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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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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Daily Living with Aging Involves More than Health

Human aging: progressive accumulation over time of physiological, psychological and social changes.

           Health:   the general condition of the body or mind with reference to soundness and vigor, freedom from disease or ailment.

 Aging is a many-sided status that can be seen from different angles depending on the background and interest of the beholder.  Aged or not-yet-old-relatives, groups, disciplines, professions, businesses, legislators, economists and governmental agencies each view aging and the aged through their own mindsets, value systems and vested interests.   Many of them include the health of the aged in their focus and actions.

As a nurse, I was taught to view aging from birth to death from the perspective of health. Normal versus abnormal.   I looked at my patients through this lens of health and I worked for its promotion, maintenance, preservation, treatment and palliation. My health-oriented viewpoint was wide-ranging even as I aimed for specificity. But in my mind health tended to involve gradients of healthy and unhealthy.

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Now, decades into my “old age”, I find that seeing aging primarily through the lens of health is too confining. I sense that such a viewpoint can put both blinders and dampers on me in ways that influence aspects of my aging experience that may be only marginally associated with health.

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I don’t question that health has huge importance to my life and its quality. It determines what I engage with and how I am able to engage.   Perhaps it is because I am remarkably healthy that I’m finding the aging experience to be so much more than health.   (Those of you with ongoing health problems can let me know if this is true.)

My aging experience has been full of intangibles, filled with both richness and flaws. It’s held remarkable surprises and unexpected pitfalls. It’s offered defeats in efforts to manage growing incompetence, and prevent accidents or illness, and bursts of triumph when I outwit them.   It’s the impatience with functioning at my ever-slowing pace. It’s the feelings of loss in areas of control and privacy. It’s the mourning with losses, even little ones.   It’s the contemplation of life and death.

My aging has offered a wide range of new experiences.   A sense of time and solitude, to allow just being, reminiscing and hatching new ideas. The warm closeness of companionship with visitors, emailers and characters in good books.   The changing seasons in all their dimensions of growing, maturating and resting.   The music that brings memories of performance or listening. Vistas of cloud formations, sunrises and sunsets over mountains and water; the busy daytime city and the quiet amber of its nighttime. Ballets and battles of the of hummingbirds at the feeder outside my kitchen window. The movement of tall evergreens in the invisible winds and their windless stillness. The comfort of a purring cat on my lap. The warmth, color and movement of flames in the fireplace that holds darkness, cold and loneliness at bay.   The aroma of the first cup of coffee and the uncertainty of completing the morning crossword puzzle.   My joy in feeling fulfilled in tasks I didn’t think I could do. My feeling both needy and yet capable of helping others. My knowing and still learning. The years of aging have brought all these and so much more.

I want to freely, profoundly experience all of the facets of aging that come my way. I want to do it untrammeled by any need to consider whether something I’m experiencing is healthy or unhealthy. But at the same time I want to retain and use my health lens and knowledge . . . appropriately and creatively.

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I want and need to keep my rich aging experiences and my health, each in its proper place and help those who are a part of my aging experience to do this as well.

Aging and Ageless, A Paradox?

Being both aged and occasionally feeling that my age is irrelevant, seems paradoxical, yet I experience it. I surely show, experience and acknowledge the effects of all my 97 years. But at the same time I experience a sense of agelessness at times in relating to others. I seem to slip into their “age” however they are experiencing it. I have no explanation for it, so I don’t “look this gift horse in the mouth.”

It may well have started long before I became really ancient. I was blessed to have all three granddaughters born after I retired and to have them as near neighbors. I had time with them from their infancy on. (They also had entrusting mothers.)   Each was verbal and imaginative and seemed to have no trouble integrating Gram into their lives and their pretend games.

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With my first granddaughter I became a vulnerable dinosaur, escaping the deadly T-Rex as we made our peril-filled way to the “Happy Valley” during our afternoon walks.   My second granddaughter was a fairy godmother; and I became a Cinderella. My fairy godmother invited me to choose my gown — style and color, the color of the upholstery in the carriage and the horses. Then we went to the ball as we walked away from home. On our way back home the clock had struck midnight; my carriage was becoming a pumpkin once again and our horses little mice. It was a struggle to reach home.   With my third, we read Swedish children’s books that I’d been introduced to during my workshops in Sweden.   We read the books in Swedish, studied the pictures and joined fantastic adventures with Bamse (a famous Swedish teddy bear who became incredibly strong when he ate his grandmother’s special honey) and his buddies, “Lille Skutt (a rabbit), Katten Janson (a cat), Husmusen (a mouse), and Skalman (a very wise tortoise).

