older womanGrowing up in a rural area of Texas I was taught as a child that living to a ripe old age was a true blessing.  From my perspective, having my great-grandparents, grandparents and many great aunts and uncles around to enrich my childhood verified this fact.  Although not highly educated in the formal sense, they imparted an incredible amount of wisdom and life skills that impact my life to this day.  As an adult, watching these same individuals age, and in some cases pass away, I realize that many of the characteristics that have made them such wonderful role models make their later years more challenging.  The best way I know to explain this statement is to tell you my “tale of two grandmothers.”

My grandmothers were raised in rural Texas communities on family farms.  This fostered a fierce sense of independence and self-sufficiency.  For the most part in those days, you grew or made what you needed.  They married men from similar backgrounds and started their families.  Both of my grandmothers have seen more in their lifetimes than I can ever imagine. They survived a world war, the great depression and natural disasters galore.  Now their focus has turned to surviving the later years of their life.

Over the years they have already addressed some of the challenges many rural elderly encounter.

The loss of the ability to drive is the thing that my 96 year old grandmother mourns the most.  She reluctantly relinquished her keys after she had totaled her second car. The loss of independence was a tremendous psychological blow.  Living in a rural area limited her transportation choices to basically friends and family.  She avoided going to medical appointments, the grocery store or other errands, sometimes to the point of doing without, because she felt she was being a burden on others.

Both grandmothers have been forced to move out of the homes they have lived for the majority of their lives to other locations due to health issues.  The stress from having to “move to town” cost my 93 year old grandmother the hearing in one ear.

Now in the final years of their journey they are working through new challenges.  They are now trying to address the increased need for medical care and the resources required to finance this level of care.  This is especially challenging for the grandmother who married a farmer.  Without a pension and very little social security income, she is once again forced to rely on her family to help navigate the expenses of residential care.  The grandmother whose husband fully paid into social security and has a pension, is still trying to figure out how long her resources will last as she has moved to a point where a higher level of care is required.

All of these challenges, along with health concerns, have both grandmothers starting to question the “blessing” of longevity.

Our Guest Blogger this week is Leslie Hargrove, MCHES, Executive Director, Texas AHEC East Coastal Region

Join us for a real-time discussion about the rather grave question raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

This is a vintage fruit crate label and has nothing to do with the content of the blog.

This is a vintage fruit crate label and has nothing to do with the content of the blog. I just am aware of these as an art form from the past.

There is a stigma about aging in our society. The elderly are often expected to follow a particular pattern of behavior and these behaviors are accepted. Perhaps our perceptions are built from stories in the media, personal experience, or cultural norms. When we think of grandpa or grandma in their late years, movies have helped us envision the little old man feeding pigeons at the park, grandma sitting on the front porch in her rocking chair playing a crossword puzzle, or both heading out to the weekly bingo game. Does growing old mean we have to fall into a particular, expected pattern of activity or inactivity? Are the typical, expected behaviors healthy for the elderly? Can the aged still make meaningful contributions to society?

I recently visited with Dianna Smith, a sixty-seven year old woman who has been retired for three years and recently lost both of her elderly parents. Smith shared her thoughts on aging from her personal experience and offered some advice to others.

According to Smith, “There seems to be a general perception amongst young adults and the elderly that once you grow older, you no longer have to contribute to society, you don’t really have to do anything, you have reached the point where you can relax and just be taken care of.”

Is this all that there is when we get older? Smith says “No, absolutely not!” Her motto is “live until you die.” She believes that staying active is the most important thing you can do as you age. In fact, research suggests physical activity contributes to the reduction of psychological distress among the elderly because it promotes psychosocial interaction, improves self-esteem, helps in the maintenance and improvement of cognitive functions, and serves to reduce the frequency of relapses of depression and anxiety (Stella, 2002).

When it comes to aging and staying active, first consider taking on new challenges. “You have spent your life learning who you are, finding your interests, and perfecting your skills. Growing older does not mean you have to leave those things behind. Rather, find new challenges that relate to your interests and skills,” said Smith. For example, Smith started learning to play the violin at age fifty-seven. “The social norm seems to be that learning to play the violin from scratch is not within a retired person’s scope of activity or ability. It is reserved for young children,” said Smith. However, at the age of sixty-seven, Smith now plays with string ensembles and symphony orchestras. In fact, playing the violin has opened up new opportunities and experiences such as accompanying a string ensemble to Ireland where they played at numerous sites. She was able to visit a different culture and meet new people because of her desire to accept new challenges and interests.

