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.

 

Living with Increasing Precariousness

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Losing one’s sense of balance as we age seems to be a given. Both brain and weakening muscles are culprits. We are urged to engage in exercises to promote our balance from middle age and on. And many elders go to programs to continue to work on maintaining their balance as long as possible or exercise at home.

Of course, some people start off with a fine sense of balance. I didn’t! Balancing tasks or sports were never my gift. “Klutz” is the word I think they used for people like me. Thankfully most of my adult life was conducted on stable flat surfaces so I could ignore my deficit.   And I didn’t notice that my disequilibrium was increasing until my late eighties. Then, anything that changed the angle or evenness of the surfaces became dangerous. Inclines that occurred front to back and side to side at the same time were frightening.  My gait became wider and more unsteady. (Ungainly is the word that comes to mind.)

That was when I bought my walker. Using it was highly optional in the beginning, but increased steadily as I became tippier. I was able to walk with a normal gait when my hands rested on its handles — that felt so good. This year I am constantly aware of my precariousness (even when I’m standing still if you can imagine it)! Picking up objects throws me off center. And those stomach-dropping near-falls for whatever cause have become more common.

So now I have to engage with constant precautionary measures to both feel secure and prevent falls.

I keep my walker constantly at hand (reachable).

I am even more conscious of keeping my nose and toes pointed in the same direction.

I wear shoes that have a tread in the sole. A few near-falls taught me to lift my feet if I am to move sidewise or make bigger turns — treads stick as they are meant to. (My kitchen is the most dangerous area.)

I squarely face any object I plan to lift and try to come as close to it as possible and center myself before lifting. I try to adapt to the weight before moving. I also hold it close to the middle of my body while carrying it. I now plan ahead and ask for help if the objects are high or low (bending over to lift something increasingly is an invitation to disaster).

I use my walker to carry heavy or multiple objects and position it before lifting so it minimizes my turning.

I plan my turning moves before executing them.

Even when merely standing, I think of centering myself.

People who hug me become aware that hugs can be tippy.

I’m grateful for people who look out for me, help me avoid tippy situations and are skilled in placing their sturdy left arm under my right arm to give me a sense of security.

So far my protective measures have been working as I’ve had no falls for well over a year.

Most often I approach life with a “sufficient unto the day. . .” perspective. But there are occasions when I wonder where my obviously progressing instability might suddenly change that.

[image courtesy of Getty Images]

My Wondrous Vicarious World

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Vicarious:  felt or enjoyed through imagined participation
in the experience of others.

If you were to shadow me for a day or two here in my day to day world, you would think it the dullest, monastic life ever.   My physical world is the first floor and deck of my home.   I make a weekly excursion for groceries and go out for occasional appointments. I also have visits from family members and friends a day or two each week. My daily check of email often results in outside contacts as well.  Special occasions occasionally take me out to family dinners or celebrations and an annual flight or two to Sun Valley. Now if that were all, most of my days would seem drab indeed. But I also live in a vicarious world delivered to me by group of widely-different, fascinating people who regularly and artfully take my mind and imagination to places and ideas I would never otherwise experience.

“My people” are mostly female but thankfully a few males too. They range in age from 7 to 97; and all but one are more than 20 years younger than me. They represent various faiths, (some, devout believers and others less so), some spiritual but not religious and some atheists. Politically they range from very “blue” to intensely “red”. Their nationalities or heritages include: Ashkenazi, Canadian, Danish, German, Iranian, Italian, Korean, Native American, Norwegian, Puerto Rican, Swedish, Ukrainian, Vietnamese and the polyglot backgrounds of so many Americans.

In terms of occupations, previous occupations and serious avocations, the range is wide indeed: adoptive parents of a son with Down Syndrome, beekeeper, budget analyst, caterer, CEO/inventor, cheese expert, Dean, dog trainer, doctoral students, foodies, gardeners, guitar player, jewelry creator, Latin/Greek professor, lawyer, memorialists, newspaper journalist, nurses, nurse educators, opera star, pastry chef, philanthropists, photographer, plane pilot, social worker, symphony musicians, teachers/students including special education, teenagers, violinists, world travelers. They are: young children, parents of young children; adults with aging parents, old parents with middle aged or older children, each dealing with different stages and responsibilities in their life journey.

