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Useful Articles by the Home Not Alone Staff:

Four Articles about Aging

Denial: Tips to Manage a Normal Part of Aging

David W. Stephen, Ph. D.

Aging means change, sometimes unwelcome change. Dealing with the changes in the aging process may seem like a series of unexpected turns and crises. It does not have to be so. Understanding that denial is a normal reaction to disturbing changes can make the aging experience for the family less stressful.

Ignorance is not bliss. Denial is a kind of self-imposed ignorance, a defense mechanism that helps block a feeling or intellectual realization because admitting the feeling or reality is painful. Elders often deny they need assistance or that their abilities are diminishing. It is difficult to admit that one needs help, because that may be perceived as indicating a loss of independence and a loss of self worth. Family members may deny that an elderly loved one, on whom they have relied for so many years, now needs assistance with simple activates of daily living.

Aging is not an unexpected occurrence, but often, our first reaction to the process is to deny its progression. When an elder care crisis occurs, we naturally yearn for a magic resolution and sincerely believe any downturn is temporary. Sometimes the aging parent or adult child adamantly proclaims (aloud or silently) that a need for care has not really evolved, never could, never will. Remaining in this state is the dark side of denial. Denial can isolate us from reality and from one another. This isolation makes it difficult to reach out, communicate, and cast off the constraints of confronting what we would prefer to ignore.

On the other hand, denial is not all bad. It may be helpful to think of denial as a “safe retreat” when the emotional costs of accepting a situation are too high. Denial is a less expensive solution but is somewhat akin to spraying air freshener on the dog to rid the dog of the smell of the skunk he tangled with. It does not make the problem go away. It is unproductive and even mentally unhealthy to remain “on vacation” in the safe retreat of denial.

Denial Dissected

Let’s break this down into two parts, denial by family members and denial by the elderly loved-one. In my home care experience, it is usually an adult child who calls first, asking for assistance with eldercare. Although this indicates that the caller is not denying a need, it does not indicate that other family members agree with that assessment or that the caller fully accepts the level of care needed. Let’s first deal with the communication that is necessary in order to get family members all on the same page.

Denial by Family Members

An effective way to counter denial by other family members is to present clear facts in a non-threatening way. One of the most productive forms of communication is assertive communication, rather than passive or aggressive communication. Family members may often express denial through passive communication. You can recognize passive communication and denial when you hear statements like, “It’s not that much of a problem. . . Nothing serious has happened, yet. . . Oh, everybody has days when they forget. . .” Passive communication is an attempt to avoid conflict. Avoiding conflict is not helpful in facing and resolving the problem at hand.

If you try to counter denial aggressively, aggressive communication is equally unproductive. Aggressive communication may take forms like, “If we don’t do something now, there’s going to be big trouble. . . You don’t see it everyday like I do and I’m telling you that we have a problem here. . . You don’t help out, I’m doing it all, I see this more clearly. . .” Aggressive communication is an attempt to force your needs, feelings, desires and beliefs on others. While this seems like a reality-based approach, it can make others feel defensive and uncooperative. Remember to listen as you speak. Try to hear your words though other’s ears because you may not think your statements are aggressive (just “reality”) when they are, in fact, perceived as sounding aggressive.

Assertive communication allows you to express your own feelings and observations, while respecting the desires and needs of others. Assertive communication avoids “you” statements and, instead, uses “I” statements such as, “I need to know Mom is eating dinner and taking her medications so I can sleep at night. . . I really do want to discuss this and work this out. . . I need a break. . .” Assertive communication also avoids “should” statements such as, “You should try doing the care for a while. . . You should see him when he tries to go grocery shopping. . .” Substitute objective observations about concrete incidents, and assert, “Last Sunday she took her morning, noon and evening meds all by 11:00 a.m. . . There were two burned pans in the sink when I came over on Wednesday. . . We bought groceries, but five days later not one banana was gone, or rather, they were so far gone I had to throw them away. . .”

