Friday, April 30, 2010

Crucial Conversations #2

What are some of the factors that inhibit these crucial conversations?

I suggest there are four major factors:

1. We equate being an adult with being in the public sphere, independent and self-sufficient.
2. Bodily functions are considered to belong to the private sphere, the private self. If we talk about these at all we do so with professionals in private offices.
3. Weakness and disability are considered abnormal, almost aberrant. Never let them see you sweat!
4. For our ancestors roaming the savannah, the desert, the forest---the old and the weak become prey when they fell behind or looked weak---we still have that deep memory and the instinctive drive to keep up, hide disabilities.

As a consequence:

~We hide aging and illness in the private home and denigrate dependence on others.
~We don’t know how to communicate about our disabilities in a way that furthers respectful interdependence.
~Like many behaviors that used to be pro-adaptive, the instinct to hide needs and weaknesses can sometimes be mal-adaptive.

I think that hearing aids are a perfect example of the potential for maturing from independence (often a cover for hiding a disability) to respectful interdependence.

There is nothing wrong with my hearing. People these days just don’t speak up. My TV is not too loud---and anyway---My house! My rules!


I will wear a hearing aid so that I can better communicate. I trust the people around me enough to reveal my disability. Also I can contribute to their quality of life by not assaulting them with the noise from my TV.

Wednesday, April 28, 2010

Crucial Conversations

There has been a much-needed push in the media to get people to talk about end-of-life issues with their doctors and with family members. As important as these conversations are I suggest that conversations about aging are more crucial. Why?

The dying process is hugely important but relatively short-term (weeks or months). Much of the sequence and rhythm of events is dictated by the illness that is now terminal. Family and friends are called upon to provide company and care in this highly charged atmosphere. Lots of drama and adrenalin.

The aging process is more of a decades-long marathon. Most everyone who ages will experience some combination of

various chronic conditions, for example, arthritis, hearing loss, diabetes, memory deficits, etc.
acute illnesses at intervals, for example, cancer, stroke, heart attack, broken hip, knee surgery.

Almost everyone will eventually need some assistance with the normal activities of daily living ranging from food preparation to transportation to personal hygiene.

We may not know exactly what will go wrong and when but we do know that there are going to by these kinds of problems. My questions is---how do we begin to talk with each other about these probable futures?

So much is at stake!

It isn’t until we start to talk honestly that we can discover to ourselves and to each other our current condition, probable futures, values, assumptions, ignorance, fears, hopes. Especially we need to talk to the people on whom we will be depending---whether we like it or not; whether we want to or not---so that the partnership can be as informed and consensual as possible.

Monday, April 26, 2010

Suicide as a Long-Term Care Plan #2

While I was venting my frustration with the suicide-as-a-long-term-care-plan strategy, my colleague, an investment counselor, remarked that these folks should “put that in writing and give it to their kids.”

For once I was speechless. I really had to think about the ramifications of what he said.

At some point everyone who is aging will need services, equipment, and medical treatment---long-term and/or short-term.
Somehow these have to be paid for or donated---individual resources, family, friends, local organizations, government.
When I think about all the people I know who do not have kids to notify---do they send their intentions to their siblings, friends, and people at church?

How would this notice read? For example:

“This is to let you know that I have decided to make no provision for my needs as I age. I am opting to commit suicide at the point when I can no longer take care of myself. I do not want to be a burden. I am not expecting you or anyone to take care of me. You are all officially off the hook.”

We are really dealing with two groups. One, the huge number of people (70+) who could never have imagined living so long let alone amass the resources to fund these decades given the realities of today’s aging milieu. For example, my oldest client just died at 102.

The second group, to which I belong, are the 40-70 group. We have to face up---longevity will be the norm, an expensive norm. For us, planning and providing for old age is not just about taking care of ourselves---in my opinion it’s a much more life-affirming way to let others “off the hook.”

Saturday, April 24, 2010

Suicide as a Long-Term Care Plan

Earlier this year I went to a talk about long-term care insurance.

On my way to the bus I caught up with one of the other attendees, a woman in her late 40’s. She commented that the talk was very interesting but irrelevant since she had long ago decided to commit suicide when she started to decline into old age.

I wish I had a dollar from everyone who has told me this is their plan to cope with the vicissitudes of aging. Suddenly three separate reactions vied for expression---like a Three Stooges episode where they are all trying to get through the door at the same time.

Anger. Perplexity. Compassion.

Anger because I have seen the aftermath of suicides. It is not a peaceful panacea. It seems to me as if the person embracing this strategy has already cut themselves off from the land of the living. Note: I am not talking about end-of-life issues resulting from terminal illness.

Perplexity because this woman is obviously educated and has resources. So many of the declines simply require supports. If one can’t drive---there are cabs. If one can’t hear---there are medical devices. I have had clients tell me that if they can’t drive that will be the signal that it is time to kill themselves. I usually ask “You’d rather die than take a cab?

Compassion because I sense the almost primal fear and dread that underlie this kind of decision.

In the meantime we are making our way to the bus.

I turned to her and asked: What if, when you get to old age, you change your mind?

Why not make a plan just in case? Wouldn’t you like to have a choice?

Thursday, April 22, 2010

Now That I've Actually Been in Practice...

I stopped writing this blog for various reasons. At the top of the list was wanting to have more actual geriatric care consulting experience with individuals and families. Now, after 20 such adventures, I want to capture some of the anecdotes and insights.

First of all, in all twenty situations I was called in by family members or friends---not by the individual who was the focus of concern. The main reasons the individual did not make the call him or herself:

~Unaware of any problems
~Wanting to keep problems “in the family”

The main reason that a friend or family member made the call---the individual’s problems were beginning to impinge on their lives to an extent that could no longer be ignored. Impinging how?

~increasing awareness of a parent’s or friend’s failing ability to cope with daily activities
~worrying about resources (time and money)
~worry about future risks and future resource requirements
~growing awareness of how little information they had
~growing awareness of the lack of any kind of plan
~fear that he or she would be stuck with the care---would have no choice in the matter

It is very upsetting to find oneself looking at a loved one and experiencing mostly worry, insecurity, the anxiety of unanswered questions and perhaps some dread mixed with resentment.

I am learning that it is vital to get these feelings out in the open without judgment as early as possible. This honors everyone’s reality. Clears the air for the hard work ahead.