Via in-person visits, email, e-pictures and occasionally the telephone, we exchange aspirations, experiences, ideas, interests, lives (past and present), journeys, opinions, books and travel. Those who cook or bake share their goodies — so I’m well and gloriously fed. Gardeners share their flowers and produce. One keeps my hummingbirds fed year around. The beekeeper keeps me supplied with honey. Someone who loves libraries keeps me constantly supplied with books that interest me (I’m old fashioned enough to enjoy turning pages rather than swiping them.) With many I share tea and cookies. With some I share potluck lunches, suppers and DVD opera nights. With two I serve as mentor and editor in their memoirs.  A son takes care of negotiating with contractors for house repairs and maintenance, another takes me with him and his family wherever they travel that I can still manage.

As for travel, and a seemingly endless range of experiences, I have vicariously:

skied the slopes of Whistler and Sun Valley

browsed the huge Consumer Electronics Show in Las Vegas several times

visited “Rome in Latin” with college students and also learned about writing poetry in Latin on both a Michigan farm and in a Sicilian olive grove setting,

sat through multiple Intensive Latin language and drama-performed-in-Latin university courses

learned to critique and enjoy “Paradise Lost” with a college English major

attended equestrian classes and the Rolex meets

learned about beekeeping and spent early warm summer evenings in a garden where the “lady bees line up on the edge of their hive and smile at me”,

seen Ireland, New England, Paris, the Jurassic features of Devon, and my own locale through the eyes of a remarkable photographer who shows me less obvious features

experienced a two- week course for high school students at Oxford University

learned the artistry and skills of making jewelry and running a successful on-line shop

parenting a boy with Down syndrome through 40 years of his life

swum with playful sea lions, shy turtles, colorful fish and hordes of zoo plankton amidst unpredictable currents that threatened to force me onto poisonous sea urchin beds in waters of the Galapagos Islands

walked for over a month as a solo pilgrim with a 12# backpack on the 500+ mile Camino-Santiago trek and later repeated the trek with a family group

visited Denmark in the Christmas season with a couple

marched pink-hatted in the women’s march in Washington D.C and sans-hat in local marches

enjoyed Wisconsin Friday Night Fish-Fry food and entertainment

auditioned and gone through Julliard’s 4 year operatic training program; learned about 21 soprano lead roles and performed in the opera houses of Europe, Egypt, Mexico, South America and USA

participated in a 2 year pastry chef course and the stringent, 2 day challenging final exam requiring both skills and time management. (We passed it on the first try.)

seen Disneyland and three Metropolitan Opera House performances through the eyes of a young man with Down Syndrome

attended/entered a Rhodesian Ridgeback into Rally competitions and dog shows

cruised around the southern tip of South America and met with penguins on the Antarctic coastline and so many other waters

golfed on Kona golf courses

been introduced to books I never would have found

and so much more.

When my relatives and friends have memorable or even ordinary experiences, they see to it that I get to enjoy them too and all within the safety and comforts of my home.

So here I am with still another set of contrasts in my old age. My physical world is seriously contained as fits with my current status, but my vicarious world is completely safe, amazingly wide-ranging and continuously, newly fascinating.

Blessings on you if you are the person actually engaging in these activities and are sharing your experiences with others like me.

 

Decision Dysfunction

“You don’t know what you have until it’s gone.”   All my life I had been blessed with opportunities to make choices in many areas and apparently the ability to comfortably decide. It was so ever-present that I took both for granted. Then (somewhere in my late 80’s I think), my decision-making functions insidiously began to change. I still was fortunate to have choices to make, but my comfortable deciding process was eroding. Instead of automatically deciding and doing, I was increasingly dithering, delaying and distressing.