Denial by the one who needs help

The elder who needs assistance, but denies the need, can be extremely frustrating. The reasons a senior may need assistance fall into two basic categories, dementia and physical limitations. A person with dementia cannot control behaviors like memory lapses, difficulty in finding the right word, confusion, inability to follow a series of steps, etc. It is not necessary to convince them of mistakes, to ground them in reality, or even to get them to agree to the need for assistance. Depending on the degree of impaired cognitive ability, it may be appropriate to simply agree with them or to redirect their attention. I recently had a senile client who was very resistant to having a caregiver come to her home, but by the second week, was waiting eagerly for the caregiver’s arrival each morning and now hugs her when she leaves.

In the case of physical impairment and a clear mind, overcoming denial is more difficult. I have had luck with the following strategies:

An appeal to authority – A doctor, minister, priest, rabbi, legal advisor or trusted peer can sometimes be instrumental in getting the elder to accept assistance.

Incremental approach – Instead of trying to solve all the assistance needs at once, the caregiver may be introduced as simply “someone to do the vacuuming.” After an initial break-in period, care can be extended to fixing meals, running errands, med reminders, etc.

Insurance – A rational conversation discussing, “Where do you want to be in five years?” can lead to the assertion, “I want to be right here, at home.” From there, you can plan ways to make sure that goal is achieved by planning how to avoid accidents and incidents that may take away the elder’s ability to stay home. Accepting assistance then becomes an insurance policy to attain the goal.

Help me – Using “I” statements makes you the person who needs help. ”I can’t take a vacation because I worry you’ll need me to come over.” An elder will often accept help from an adult child but object to the same assistance from an outsider. This is a good strategy to gently move some of the caregiving burden from the family member to another caregiver.

CEO – Promote the elder to Executive Manager of Care Planning. Like the insurance approach, this is a way to empower the elder (or sometimes the elder’s spouse) to feel like they are gaining, rather than losing, control and independence. I’ve seen this work with seniors who have had a professional career and know what management is. With this strategy, it’s a good idea to get the new CEO to agree to not make changes in the care plan without first consulting you or other VPs.

“God, give me patience. . . but hurry!”

Sometimes it is helpful to simply discuss the concept of “denial.” Examine past episodes of denial when disturbing events occurred, such as the past death of a loved-one, previous loss of a job, the fire or tornado that caused a significant loss of personal possessions. We have all experienced such tumult. Denial is a kind of disbelief in reality and is a completely normal reaction to unwelcome change. Think of denial as a stage though which each person affected must progress as change occurs. Denial is best managed with careful planning, good communication, and loving patience.

Genesis Re-written: Why People Get So Old

David Stephen, Ph.D.

Originally, when God created Heaven and Earth, all creatures were equal. All enjoyed the same bounty and all had the same life span. Of course there were some differences. Monkey could climb trees better, Donkey was stronger, and Man had more brains. So why does Man live longer than most other animals? Here is a parable.

One day, God was walking around enjoying His creation and felt so good about everything that he decided to give an additional gift to any creature who asked. Monkey, Donkey and Man approached God to show their gratitude for creating such a perfect world and God asked, “Do any of you want anything else?”

Monkey was afraid God would get mad if he asked for more, but finally spoke up. “Everything is great here. There are so many trees with fruit that all I have to do is climb up and get whatever I want, any time I want it. I don’t need anything else. But why did you make me live to be sixty years old? By the time I’m forty, I start to get aches and pains, and by fifty, I can hardly climb at all. At sixty, I have to rely on younger monkeys to throw me down food, and sometimes it’s just scraps and cores. Sixty is too old. Can you please take ten years off my life? I would rather have a shorter and more active life.”

“Your wish is granted,” said God, who wasn’t angry at all. “How about you, Donkey? Do you want anything else?”

