Michael hands the store clerk $40 to pay for groceries and the clerk gives the change to his young caregiver. The waitress looks beyond Shirley and asks her niece, "what does she want to drink?" Leo's doctor interviews him during an initial visit but directs his eye contact to Leo's son. Anyone who spends time with an older individual can offer a similar anecdote about how the elder is ignored with the assumption that he or she isn't capable of speaking or acting on his or her own behalf. Even people who should know better often dismiss an elder without thinking.
Most elder people age very well and remain very capable, even with some of the inevitable decline that comes with aging. Nonetheless, too many of us attach incorrect labels and stereotypes to graying hair and lined skin.
Older people generally don't see themselves as old and don't want to be identified as "seniors." Like all of us, they're rather be identified with their interests, experiences and philosophies of life. We don't approach all "40-somethings" in a prescribed way or expect them to confine themselves to the company of other people in their forties. Yet, we often expect the elderly to act in a certain way and to be content around people their own age. Older people are as diverse a group of individuals as are young people.
How does one resist the temptation to focus on age and to instead see the person with a rich history and many capabilities and sensitivities? How do we politely but firmly inform an unenlightened salesperson or care provider that they need to regard and interact with the elder?
Often, directing eye contact toward the elder can communicate that the elder is the one who is central to the interaction. When an elder's input is ignored by another, ask the elder questions to elicit his or her involvement and give the message to others that the elder should be involved. If a subtle approach does not work, ask that questions and interactions be directed to the elder.
An older person may require more time to process information and respond, but most often, if given time, they can do so. Hearing deficits may require direct face to face communication and low, slow speech. A bit more time and consideration is likely to be all that is required to keep older individuals involved in their environment and their decisions.
Finally, many of us encounter elders who have significant impairment of thinking, who perhaps don't recognize their loved ones, and/or who are unable to let us know their thoughts and feelings. It can be frustrating and sad to visit these elders as a personal connection can be elusive. It is easier for family and caregivers alike to act upon those individuals rather than to interact with them. In such instances, address the elder during discussions, offer explanations, and use touch to offer a sense of inclusion. Look into that person’s eyes and ask caregivers to look into their eyes. Begin care or a quiet visit with the silent greeting "hello in there."
With practice, your visits with elders can begin to serve as a model for all of your personal interactions.
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"Sometimes the gentlest of breezes can topple us off the precipice." While we all know that death will come, its inevitability is difficult to accept. Often we search for answers through medical procedures and technology, when the true answers come from nature, the "gentle breeze theory." The world of technology and a "fix it" mentality are blessings, yet they can also be a curse. Instead of helping families experience death as a gentle breeze, they may create a stormy and troubled time.
How do individuals and families discern when enough - when testing to find the answers to the "why" of a decline or the "what" might be done - is enough? How do we recognize when less is more? How can we come to embrace death as an option, rather than view it as a defeat or a sign that we didn't do enough? That takes thoughtfulness and a measure of courage.
Clearly, such decisions are among the most difficult we'll ever make. Personal values, the meaning of life, and view of death are part of the decision making, and as important to consider as medical information. There is no right or wrong, and each individual family must come to peace with its own decisions. Some considerations, however, can help a family be more clear and comfortable with their decisions. As tests or procedures are proposed, it's important to ask:
- what information will be gained?
- how will that information guide care decisions - will it make a difference?
- how much discomfort will be involved?
- what are the risks of not doing tests?
- what are the alternatives to tests and/or procedures?
Most importantly, information needs to be evaluated in the context of an individual's life context. An individual who was very active and engaged in life may have the reasons and reserves to withstand difficult treatment and will have a different recovery than one who was bedridden and whose pre-illness physical and mental resources were near depletion. Ultimately, it's important to consider: "will the medical interventions merely forestall death or will they likely provide for a comfortable and meaningful life?"
Very often health care providers are foremost in helping the family with their decisions. It is important that those providers know the person, their history and values, their pre-illness life circumstances. While specialists brought in for consultation can give information about tests and procedures, they are often less able to fit the information into an individual's life context - that is for the regular care provider AND the family to do. Other supports to and for the family - valued friends, ministers or rabbis, hospital chaplains - can be an important source of guidance.
Choosing to forego tests and treatment is not the same as doing "nothing." Choosing to accept death and support the dying process is a real and valuable intervention. But doing so can seem foreign and out of sync with a culture that strives to keep aging and death at bay. The opportunity to accompany someone in the dying process can be life-giving and comforting. It is an opportunity lost if it is not actively considered as an alternative to treatment. Choosing death can be part of choosing and gracefully accepting all of life.