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It would begin in the morning with decisions about what to wear that day and then what to eat morning, noon and night. As time progressed I found myself sitting in my recliner thinking about onerous chores that needed to be done and then delay doing any of them until I reached deadlines. I excused my inertia by thinking that the cause was lack of initiative or energy. If I invited guests, I’d fuss about the menu. If I was invited to go with the family for a weekend or a week’s vacation, I’d shillyshally about what to pack until the last possible moment and then put things into the bag. Since mini and maxi decisions were an integral part of each day, a deeply underlying mood change was growing. I was subliminally and increasingly uneasy.

Then I came upon an article reporting research on decision making that involved multiple elements.

Frey, R., Mata, R., & Hertwig, R. The role of cognitive abilities in decisions from experience: Age differences emerge as a function of choice set sizeCognition, 2015: 142, 60-80 DOI:

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A bright light illuminated my situation. My old brain had been struggling hard to satisfy my decision-making needs when it came to making choices involving larger numbers of items. These choices were so daily and ordinary that the number of items as a cause for complexity never occurred to me. What a relief to understand what was happening. Was it going to change my decision-making capacity? No! But now I knew what to expect and could work with it.

In clothing choices I could think whether I was dressing to please only me if no planned visits were on tap; or what would please the particular visitor, or suit the errands of the day. At least I had that much structure. I could also prune my wardrobe. As for packing, I accept that I will continue to settle for making last minute decisions. So far, they seem to work.

With food, I took several routes. I would still cook from scratch; that was non-negotiable, for now. I:

stocked the pantry, refrigerator and freezer with foods /ingredients that would lend themselves to impromptu decisions.

made larger pots of soups or soup bases and entrées that met my nutritional needs to store in the freezer in meal size containers that could be quickly thawed.

opted for pre-washed salad greens and made up a variety of vinaigrettes to dress them—quick, easy choices

found a breakfast that met my nutritional requirements and that I thoroughly enjoyed in taste and texture, so that became a happy standard.

Now it was only lunch and dinner . Even if I dallied in my choice, there was always something quick to fix.   As for guest meals, they’re potluck. My energy level has dictated that I set the table and make one item, and they provide the rest. Together we make the decisions on the meal and their brains are working better than mine.

As for chores, I blend deadlines, logic and conscience, reminding myself how good it feels when they are done in a timely fashion and I can just enjoy their being done instead of feeling guilty for not doing them. That seems to be working, at least some of the time.

All in all, I’m feeling much more sanguine about the challenges and my responses. I’m “stroking” my limping brain for doing the best that it can. I’m also deliberately and regularly valuing the areas of choices I still have and the adaptations that seem to be working. For now at least, my sense of balance in this area is restored.

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Three “R’s” for Aging – Resourcefulness, Resilience, Relevance

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The three ”R’s” are 1) the fundamentals taught in elementary school; especially : reading, writing, and arithmetic  2) the fundamental skills in a field of endeavor [Merriam Webster]

As I skipped off to school for the first time on that cold January day in 1928, I knew I’d be studying the basic “3 R’s”—“Readin, Ritin, and Rithmatic”.   I couldn’t wait and it didn’t disappoint.   A little more than seven decades later I was to discover that for me, there were 3 R’s associated with life as an elder. I hadn’t thought of it as a “field of endeavor” at the time, but so it proved to be.   This time my classroom was my home schooling, my assignments were daily living.   Over time I came to discover that three basic fundamental skills I needed to engage with aging were also “3 R’s”. Generically defined, they are:

Resourcefulness : the ability to deal with new situations or difficulties quickly and capably

Resilience: the ability to recover/return to normal from adversity.

Relevance: the ability to be accurate and appropriate in relating to others.

The three R’s were spot on but the generic definitions had to be modified in order to make them accurate when applied to engaging with aging.

