Thursday, 20 August 2015

Dementia Village

It's interesting to look at how other countries look after their elderly. I am fascinated by places that 'go the extra mile' and customize situations to meet individual needs in a unique way. I recently saw a  news piece on something called Dementia Village in Amsterdam. It is a true 'village' for people with dementia, without an institutional feel. There is a grocery store, hairdresser, restaurant and other amenities that  motivate residents to stay active and participate in life. There is a huge staff to resident ratio and all are trained to manage dementia. The living space is very home like and people are grouped with others who share similar interests. It is an absolutely phenomenal approach to Alzheimer's care and one that should very much be used as an example around the world.

In Ontario there are some retirement homes that have memory floors for people with dementia. They will often have items that people with short term memory loss can interact with. Things like a baby carriage and dolls. I have seen women residents carry around the dolls and push the carriages recalling a time when they had young children. There may be rooms with a calming environment to help people cope with agitation that is sometimes present. This however is not something I have seen in Long-Term Care where the majority of people with dementia end up. Homes that have these special customized floors are often private settings where the cost can be substantial so many on basic pensions cannot access the care and are left with the only other option - nursing homes.

With our growing population of seniors, it is quite obvious that we will also have a growing population of people with cognitive impairment. We, as a society, need to find innovative ways to provide care in the coming years or we may end up with many falling through the cracks in terrible living situations. Easier said than done though. Something like this would involved tremendous planning and money and most importantly, buy-in from government bodies willing to look at options for meeting the needs of the vulnerable in our society.

Thursday, 13 August 2015

The Fountain of Youth

Today I read a news piece about a woman who just turned 105! Best of all she is well and volunteers at her local hospital. Despite having good genes - likely a prerequisite to living so long and healthy - it seems to me that she has somehow figured the secret to staying 'young' and vibrant.

Whenever you hear about people reaching 100 or more, the question the interviewer always asks is: what is your secret to longevity? The most common answer given seems to always have to do with healthy living (though sometimes its 'a drink a day') but,  maybe it's more than that. Perhaps it's a mix of many things - one part genes for sure, one part healthy living, one part healthy attitude and probably several other factors as well. But assuming things we can't control - like our genes - what makes the difference between ageing well and not ageing well?

Ageing is inevitable and is far better than the alternative, but it seems like many are searching for the 'fountain of youth'. Maybe that fountain is in our heads........ What keeps you young and what makes you feel old? Is it true that you are only as old as you feel? Does an ageing body always necessitate an ageing attitude?

I met someone recently who never tells anyone her birth year - she says it creates restrictions on what she can do if people know her age! She doesn't feel her age and with her attitude, simply doesn't look her age either.

I think that seniors of today are in fact 'younger'  in spirit and likely healthier than seniors of the past - many work well past traditional retirement or volunteer for many years after retirement. Many travel and have hobbies. Many exercise and worry about healthy eating. They aren't defining their abilities by the number on their birth certificate. It's about attitude, feeling vibrant and useful and a willingness to learn. Could this be the real fountain of youth?



Friday, 7 August 2015

Elder Orphans

In my years as a hospital social worker, some of the most heartbreaking cases involved people who did not have families. It was especially difficult if demenita and relocation was involved. The memory of some will stay with me forever. Those without families are by necessity, fiercely independent and understandably often have trouble accepting  and organizing help.

So, it is with great interest that I read articles about 'Elder Orphans' of the future. This is a term now used for people without children in their later years. It is expected that anywhere from 20 - 25% of our current boomers will be in this category when they reach old age. Family seem to provide a great deal of 'caregiving' in studies that are done - I read one that said in the USA its is approximated that 70% of caregiving is done by families currently. With less people having children and less children per family, the issue of caregiving is sure to impact the seniors of the future in a big way.

That being said, all social workers have encountered families that are either unable, unwilling or incapable of helping with caregiving and decision making so having children is not a guarantee that you will not encounter issues in the future.

So, I wonder - how can we ensure that we are not among the group that end up relying on strangers to make decisions for us and arrange our care? I don't really know if there is a clear answer yet. There is nothing like human contact and concern from someone who knows and loves you.  I suppose planning ahead is the key to reducing the chances of having to rely on 'the government' or strangers for care. Creativity and innovation in terms of sharing & providing care might become a necessity. My advice to everyone: plan for old age whether or not you have children. This would apply to finances as well as care. Are there people you trust that you would give your Powers of Attorney to? Consider Long Term Care Insurance if you are concerned that you won't be able to afford care in your old age. As you get older but are still healthy, look into non-traditional seniors housing - in the next 20 years I am certain that we will see a rise in co-housing structures, innovative retirement care and different care at home models. It's never a good idea to wait for a crisis. The healthier you are when you make decisions, the more likely you will have choice and can guide your own destiny.

Friday, 24 July 2015

Legacies

There was an unusual obituary in last weekends paper. It was funny, memorable, honest and a great tribute to a very much loved lady who died at 94 and had many children, grandchildren and great-grandchildren to mourn her loss. It created a stir on social media and as a result, an article about it was written a couple of days later. http://www.thestar.com/news/gta/2015/07/20/obituary-for-toronto-woman-94-lights-up-social-media.html. Instead of simply mourning her loss and elevating her to the status of saint with this obituary, as most obits do, her family celebrated her life and acknowledged both her faults and her humanity. It was indeed a lovely tribute.

And it got me thinking about legacies and what we leave behind. I think as we go through life most people don't put great pains into trying to figure out how they can leave a lasting legacy behind for their families. More often people seem to think in terms of money or possessions rather than the qualities they want to be remembered for. I wonder how many people go through life wanting to leave behind a better world when they are gone. And how many never think in terms of how they will be remembered.