As each granddaughter grew older we became companions as well as relatives and have had both practice and pleasure in learning from each other as we moved through different ages, occupying changing roles as we each aged in our own ways.

These days it’s a comfort to relate to my visitors of different ages (all at least one generation younger than me and most more than that). The disparity of ages feels unimportant. (It still seems to hold true even with the little ones who visit.)   I recognize that my guests acknowledge and accommodate to my agedness, but it is subtle. Do we talk about age, theirs or mine? Sometimes, but it’s usually exploratory and merely a part of a larger conversation.

I don’t know what has made this experience of being both aged and ageless possible, but it certainly offers wonderful experiences that continue even now.

When Initiative Does a Disappearing Act

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Somehow, somewhere, I began to realize that my “get up and go, got up and went,” quietly, sneakily over time. I suppose that is better than having it drop off suddenly because of an accident or illness. But still, I miss it. Of course there always have been less desirable tasks I’ve had to force myself to do and others I could do all day long. But these days, even things that don’t require much physical energy and that I don’t mind doing have become a chore. I postpone, make excuses to myself or decide they aren’t all that essential. Now this is something new.

  • Data: Almost everything feels like “too much.” How can that happen when I’m still basically happy and healthy? I still can do and actually accomplish the avoided task (in one way or another), when I actually get started.   So it’s the “getting started” that has changed.   I feel guilty when I loll about not doing what I know needs to be done, so it’s no pleasure. And certainly I’m relieved, satisfied when I do them.   My daily living balance of requirements and resources is out of balance in a way that feels important and I’m not happy.

Given this data base, it’s time to put my EWA to work and see what, if anything, I can do about it.

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  • My first EWA task is to consider my indolence’s dynamics and genesis.
    • The thought that comes to mind is that: not-doing-something involves decision making as much as doing something does.
    • I remembered that both short term memory (STM) and decision making (DM) parts of the brain start decreasing their efficiency in the fourth decade.
  • Then compare that undergirding knowledge with my presenting situation.
    • Yikes, mine have been on a down-hill journey for close to 50 years and will no doubt continue. It’s just progressed from having difficulty deciding; what to wear, what to pack, what to eat, etc. to whether or not to do a single task and just not doing things, or at least putting them off, making excuses to myself.
  • Next, it’s time to get creative. I considered whether any strategies I’ve been using successfully with some lapses in STM might apply to this.   (Why reinvent the wheel when it might be usable in a different way.)
    • Developing rituals successfully counteracted the way STM (1/21/17) was messing up my life. I found it challenging to stick to the rituals in the beginning, but now months later they are almost habits, habits + conscious mindfulness actually. I feel positive and more in-control when I do them.

This strategy might be a way to work around my waning decision making. (see 2/22/18; 12/12/18; 1/15/19)

  • My initial adaptive strategy: Develop new rituals of making a commitment to: complete every cluster of related activities at the time I engage the initial one (rather than move on to something I’d rather do).
  • E.g. I’ll dress when I get up and make up the bed, hang up or dispose of any unused clothing before leaving the bedroom. I’ll rinse and stow the dishes in the dishwasher after each use. I’ll prep the veggies and start the soup base after I stow the other purchases etc.  

Well that’s a start. I’ll see how that goes.   With any success and feel-good from those efforts, I suspect my brain will alert me to other tasks I can take on and handle differently.

  • Progress report and evaluation A couple of weeks into trying the above and adding other areas to it seems to be working.
  • I’m holding to my commitment of clustering related activities and it doesn’t feel too demanding (much to my surprise)
  • My brain seems to be enjoying a new challenge and appears to still be wired to remember, manage and even add new areas.
  • I’m feeling gratitude that other parts of my brain seem to be allowing me this much recognition of changes and creativity to make working adaptive strategies.

I do hope it all holds out for some time. But that’s the concern for another day. “Sufficient unto the day …” still needs to be my motto.

Have any of you readers had this challenge?
How have you managed?
Please share.

Communicating “What Matters”

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The other day, a friend and former nursing colleague sent me material from the Age-Friendly Health Systems. In it I learned about the “4M’s” model for Age-Friendly Health Care. They were: What Matters, Medications, Mentation and Mobility. What struck me was that “What Matters” came first and was seen as separate but then was threaded through as the guiding purpose for managing the other three.