Second, as we age, we may become limited in the extent of activities we can perform due to physical or mental constraints; however, we can still adapt to the changes that occur with aging. Perhaps you used to enjoy jogging, but can no longer handle the stress on your knees. Adapt and start walking. If you can no longer walk, try riding a stationary bicycle. There are always alternatives.

Finally, get involved and form new social networks. As we progress through life, we find friends through work, church, or family. As we age, these groups can change. Our family and friends pass on or our church members move away. It is important to accept invitations to new social groups for support and longevity. Staying socially active helps relieve stress while also building new supportive relationships.

Overall, Smith believes that staying active physically, socially, and spiritually helps us live a longer, more productive life. You can still contribute to society and also find enlightenment through your experiences as an older adult. After our discussion, I was reminded of a quote authored by Stephen King used in his movie, Shawshank Redemption. In this movie one of the lead characters is released from prison at an elderly age. After coping with the stress of life in the free world as an older man, he must make a decision. “Get busy living, or get busy dying.”

Aging is a part of life. It is up to each of us to decide how we want to approach aging. Staying active physically, socially, and spiritually can actually make you healthier and prolong your life. If you are living longer and healthier, then the next question might be when do you actually consider yourself old? As for Mrs. Smith, she is going to continue to stay active taking on new challenges, finding new physical activities she can perform, and meeting new groups of people. She will continue to “live until she dies.”

Our Guest Blogger is Mark Scott, M.B.A., C.P.M., Director, Texas AHEC East-Piney Woods Region

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Mark suggests these questions for the Tuesday discussion:

  • What is your outlook on life from an elderly perspective?
  • What are common social stigma about the aged?
  • Do we have to conform to those accepted behaviors?
  • What other activities can we do or adapt to as we age?

Reference

Stella, F., Gobbi, S., Corazza, D., & Costa, J. (2002). Depressa˜o no idoso: Diagno´stico, tratamento ebenefı´cios da atividade fı´sica. Motriz, 8(3), 91–98.

“I will never be an old man. To me, old age is always 15 years older than I am.”   -  Francis Bacon

When do we become old? Is it when we have gray hair? Is it when we retire from work? Or is it a specific age; are we old when we reach 55? 65? 100?  The Pew Research asked this question back in 2009 to nearly 3,000 adults. This was the response:

  • 13% said you are old when you have gray hairturtles
  • 23% said you are old when you retire from work
  • 32% said you are old when you turn 65
  • 45% said you are old when you have trouble walking up stairs
  • 76% said you are old when you can’t live independently
  • 79% said you are old when you turn 85

So, when are we old? I remember being in the 7th grade and thinking that 30 year olds were old adults who had their lives all together.  Now, that I am hovering around 30 myself, I realize my middle school-self had no idea what she was talking about!  Besides feeling old every time I see a new gray hair, I usually feel like I’m still in my early 20s (until I am around young people of that age!)  It is all a matter of perspective.   If you don’t feel old, then you must not be old, right?  This seems to be consistent with the Pew study which states that, “Among 18-29 year-olds, about half say they feel their age, while about quarter say they feel older than their age and another quarter say they feel younger. By contrast, among adults 65 and older, fully 60% say they feel younger than their age, compared with 32% who say they feel exactly their age and just 3% who say they feel older than their age.”

I guess the wise old cliché “you are only as old as you feel” must be true, since “being old” is clearly not defined. After all, age is only a number.  There seem to be many more career changing adults now than ever.  This could be attributed to many factors including: opportunity, financial assistance, job market, economy, etc., but it’s also older adults not letting their age get in the way of wanting to learn something new and pursuing what makes them happy.  Age alone does not decide when your mind and body are old. Why do we need others to define what is or is not appropriate for our age? Take for example the list of people below:

Did you know that?

  • At 100, Grandma Moses was painting.
  • At 93, George Bernard Shaw wrote the play Farfetched Fables.
  • At 91, Adolph Zukor was chairman of Paramount Pictures.
  • At 90, Pablo Picasso was producing drawings and engravings.
  • At 89, Albert Schweitzer headed a hospital in Africa.
  • At 88, Michelangelo did architectural plans for the church of Santa Maria degli Angeli.
  • At 85, Coco Chanel was the head of a fashion design firm.
  • At 82, Leo Tolstoy wrote I Cannot Be Silent.
  • At 73, Peter Mark Roget published the Roget Thesaurus.
  • At 76, Nelson Mandela was elected president of South Africa.
  • At 65, Pulitzer Prize and National Book Critics Circle Award winner, Frank McCourt first began writing.
  • At 64 Laura Ingalls Wilder published her first book Little House in the Big Woods.
  • At 48, Susan Boyle first appeared on Britain’s Got Talent and launched her singing career.

