing my personal world. I use “simplifying” instead of “downsizing” and “differences” instead of losses.

I try to anticipate activities that will be affected by an ARC’s progression; then plan ahead for the new ways I will need to adapt.   I reasoned that this might reduce the shock and surprise when it happened. And it has given me a sense of greater control in some areas despite losses in others. (Still, I experience shocks at the point when an ARC abruptly rears its head, e.g. discovering one morning that I could no longer tie my shoes and another when I could no longer open the dishwasher.

I deliberately use my “watch bird” (see “Meet my Watchbird” 11/30/17) to force me to keep an eye on my:

ARCs, are they continuing to change? How?

adaptive strategies (How well are they working?)

satisfaction and contentment (Emotional responses are necessary data too.)

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As a part of my ongoing need to feel as competent and independent as possible I plan for ways to make it as easy and efficient as possible for those who enable me to do the things I need and want to do . I

do as much as I can in the activity

identify specifically the areas of need

identify the specific assistance that appears to me being most efficient

integrate others’ perceptions and approaches

communicate appreciation and reciprocate any available ways.

Looking back over the weeks and months, I recognize that my world has indeed become increasingly simple. So far, I am comfortable and content. Do I miss some things? Yes, occasionally but most often fleetingly. The simpler life suits me, as I now am.

How long are my current approaches to growing dependency going to work? I have no idea. For now,   my mantras of, “Sufficient unto the day. . . . “ and “To everything there is a season. . . “seem to keep it all in perspective.     Tomorrow? “Que sera, sera” what will be will be.

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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Can We Old Folks Be Both Frail and Sturdy?

Frail: weak, feeble, fragile, susceptible, vulnerable
Sturdy: hardy, resolute, sound, stouthearted

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Somehow the extremes of “all or nothing” are not my favorite approach to situations, though I obviously use them occasionally. (One of my early posts was “Never Name the Well From Which You Will Not Drink.” 10/12/17)  On the other hand, I realize that opposites do appeal to me, particularly in my dotage.

I may be old in years, but I feel young at heart. I may be forgetful of some things in the present, but I’m very good at remembering the past.   My handwriting is clumsy but I type quickly and reasonably accurately.   I stress out more easily, but I often can find a way out of it.   I may not be able to do some things; but, for now, I seem to be fairly adept at working around those difficulties or settling for something less.

All this leads me to think that engaging with aging works best for me when I take a two-pronged approach.   It involves a consciously and purposefully identifying and owning who I am and the status of my limitations and capabilities, in other words, both my frailties and my sturdiness.

Writing this blog has made identifying and owning my frailties almost unavoidable (barring blind spots). I accept that frailties at my age are normal. The only way to manage is to notice and identify exactly what is difficult and what has become impossible.   For example, I took inventory one day of my rapidly weakening grasp. In the end I identified 18 current challenges plaguing me from rising to retiring, and of course the list will increase as my grasp weakens more. But on the sunny side, so far, I’m creating ways of managing most of them, working around them, or giving up some impossible activities. (My daily living has slowed down and been simplified significantly with all this accommodating).

I was raised to have the Swedish modesty so I find it harder to identify my sturdiness, and strengths. But when I’m being honest, I realize that one can’t use strengths well unless one knows specifically   what they are. So I look at them and am grateful for them.   Trying not to make mountains out of molehills and accepting what is normal has been helpful Finding pleasure in being creative, even in primitive ways is also a part of my sturdiness.

Others have helped me to discover blind spots about my strengths as well. When they recognize and share a capacity that I can’t see, it enables me to experiment to find out if what they think they notice is there for me to use. I find myself being grateful when others help me to really recognize them and then offer support for me to see what I can do.

An example of a life changing nudge from others is this blog. When the current Dean of my School of Nursing heard me ranting about what a rotten image the aging experience had been given, she prodded me to put my ideas out in a blog and offered concrete support. I very dubiously took up her challenge and began testing and practicing to see if my brain still could function this way. I found myself stretching and pushing myself beyond anything I’d dreamed of. And at 95?

In earlier years, perhaps there was not so much to lose by taking my frailties and sturdiness for granted. Now, not only do I need this inventory in order to engage with my aging at the highest level possible,   but those who are supporting me in my aging need accurate information as well. I find it works best when I check it out with them. I see more and so do they.

Note to those of you who are younger: Are you seeking out strengths you see in agers in your life?   Are you identifying them in acceptable ways and offering usable support to enable them to see what they can do?

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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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