“Well, you made me very strong and I’m thankful for that. Plus, the grass is tender and delicious. Man makes me carry heavy burdens, but that’s OK because he has the brains and I have the muscle, and that’s the way it is. But, you know, I live to be about sixty, too, and by that time, I’m mostly all used up. My legs are weak and my back is swayed and Man keeps me working the same, even though I’m old and slow and tired. Those last ten years are miserable. Can you shorten my life, too, please?”

“Yes,” said God, and, turning to Man, asked, “And do you feel you live too long?”

“Lord, my life is wonderful here on earth. You have given me intelligence that enables me to outwit the other animals and they all obey me and serve me. So I’m different than Monkey and Donkey. Unlike them, I don’t live long enough and would like to live a little longer than sixty. Spend more time with my wife. Enjoy my grandchildren. Even if I get old and feeble, I have the brains to make life comfortable. For example, I’m working on an invention I call the easy chair and another I’m going to call retirement. When I’m old, I can tell stories, write books, teach people. Please, may I have those twenty years that Monkey and Donkey just gave up?”

God replied, “Since you have a plan to use your time so wisely, I’ll grant that wish.”

And that’s why humans live to be about eighty nowadays. There’s no doubt Man has more brains than Monkey or Donkey. The question is, who is wiser?

There will be a whole lot of elder caregiving needed in the coming decades. Between 1900 and 2000, life expectancy in the United States increased from 51 to 80 for females and from 48 to 74 for males. By the year 2050, the U.S. Census Bureau projects life expectancies of 87 years for females and 81 years for men. Some analysts believe that life expectancy in the United States and other rich nations is approaching a biological limit, but no slowdown is apparent yet. Reductions in infectious diseases among infants and children account for most of these life span increases, but improved medical care for adults is also adding extra years.

Baby boomers will live almost an extra decade longer than their parents and grandparents. The catch is that the extra time gets stuck on the end of their lives, not in the early or middle years, where it would be easier to manage. The population bulge of aging ‘boomers will mean that our senior citizen population will reach historical highs in the next fifteen years. Increased demand will drive dramatic changes in long term care insurance and government regulation. Needs for assisted living, long term care facilities, senior day care programs, and especially in-home care will intensify.

What can we do now? If you are a senior, talk to your children about your golden years, and encourage them to think about their coming golden years. Convince them that “forever young” is a myth. If you are younger, start making plans now to manage your responsibilities as a care giver for your elders. The way we handle our elder care needs today may determine the future shape of senior care during those extra decades that Monkey, Donkey and science have added to our lives.

Fear of Falling

David Stephen, PhD

In Lakewood, Gerry, 87, fell in his carpeted kitchen. “I had two hours crawling around trying to get up or get to the phone. I got to know this carpet pretty well,” he says. His arms and knees are covered with scabs from the abrasions he inflicted on himself during his ordeal. Across town in Broomfield, Carol, a neck injury victim, is afraid to go outside. The last time she fell, it took nearly an hour before a jogger noticed her laying helplessly at the side of her house.

Every thorough assessment of a senior’s home or personal care plan should contain the phrase “Fall Risk?” There is a growing body of research “that the fear of falling is a big reason seniors adapt a sedentary lifestyle. Experts say this defensive reaction is understandable but it puts seniors in more peril – not less – because a lack of mobility weakens muscles and increases the risk of falls,” reports the Centers for Disease Control (CDC) in a Nov. 3, 2003 report.

Falls are the reason behind 40% of nursing home placements, reports National Public Radio’s Madge Kaplan. “Falls are also the leading cause of accidental death among older adults,” she adds. Over 300,000 people each year are hospitalized for broken hips, most of them seniors who have fallen, according to the National Institute on Aging.

The bitter irony is that many older adults seek the safety of “low fall-risk inactivity” to avoid falls. Just the opposite occurs. Inactivity results in less mobility, less muscle strength, and greater risk of falling when activity is necessary. In other words, inactivity produces a false sense of security.

Falling may rob the senior of the independence and dignity of continuing to live at home. Many falls are preventable. The CDC, the National Council on Aging and I have some helpful tips to prevent falls.