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What song do you want sung at your funeral?
Marilyn died last week. I was stunned by her death, which I considered sudden. It didn't occur to me that the death of someone 84 years old might be seen as inevitable rather than unexpected. Marilyn and I had many conversations, but we never talked about death and I regret that.
It's no revelation to say that most of us have difficulty talking about death. We use euphemisms to disguise the reality and finality of death, someone "passed on," "passed away," "moved on." It's as if we think if we don't talk about death, it will happen effortlessly and even magically. Ironically, our aversion makes death and dying more difficult.
The quality of life during the later years and during the time close to death is often poor. The fear of death seems in large part a fear of being abandoned and dying alone. Conversations that are open offer reassurance that needed care will be provided and that love ones will be present.
In contemporary society, death is generally removed from day-to-day experience and people are on unfamiliar ground as death approaches. Families and the elderly are often robbed of active, informed involvement in end of life decisions. Rather they become subjected to a high tech, high intervention mode of care. If they are willing to look at the closeness of death as years advance and make thoughtful plans for care, they will be able to better maintain control over the dying process.
Many health care providers, who are expert at keeping people alive, are uncomfortable in allowing death to come. Commonly, professionals look at problems to "treat," leaving the family to consider "to what end."
We cannot be in full control of death and dying, but thoughtful discussion and realistic planning is more likely to help the family assert and maintain their values and desires in the process.
An openness to death leads the family to find resources that can help create a climate in which "unfinished business" is addressed, honest goodbyes are made, and healthy interaction is fostered. Unless willing to acknowledge that death is coming, families are unable to take advantage of resources, such as hospice, which provides valuable emotional and material support in the last months of life.
Talking about death, as social critic Studs Terkel says, is really talking about life. The late years are a time for reflection from which meaning and purpose are derived - a time for telling tales and passing on wisdom.
Willingness to talk about death opens up the possibility of rich, life-giving conversations that help create a sense of an elder’s legacy - on a very personal level. Looking at death offers the opportunity to embrace some of the best of life. -- Signe Gleeson
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You can't expect him to change; he's always been that way." Most of us ascribe to that old saw, "you can't teach an old dog new tricks." While lifelong patterns are difficult to change, an open mind and open heart on your part can offer older adults who seem "set in their ways" a sense of their own continuing possibilities and potential.
Research tells us that most elders, even those who are infirm, want to continue living. Living involves change and growth, and often incurs some emotional or physical discomfort. Most of us are reluctant to ask an older adult to take that on. But one doesn't have to insist upon change to be open to it. In encouraging another to grow, we are encouraging the person to live fully until he or she dies.
Most older people don't feel old. Even as bodies and minds become less than reliable, elders see themselves and want to be seen as willing to take on challenges. Helping them explore possibilities and options is life giving and provides the unspoken message that we consider them capable and worthy. Doing so can also be freeing for the caregiver.
Unless suffering from cognitive decline or mental illness, older people are capable of taking on the challenges that the loss and decline of aging present. They may need help, as we all do during periods of vulnerability and stress, but they can maintain a sense of themselves and their choices. Lessons can be learned at age 70 or 80 or 90 - ask anyone that age.
Some guidelines to consider are:
- Avoid
assumptions that close off choices. Because mother can't knit
the elaborate sweaters she once did, doesn't mean she can't do some beautiful
needlework. Because dad's eyesight is poor doesn't mean the world of books
should be shut off to him.
- Strive to make each encounter a fresh one. Even though a suggestion was ignored in the past doesn't mean the person will never be open to it. One older adult didn't respond for years to the three notes a week she received from her sister. But after a long illness, she wrote her sister a letter and at age 90 began writing to the family and friends she had neglected for years.
- Acknowledge to the elder that meaningful change is hard, but worth the effort. Consider that you may be shortchanging an older person by not asking the elder to take on challenges.
- Don't attach your ego to the end goal. Much of living is in the process. Even if a goal is not met, the process of reaching for it can be satisfying and pleasurable.
Our relationships and encounters with older family members are laden with emotion. When we find ourselves or an elder unable to get free of old problems and patterns, the input and insight of a skilled professional may be valuable in redefining the situation and offering a fresh perspective.
Hope is an essential ingredient in all long-term, healthy relationships. Some of us are late bloomers. Just as we relish the beauty of the autumn bush and the winter berry, with patience we can find our elders blooming, even late in their season.
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