This whole topic reminds me of the poem called 'The Dash' by Linda Ellis  - (the line between one's birth and death on their tombstone) "... For that dash represents all that they spent alive on earth. And now only those who loved them know what that little line is worth. For it matters not, how much we own, the cars...the house...the cash. What matters is how we live and love and how we spend our dash..." (The full poem can be found at http://www.linda-ellis.com/the-dash-the-dash-poem-by-linda-ellis-.html).

One poem says it all so well - in our fast paced materialistic world, sometimes we need to be reminded that life is not about possessions - its about relationships and people. A lasting legacy isn't about getting your name on a wall that strangers can read, its about the memories you leave your family with and 'how you spend your dash'. 





Tuesday, 14 July 2015

The Ethics of Ageism

There is a weekend column in our local paper that I occasionally glance at. It has to do with ethics. People write in a question and the journalist gives them a response based on what he has determined is ethical. This week's column caught my attention because it was about a senior. A daughter of a very elderly woman wrote in because her mother was refusing to eat and she wondered if it was okay to leave her to eat tea and biscuits as she requests or if she should be more aggressive in attempting to get her to eat. The answer from the columnist's perspective was that she didn't have any joy in life any more and perhaps had a change in taste buds so wanted to die a natural death. His advise - keep her hydrated but don't try to force food.

I have to say this response disturbed me considerably. At no point did the person writing in or the person responding, talk about having a conversation with the mother. From the letter it did not appear that the daughter had asked her mother why she had chosen not to eat or explored the issue with her doctor. Nor was this even suggested to her. There was no indication of dementia or mental health issues. The response was paternalistic and ageist to say the least and reminded me of a woman I knew whose family put her in a retirement home of their choosing where she did not like the food. They claimed she was fussy and it really wasn't anything to be concerned about until she died a couple of years later and they revealed that she had lost a considerable amount of weight because of the food issue and had wasted away.

I am not a doctor or an ethicist but I don't believe people who are mentally competent wish to starve themselves to death. I believe that food is one of the few pleasures we have for our entire lives and as such, if someone is refusing food there must be a reason and it should be explored.  First and foremost, someone should ask her why. If she doesn't know, then a doctor's visit is in order. I can only imagine the guilt the daughter would feel watching her mother starve to death - why she would write to a newspaper instead of talking to a medical professional is beyond me but clearly there is more to this story than that letter conveyed. Regardless of someone's age, it is neglect to not investigate an issue of not eating. The response to the daughter's letter was at the very least irresponsible and most definitely not ethical.


Tuesday, 7 July 2015

Retirement Cruising

Yet again the "it's cheaper to live on a cruise ship than a retirement home" email hit my inbox. I have seen it several times over the last few years and usually just send it to my trash box however, this time I decided it was worth giving it some thought... The basis of this circulating text is that the cost of living in a retirement home is so great, that its cheaper to pack your bags and cruise the world in comfort and style.

I need to confess that I love cruising for many reasons - something for everyone, someone else does the cooking, lots of entertainment and you see a different place almost every day. But would I love it if it were my life instead of a vacation? And what if I needed medical assistance or physical help? Would I miss having long-standing relationships? Beyond the staff, there would be no one the same from one week to the next. Would I miss my family and friends and being able to see them whenever I want? Would I go 'stir crazy' in the small cabin for an extended period of time? Besides financial implications, is it really a viable option for one's retirement?

Retirement homes give you many of the same things on land including social activity & meal preparation. But, there is the added benefit of medical attention, assistance with care, and access to family and friends. Suite sizes vary and for those with extra income, there are options of larger spaces and more than one bedroom and bathroom. The only prohibitive factor for some may be the cost. Though if you compare it to living on a cruise ship, the difference may be negligible if at all. In fact, I have heard people describe a retirement home as a 'cruise  ship on land'.

Of course, for most, there is no place like home and when possible every effort should be made to allow someone to stay in their home, albeit with assistance if required. Failing that, retirement homes are a good option which often keeps people healthier for much longer because of the regular and nutritious meals, exercise programs and social interaction. As tempting as an idea cruising into retirement is, it's likely the concept rather than the reality that is appealing.


Thursday, 25 June 2015

Senior Drivers

The other day I was driving on the highway when the car in front of me slowed down to a dangerously low speed. Fortunately, I saw his brake light a fair distance away and was able to slow my pace and overtake him, averting an accident. As I turned to see who was driving - as we so often do when we are ticked at the driver beside us - I noticed a very elderly man in the drivers' seat. It got me thinking about older drivers who may not realize that they are unsafe on the road. On the one hand I completely understand a senior or anyone really, who does not want to give up that aspect of their independence - especially if it is their lifeline to getting out of the house and doing things for themselves. On the other hand, I worry about the lives that are put at risk by people who may not recognize what a lethal weapon a car is....

I do believe that when a person - senior or otherwise - is unsafe on the road and doesn't recognize or acknowledge it - the responsibility to correct the problem lies with family and/or the family doctor. That being said, as with so many issues around care and diminishing independence, children often have tremendous difficulty broaching the subject fearing a negative reaction. However, not talking about it does not make the problem go away. The risks of not dealing with it far outweigh any concerns one should have with addressing it. There are ways one can approach it that make it easier for the senior to acknowledge.

As with conversations children have to have with their parents about needing care, I think that doing your homework before the discussion is invaluable. Find out the process for getting the person tested, speak with the family doctor about concerns and find out options for public transport or community resources for driving and shopping for seniors in the area. If you can organize others to take them on their errands, it might ease some of their concerns about losing their independence. There is no easy way to tell someone you want to take away their car keys but, there are ways to help them understand that it is necessary for their safety and that of other drivers on the road.