1. Make your home safer. Since about half of all falls occur at home, this is the logical place to start.

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Look for places to install hand rails, banisters, and grab rails, including hallways, stairs, shower, tub, by the toilet, in door ways, and even the on edges of counters in the kitchen.

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Move furniture so that you can use it as a support as you walk through the room. For example, the back of a couch makes a welcome support when you enter the living room.

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Get rid of “tripper-uppers,” especially on stairs. If it’s on the floor, maybe it shouldn’t be. This goes for small throw rugs, shoes, piles of newspapers, etc.

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Clean out the cupboards and store small items on lower shelves to avoid using a step stool.

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Put a non-slip mat or even a towel on the bathtub floor.

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Add more light and contrast to your home. More light helps old eyes see. Avoid glare by using frosted bulbs and light colored lamp shades. A wide strip of white tape can highlight the transition from kitchen floor to dining room rug or the edge of each stair step for better visibility.

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Wear shoes or slippers with good gripping soles.

2. Practice being balanced. Balance exercises are often the same exercises that help strengthen the muscles most needed to prevent falls – or to regain control if you stumble. There are lots of programs and routines for non-strenuous balance exercises.

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Hold onto a table or heavy chair with both hands while you do easy exercises,

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progress to holding with one hand, then one finger,

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then no support,

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then (if you feel very stable) with your eyes closed.

Remember that too much exercise too soon can do more harm than good. Work up to balance and strength exercises incrementally. Consult a doctor, physical therapist, trainer, or recreation specialist to get your customized program started.

HOW TO GET UP AFTER A FALL

If you fall indoors, a chair may be the most useful tool to help you get up. The National Institute on Aging recommends the following steps to get off the floor. Let’s presume that your left hip is more pain free than your right hip, and that your right arm is in good shape.

Crawl or roll to a sturdy chair with the seat near you.

Roll onto your left side.

Use your right hand, placed on the floor at about rib level, to push your shoulders off the floor. Your weight is on your left hip.

Roll forward onto your knees, leaning on your hands for support.

Move your hands to the seat of the chair.

Lift one of your knees so that one leg is bent and that foot is flat on the floor.

Place your hands on the seat of the chair for support, lean on the seat, and rise from this position. (NOTE: You don’t have to roll to your left side. If you prefer, you can roll to your right side. )

You might want to practice with a person who can help you get up if you are worried about using this method. Practice makes perfect!

Practice getting onto the floor by using the same chair and follow these steps.

Stand in front of a sturdy chair that won’t tip over. Place the chair against the wall for added stability.

Lean over and place your palms on the seat.

Lower yourself down on one knee (whichever knee you prefer).

Bring yourself down with the other knee to a kneeling position, hands still supporting you.

Put your left hand down on the floor and lean on it as you slide your left knee back so you have your weight on your left hip and left hand.

Straighten your legs out and lie down on your left side. (You may reverse this and use your right hand and right side, if you prefer)

Roll onto your back or stomach.

From this position on the floor, you can do exercises (recommended), inspect the carpet (as Gerry did), or take a nap (as I prefer to do). Use the first set of instructions to get back up on our feet. Practice with help available until you feel confident doing this alone.

Remember, being prepared is not only the Scout motto, but good common sense. Being physically and mentally prepared can help prevent falls and help you recover if you do fall. This may mean the difference between staying at home and having to move to a facility.

Miracle Drugs, Old Age Myths, and the Truth about Life Expectancy

David W. Stephen, Ph.D.

You’ve heard the claims: “Miracle Product Reverses the Aging Process! New Phyto-Supplement Takes Years Off Your Life!” If you believe it, can afford it, and it makes you feel better, then buy it and use it. Hope springs eternal in the human breast. Lord knows, I take a handful of vitamins every morning, myself. But if you’re skeptical about miracle products that promote the myth of “forever young,” here are some facts about life span and life expectancy.