I guess somebody forgot to tell them that they were “old.”

Our Guest Blogger this week is Karen Brown, MAEd. Program Coordinator, Texas AHEC East – Waco Region

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

no exitNo Exit is a play by Jean-Paul Sartre in which three dead characters, assigned to Hell, find themselves in a room with no exit (1). I sometimes think life has no exit too. Not that life does not end but that we have no real cultural expectations for how to die. We rely on an accident or disease to kill us or just allow “old age” to let us fizzle out, but we rarely have a real exit strategy.

Partly that lack of an exit strategy is related to our cultural disapproval of suicide. Generally it seems that our culture and religions say it’s OK to die when external forces choose the moment but if we choose the moment ourselves, that’s morally “wrong.”

And anytime we consider making an active choice to die, we turn to suicide as the methodology (2). I’m not a fan of suicide (I might choose the wrong moment and miss something good) but I do wonder if there is a way to die with grace and in an appropriate fashion at exactly the right moment.

Along that line, the other day I was having breakfast with friends, when one of them said, “My brother, who is 75, just joined the Exit Club.” What pray tell is that? Well, it’s apparently not called the Exit Club, but there exists the Final Exit Network (http://finalexitnetwork.org) which seems like a close fit to what my friend was mentioning.

I also came across the Hemlock Society which ceased to exist some years ago, apparently due to the association of its name with Socrates. See http://www.assistedsuicide.org/farewell-to-hemlock.html

But taking an active role in ending one’s life is not quite my concern here, so I looked for, dying without suicide. I found a few related links but they all ended up talking about suicide, not a natural death at one’s choice.

I know of stories of people who went about their day quietly, said good night to their family, and simply transitioned to the next place. We never consider that to be suicide and I’m sure it is not. It is an example of “going gently into the night” (3).

This latter process is something we need to know more about and to teach to successive generations.

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Notes

  1. The title in French is Huis Clos which means a private conversation behind closed doors as opposed to “we can’t get out of the room” but there are many reasons why we cannot get from one place to another and that’s enough for this analogy.
  2. I don’t want to consider euthanasia  at all this week. Maybe we’ll look at that later.
  3. Paraphrased inappropriately from Dylan Thomas.

fight ageismHave you ever forgotten something, and excused yourself as having a “senior moment?”   If we examine the implications of this statement we can identify that we believe older adults have memory problems or are senile.

Ageism is defined as the intentional and/or subconscious discrimination against elderly people that has both direct and indirect detrimental effects on the older population,

Age stereotypes are often internalized at a young age.  By the age of four, children are familiar with age stereotypes, which are reinforced over their lifetimes.

Our Western society values youth and beauty.  The media’s portrayal of older adults is portrayed as dependent, helpless, unproductive and demanding.  Television advertisements depict bladder incontinence, dentures, and inability to get up after a fall when addressing the older adult, whereas the young are vacationing, dancing, and enjoying life.   The value that the media and society place on youth may be reflected in the number of cosmetic surgeries among older adults.

The relationship between ageism and civil rights is long standing and is reflected in Butler’s association between ageism and other forms of social injustice. “Ageism,” he says, “can be seen as a process of systematic stereotyping of and discrimination against people because they are old, just as racism and sexism accomplish this for skin color and gender. Ageism allows the younger generations to see older people as different from themselves, thus they subtly cease to identify with their elders as human beings” (Butler, 1975).

The truth is that the majority of seniors are self-sufficient, middle-class consumers with more assets than most young people and with more time and talent to offer society.

A survey by Duke University (2001) of 84 people ages 60 and older, showed that nearly 80 percent of respondents reported experiencing ageism, such as other people assuming they had memory or physical impairments due to their age. The survey revealed that the most frequent type of ageism, reported by 58 percent of respondents, was being told a joke that pokes fun at older people. Thirty-one percent reported being ignored or not taken seriously because of their age.  Older patients are often viewed by health professionals as set in their ways and unable to change their behavior.

If older adults are treated as dependent, incompetent, helpless then they may begin to take on that role, because it is an expectation.