RESOURCEFULNESS.   As the years piled on and even normal aging changed my functional capacities, the words describing resourceful behavior as being “quick /capable” no longer described my resourceful behavior. Now it takes time for me to gain insight on what the new situation or difficulty really is before I can even begin to think about how to deal with I and then put the thought into action. What remains quick is that, once recognized, I can quickly look at them from the two sides of the balance model, thinking : “What areas of Daily Living Demands are involved in this new situation? And “Which of my functional capacities and outer resources are involved?” “What are the linkages?” Then I figure out what to do. And as for capably, years of experience have made me quite capable in terms of setting up the balance equations, and I’ve been reasonably satisfied with the outcomes my planning has achieved, I also realistically realize that I’m dealing with a constantly moving situation.

RESILLIENCE.  The situations requiring resilience in aging differ from those I experienced earlier. True there are major adversities that can occur . . . . major illnesses, trauma, loss of dear ones, being priced or taxed out one’s home,   etc. Fortunately I’ve experienced only the loss of loved ones. But, I found lots of less obvious little, but genuine adversities that occur when my age related changes reach a tipping point and create imbalances in daily living. I find that my resilience means, not a return to a previous normal, but finding ways to establish a satisfying balance between the affected demands and resources for new norms that often are at a lower level. Even then, I know it’s only temporary as the functional changes continue to progress and new norms will be set. Except for the loss of two loved ones, resilience, as I’ve been experiencing it is an ongoing, unseen, underappreciated activity.

In some reading I did in order to try to make sense of what I was doing, I found that characteristics which improve one’s resilience are said to include: flexibility, engagement , perseverance, seeing meaning in the situation and “paddling one’s own canoe”. They all seem to fit with my experience.

Resilience is an activity that includes a necessary a lag time between the occurrence of the adversity and achievement of some level of recovery. I’ve been so fortunate to have had adequate lag time. But I’ve seen other peoples’ situations where the interval between adversities became so short that it was impossible to recover and re-norm from one before another adverse event occurred. Obviously that’s when the person loses ground and fails to thrive.

RELEVANCE.  Staying in tune with the times has become a tremendous challenge for those of us who are aging in this time of rapid innovation in technology, information availability, health care discoveries, cultural norms and just the general speeded up pace of life. As we’re slowing down, everyone and everything else is speeding up.

Why do I purposefully work to remain as relevant as I can? Think about the people you know or contact who either don’t or can’t maintain relevance.   Do you see or experience others tending to be patronizingly tolerant rather than engaged? Deprecating or discounting them along with their ideas? That’s what I hope to avoid for as long as possible. I’m especially concerned about being seen as being “with it” if or when I come in contact with different health care or other supportive services.

These then are my 3 R’s for engaging with aging.

What has your experience been?

Head in the Clouds, Feet on the Ground – Possibilities & Probabilities

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In an earlier post you found that I’m a firm believer in casting widely for possibilities in any new or changing situation rather than settling for the first thing that comes to mind. But there’s the clinical part of me that is grounded in also looking at the probabilities, not as constrictions, but a starting point and compass for directions.

Probabilities are judgments that take into account a starting point and likely future directions in any given situation.   Physicians are taught from day one about the prognoses associated with any given pathology and separately with any proposed treatment. They look at four dimensions: current status, likely course of events, duration, and outcomes. These become guidelines in decisions and evaluation.

When I think in possibilities, I really try to guard against wishful thinking. Too often I’ve seen that result in disappointment, discouragement, depression and downright danger. Wishful thinking is something neither we elderly nor those who care about us can afford. So, while I want my possibility outlook to be far ranging, I also want it to be truly possible. That means, purposefully combining head-in-the-clouds and feet-on-the-ground thinking.

For me, both possibilities and probabilities each begin with an honest look at the starting point. For example, with my clumsy hands, I’m not starting with normal young hands. My realistic starting point is that the fingers in the left hand are flat; and in the right hand, fingers 5 and 4 are almost flat now.   The probability is that the 3 and 2 will also be flat by the end of the year. Thumbs seem to be remaining fully functioning.   Now I might wish that at least my right hand remained more useful, but that’s not going to happen. So my possibles are going to start out with an honest statement of both hands’ status as I seek to discover ways to:   find clothes I want to wear and can don as well as remove, a hair style I Iike that won’t make my comb fly out of my hand, food I want to and can prepare and eat, personal hygiene, reading and writing I want to do etc.   Still wide open, but not wishful thinking.