How long can a person really live? Answer: 115 years. The human life span is not increasing; it has been fixed at about a maximum of 115 years for at least 100,000 years. This is called the Maximum Life Potential (MLP). This is like the Olympic Gold Medal for aging. Very few people actually manage to live that long, just as very few people can tie the world’s record for running a mile. There are reports of people living longer, but these are a matter of faith or questionable documentation.

What is my life span? Answer: 85 years. The average age at death, or life span, is 85 years for the human race and has remained constant for centuries. Life span is a theoretical average age at death for the human race, taken as one large group. If there were no disease, no accidents, no birth defects, and if you (and everyone else) lived a perfectly healthful life in every way, average age at death would be 85 years. Average implies that people die at differing ages. A few would reach the MLP of 115. A few others would only make it to 55 or less. But remember, we do need to consider disease, accidents and other causes of death to get a more accurate picture. That picture is called “life expectancy.”

What is my life expectancy? Answer: 80 years for females, 74 for males (in the USA). It’s not 85 years (the statistical human life span) because we have to factor in disease, accidents, etc. The good news is that YOUR LIFE EXPECTANCY IS INCREASING! This is primarily due to three things, a statistical effect, better health care, and healthier lifestyles.

First, the statistical trick is that infant mortality is lower today than it was in 1900. If fewer Americans die as infants it automatically pushes the average age at death up, just as if fewer students score “F’s” on exams, then the class average improves.

Second, with improved health care, we now prevent deaths from diseases like smallpox and polio. Medical treatment has improved so that more people also recover from accidents and illnesses that were previously fatal. Doctors can now diagnose illnesses and disorders earlier and that can increase your life expectancy.

What can I do to live longer? The third contributing factor to increased life expectancy is in your control. Living a healthful life in childhood and middle age contributes to being healthy and vital in your golden years. Diseases such as emphysema and heart disease can often be prevented by a healthful lifestyle. Long term moderation in smoking, drinking, and maintaining sensible eating habits can keep you looking and feeling young and vital.

Vitality in your senior years is what you really want. You can’t avoid growing old, but you can avoid growing old, feeble and dependent. Here’s the great news! We are seeing a decrease in the number of senior years during which we are dependent and feeble. Given this news, in a perfect world here’s how the aging process would proceed. You live a healthful life for 75-85 years. You get old but you remain full of vitality and do not need much assistance. Then, one morning you awake feeling fine and take a long walk, by noon you are in a wheelchair, by dinner you need help eating, and before the ten o’clock news you’ve passed on to join your ancestors and your Maker. At least that’s how I want my last day to go.

So the best bet is to pray that you avoid accidents and illnesses, get medical attention sooner rather than later, be moderate, and actively pursue healthful habits throughout your life. Your goal is to remain vital so you can stay at home as long as possible.

But don’t expect to get as old as Methuselah, even if you buy miracle products or take as many vitamins as I do.

Shangri-la and Old Age Myths

Shangri-la myths come from the Greek legend of the Hyperboreans who lived to be 1,000 years old in a land of sunshine and perfect health. Eventually they became bored with life and leapt into the sea. Some such secluded places may exist, but if people live longer there, it is most likely that they eat moderately and healthfully, do hard farm work even in old age, and are valued by other clan members. Maximum Life Potential age (MLP) remains at 115 years.

In the Book of Genesis, Adam and six of his direct descendants are reputed to have lived over 900 years. Methuselah, was the oldest at 969. The truth of this is a matter of faith. In recent history, no claims of such longevity can be documented. Age exaggerations may be due to having a grandfather, father and son all with the same name, resulting in unreliable records. Some remote societies revere elders and exaggerate age to elevate status. Lunar calendars and the Moslem 10-month calendar contribute to fuzzy math. Given a 10 month calendar, a 115 year old (MLP age) would be counted as 138.

According the Guinness Book of World Records, the verifiable winner of the Oldest Person award is Shigechiyo Izumi of Japan, at 114 years of age, one year shy of the MLP.