Now if that is the way our caregivers are viewing elderly and our care, it means that it is up to us to know and communicate — not fuzzily or vaguely — but clearly and specifically what it is in us and our approaches to living with our aging that truly “matters” to us. Caregivers are not mind readers, nor are our near and dear ones. They can read the cues we send out, but those can be just blurry reflections of what really is important to us.

I’m a very old person living semi-independently in my own home (family and friends pitch in as needed, thank goodness). So, I’ve really not felt the need to delve into my deepest basic needs, as I age and adapt.   I thought first of what I would hope would be considered and respected by workers in any kind of external support systems that might come into play as I become increasingly dependent.

“What matters” at the most basic level has existed in me, “in spades” the whole time. And it has certainly guided how I play out my daily living and relate to others in the process. But spelled out, it has not been. Now, I’m taking it on, seriously.

In my initial thinking, four “What Matters Most to Me” emerged. They undergird everything else. I need and want to

exert as much control over my life as possible. Linked to that is my desire to be and be seen as reasonably self-sufficient. (Becoming 97 has taught me that it is foolhardy to think in terms of total self-sufficiency, so relative self-sufficiency is my standard.)

have my personal boundaries respected even as I realize that I must allow health care providers and others into my private world. But I would hope that it would be a collaborative approach that involved mutual understanding of the need, rather than presumption that any intrusion was routine, system-based, or in others’ automatic presumption of what is “best” for me.

be seen as credible even as I acknowledge the existence of blind spot and an aging brain.   I want opportunities to demonstrate my degree of credibility as needed rather than be subjected to general presumptions based only on age or diagnosis. I’ll also need to accept that my credibility will need to be tested and verified.

have relationships, both personal and professional, be mutual and collaborative when we agree and when we disagree, have similar or different backgrounds, goals and outlooks.

learn about and respect what others want and need in any interaction or transaction and incorporate that into my responses.

These address my most basic “what matters”. Health care providers at any level will also need current specific data on elements of my day to day status and adaptations as they relate to their perspective and work at that point in time.   And I need to be prepared to communicate this kind of “what matters” in ways that are relevant and usable to them as they care for me. But that’s gist for another blog post.

Clocks and More Clocks

Clocks

Here I am, a fully retired 96 year old woman, living in my own home and able to do what I wish, when I wish. Many of my days are wide open. Yet I have and want clocks, accurate in their action in every room. There is one that is night lighted beside my bed. There’s one on my desk in addition to the one on the computer monitor. There is one opposite my recliner, and a lovely grandmother clock that chimes the hour and quarter hour (rather loudly) in the living room (it was a no-occasion surprise from my husband one time). In the kitchen there are clocks on the radio, the oven and the microwave. And on top of that, I wear a watch! It doesn’t make sense.

Somehow, time seems important to me, even now. Maybe it harks back to my childhood. My Swedish parents respected being on time. They consistently modeled it. Decades later I encountered a man who’d been posted to the American consulate in Stockholm. He told me that there was a 4-minute window for arriving at a social engagement such as a dinner—2 minutes before the appointed time to 2 minutes after. That rang a bell as I recalled how my mother made her last minute dinner preparations to coincide with guests arriving at the hour invited. And arrive promptly they did.   Even our supper tended to be at 5:00 each week night. Fortunately, my husband’s patterns were similar and our sons had little choice in the earliest years.   So this way of living continued through the decades

What has complicated this even tenor of my ways is my changing capacities that threaten meeting deadlines, whether it is expecting guests or being ready to leave when my ride arrives. I don’t mind when others are early or late, so it’s only my behavior that’s involved. For ordinary days when I’m alone it’s no problem, but I’m uneasy about being ready in time when it involves others. It’s hard to know how long it’s going to take me to get ready. All sorts of calamities strew my path. I have trouble making decisions, so they take longer. I have trouble putting on a piece of clothing. I drop things, spill things, have trouble manipulating things. And hurrying just increases the risks. I try to be organized and plan ahead. Then I start early to allow for my calamities, watch the clock and most often relax for a few minutes before the deadline; or feel comfortable greeting guests or the ride if they are early.

Nurture or nature, apparently I’m wired or conditioned to enjoy some predictability in rhythm and flow of my days even in the midst of age related changes.   Addressing my need to be ready on time and the barriers to it is a work in progress.    

C’est la vie! And lucky to have my home, my clocks, people who can fix or adjust them, visitors who accept me as I am, and people willing to take me and my walker out and about.