Healthcare practitioners must examine their beliefs and educate themselves so that they do not have biases that can compromise clinical objectivity and patient care. Examples of provider beliefs are: seeing the patient as chronically ill and frail, decreasing the opportunity to ambulate or engage in self-care; fear of narcotic dependence, which gets in the way of pain management; under treatment of depression, believing all elders are depressed; promotion of bed rest, with subsequent loss of function. Currently, hospitals perpetuate dependency which erodes the patient’s self-esteem, identity, and individuality.

old people

References

  1. Butler, R. N. (1975). Why Survive?: Being Old in America. New York: Harper and Row.
  2. Cornwell. J.  (2012). The Care of Frail Older People with Complex Needs: Time for a Revolution. King’s Fund, London.
  3. Perry. D. (2012). “Entrenched Ageism in healthcare Isolates, Ignores and Imperils Elders.” Aging Today: March/April.
  4. Kydd.  A.,  Wild D. (2013). Attitudes towards caring for older people: Literature review and methodology.
  5. Palmore. E. (2001).  The Ageism Survey: First findings. The Gerontologist. Vol 41. No 1.

Our Guest Blogger this week is Bronia Michejenko, RN, MSN, GNP, BC.

Join us for a real-time discussion about questions raised by this essay on Tuesday at from 12:00 p.m. CST to 12:45 p.m. CST (10 a.m. PST/SLT). See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

aging seminar 1This is the 137th blog and we have explored many issues affecting older people, especially those in rural areas. The topics have been very diverse and I wonder if we have covered all the essential areas? I want to ask y’all out there to help in identifying the BIG areas where getting older presents us with challenges.

On March 15th, Tony DiNuzzo, Rebecca Galloway, Bronia Michejenko and myself will present a panel discussion on issues in aging for our HomeTown Science 3D Seminar Series (http://www.utmb.edu/hometownscience). The discussion is called Aging and Wellness: Ways Science Can Help and we will spend time talking about five questions. To me these five questions embody the BIG issues that face everyone who moves into and beyond their seventh decade.

aging seminar 3Each question is below with a brief expansion of the issues involved.

  1. Who wants to live forever? – The question of quality of life – When does quality of life trump healthcare interventions?
  2. Why does everyone seem to die from a broken hip? – Strength, balance and rehabilitation – What can elders and their families do to reduce the consequences of loss of strength and balance?
  3. Nobody is taking my car keys away! – Mobility, access and depending on others – What are the options for getting around when driving one’s self is no longer an option?
  4. aging seminar 2I don’t want to die in a nursing home. – Where and how to live throughout ones lifespan – What are the options for aging in place?
  5. Why do I have to repeat this every time? – Coordination of care and teamwork – Why can’t health providers share information and test results so it does not have to be repeated over and over.

I did leave off particular diseases even though aging does make us more prone to a number of conditions. In a way disease is unpredictable but I think everyone has to face the issues above, illness or no. Finally, one’s particular illness will probably make some of the issues more challenging.

aging seminar 4So, here’s my question for today. Are these five item an exhaustive list of the issues around aging? Can you suggest another? Comment below or come to the Weekly Discussion on Aging and we’ll brainstorm the question.

Join us for a real-time discussion about the questions raised by this essay on Tuesday at from 12:00 p.m. CST to 12:45 p.m. CST (10 a.m. PST/SLT). See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.


aging seminar 5

HelloLovell Jones wrote in today’s Austin American Statesman about how cultural differences influence what medical researchers study. He tells how he came to UT’s MD Anderson Cancer Center in 1980 to study breast cancer and how he was especially concerned about the high rate of breast cancer in African-American women. Now retired, and after a lifetime of study and advocacy in this area, he reports that given all the advances in the treatment and prevention of breast cancer, the mortality rate “in African-American women in Texas remains almost four times that of white females.”

Jones further points out as an example, that with his retirement there remains “no African-American full-professor in the basic or behavioral sciences” at MD Anderson.

He attributes the lack of progress in cancer care for African-American women (the first fact) to this second fact. If there in no one in senior leadership positions who understands the needs of a particular group then that group suffers from “benign neglect, institutional discrimination and internal politics… [leaving us] with a system that has been unresponsive to both research and health-care needs.”

This is an most interesting observation. Over the last few decades, all of American society appears to have become more sensitive and attuned to the special needs of the many, many sub-groups that exist. It would seem however that regardless of our sensitivities we tend to disregard groups that are not like ourselves. Thus, if no (choose your group) people are involved in the leadership then the needs of the (that group) people may get overlooked.

Might this apply to the elderly too. So maybe, suppose we have a thirty-something with a Ph.D. in Gerontology, with a useful set of specialized skills, but he/she is not a group member (not old), therefore, however hard he/she tries, the needs of the elderly will remain an abstraction and essential needs may not be served. Do you think this might be true?

What implications does this bring up?

Reference

Jones, L. Factor our cultural differences into scientific health discovery. Austin American Statesman, February 28, 2014, section A, page 11.

Join us for a real-time discussion about questions raised by this essay on Tuesday at from 12:00 p.m. CST to 12:45 p.m. CST (10 a.m. PST/SLT). See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

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