I also believe that both possibilities and probabilities need to be dealt with neutrally. I’ve found that adjectives and adverbs that connote good or bad are not helpful, they are stifling.  And certainly blaming doesn’t help either. My situation is what it is. Will labeling it and the data that support it as good, bad, desirable or undesirable change anything? Hardly at all. Does that mean I shouldn’t rant about where I’m at and what’s happening if I feel like it? Not at all.   I just make it a separate activity from dispassionately dealing with my data and planning.

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It’s a reality to me and those who care about me that I’m aging in both mind and body.   I suspect it’s true for you and yours as well.   Change is the name of our game. So it’s reasonable to think and plan accordingly.   I don’t want probabilities keep us from sending our heads into the clouds in terms of possibilities.   And at the same time do want us to acknowledge our wishful thinking and then move on creatively and positively with our feet on solid ground.

Care to share your ideas and experiences in this area?

What Do I Have to Offer?

What can I give Him, Poor as I am?
If I were a Shepherd, I would bring a lamb;
If I were a Wise Man, I would do my part,
Yet what I can I give Him? Give my heart.

From A Christmas Carol, Christina Rosetti, 1872

As the effects of aging gradually erode my capacity to do things for others (knit, sew, bake things, even shop and then wrap and tie gifts), I find myself increasingly uncomfortable with the situation. I’d not seen myself as a needy person who wanted others dependent on me, but I do like to feel useful. And I’d been brought up to reciprocate. With growing limitations on “doing capabilities” how can I fulfill my need to feel useful to others and reciprocate all the kindnesses I receive?

I’m not like the little boy in the poem who could just give his heart. The only option that occurs to me as the alternative to “doing unto” was the possibility of “being unto”. I wonder if or how that might be an adequate alternative. “Things” are so concrete and finite — you know when you’ve done it as does the recipient. “Being” is so ephemeral. I’ll know what I’ve tried to offer. Would the recipient recognize my offering? Does it matter?

As I pondered, I began to take inventory of the resources I had that could make me useful in the “being” realm. I am richly endowed with time and availability these days. I have a welcoming, casual, comfortable house. A living room with two swivel rocking chairs (also a recliner, but that’s mine). The rockers rotate so one can look out the wall of windows at the busy bridge, the bay and its marine traffic, the cityscape and beyond a craggy mountain range.   Or, when it was gray and nasty outdoors, there was a reliably cheery fireplace. The kitchen holds both coffee and tea pots along with the fixings to put in them. And the cookie tin is usually reasonably full. I can manage to set a table and probably one dish for a meal if others bring something and don’t mind pitching in. So, I have an environment in which one could share a meal, unwind, chat, or just sit with a companion.

Beyond that what do I think I personally have to offer? A genuine pleasure in people, their lives and ideas; and a pretty nonjudgmental attitude. I enjoy chatting and listening (if you don’t speak too softly).   I’m comfortable with periods of silence. I think I can be a sounding board , a listener who will just take in the message, help explore but not have ready solutions. Or go on joint exploration expeditions of thought and planning. I’m pretty good at putting nebulous things into words. I can trust others with my ideas for their critique and exploration. I have stories to tell and enjoy others’ stories.

I also have two arms that are still capable of hugging should the occasion seem to arise (as long as I center my body or have a handy solid support nearby before the encounter.)

I’m not able to do hand written notes or letters any more, but my keyboarding is still speedy. I can initiate or respond to emails promptly with thought for what might be of interest or appropriate. I can offer editing skills of writing with whatever expertise and creativity I have.

As I think about it I realize that I’ve already been doing this whenever it happens to occur. So what might be different? Obviously I wouldn’t announce “This is a gift because I can no longer wrap one in a box for you.”  It would just have to be a silent offering given with awareness and care. It remains to be seen if it is enough to satisfy me and those involved.

There will be no blog post next week – Merry Christmas to all!