Read an interview with Ann-Ellice Parker to discover a new and positive approach to death and dying.

http://blog.sevenponds.com/professional-advice/an-interview-with-ann-ellice-parker

Last Thanksgiving I spent some time with a strikingly beautiful octogenarian, a Dorothy Dandridge type beauty who spoke Spanish the way only a black Latina of her generation can – perfect enunciation with a striking and characteristic prolongation of the trill on the “r”s and “rr”s. She looked as if she’d just stepped out of the 1940’s silver screen. I fell in love with her immediately and talked about her for days.

Lucia (not her real name) was clearly someone who had taken care of herself. She had beautiful long hair, perfectly coiffed, a figure devoid of extra weight and a lovely style of dress. She was a vision, not just of superficial beauty but manifesting a sense of caring and pride in herself. I could see also that she was cared for.

There were some personal things that made her special to me. She reminded me of my Aunt Fidencia and her beautician friends – all black and from Cuba or Puerto Rico. Meeting her provided me with the opportunity to speak Spanish which is increasingly rare for me these days. Also, she was part of my extended family by marriage, part of the mespuchah as the Jewish people say.

But as I continued to consider her impact on me, I realized a few other important things.

Seeing Lucia and spending time with her showed me some important things about living long and well. Lucia lives with her daughter, her son-in-law and grandchildren. She was surrounded on Thanksgiving Day by a huge crowd of family and friends, of all ages. In-laws, cousins, friends, grandchildren all came together across generations, threw open the gates of nuclear family constriction, and shared the spirit of the day. I felt fortunate to witness the way that love and connection always makes life better just as they most certainly prolong our days.

On hearing some old Puerto Rican tunes, Lucia started to sing and her daughter and several family members joined in. While she smiled and sang, the twinkle in Lucia’s eyes conveyed her joy, and revealed to the astute observer that she could still locate her delight in living. A sense of humor and the capacity to laugh are, after all, markers of longevity!

I was delighted to make her acquaintance! Or so I thought.

Lucia kept saying, “We’ve met before in Puerto Rico. At Doña Petra’s house.” I didn’t remember a Doña Petra, and Lucia’s daughter and I tried a couple of times to convince her that she was mistaken. Considering her age and the customary problems of memory, we didn’t persist too long. How funny it was, then, to subsequently discover that Lucia and I had indeed met in Puerto Rico thirty-four years before when my daughter was a newborn. While visiting Puerto Rico to see my daughter’ paternal grandfather, we’d gone to visit his mother, the baby’s paternal great grandmother, Doña Petra.

Another lesson! Our elders have always something to teach us and even they can give us back our memories.

But I don’t want to suggest everything was perfect. Lucia had one noticeable problem. She was hard of hearing. How much this loss can drag elders away from the world – making it hard to engage fully with others and pulling them into a world that is increasingly silent!

Hearing loss is one of the many challenges of aging, and as with other challenges of this period, elders are called to let go and to find ways to turn losses into gifts. I don’t yet know how Lucia copes with her hearing loss, but I do pray she finds in this loss, an opportunity to turn her attention to what matters most – a warm embrace, the comfort of a satisfying interior life, and faith in her family and whatever higher power she holds dear. I could tell by meeting her (again) that whatever strategies she is using, she is coping well!

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The local scene in the Pioneer Valley is full of activities that relate to the art of living (and dying) well during the senior years. Let me tell you about a few exciting developments:

The Amherst Senior Center has a wonderful part-time nurse on staff. Lisa White provides treatments, education and referrals and is at the Center on Mondays from 10-12 and from 12:30-2:30 and on Thursdays from 1:30-3:30p.m. Please call 413-259-3257 for further information.

The Dementia Initiative founded by Eleanor Wakin, and situated at Cooley Dickinson Hospital in Northampton, is working to create “a continuum of support for dementia patients and their caregivers.” Read about more about the initiative at: http://www.cooleydickinson.org/dementia-initiative

Joanna Brown has written a beautiful work describing her own experience of caring for others. Her book Caring for Dying Love Ones: A Helpful Guide for Families and Friends fairly bursts with useful information. My favorite section so far is “Taking the Temperature of the Caregiver.” Having been a caregiver for both of my parents as they were dying, I know how important it is for the caregiver to pay attention to his or her own well-being. This is a book for those who are caregivers and for those of us who are, or will eventually be, care recipients. You can find the book at http://www.amazon.com/Caring-Dying-Loved-Ones-Families/dp/0981982018/ref=sr_1_1?ie=UTF8&s=books&qid=1296361617&sr=1-1

Psychologist, Sara S. Wolff’s book Vital Aging: Seven Years of Building Community and Enhancing Health is next on my list. It tells the story of the women in a group that Dr. Wolff led. Since I once saw Dr. Wolff in therapy myself, I know what a gifted therapist she is! I can’t wait to read about her insights and the women’s experiences.

Last, but not least, Janet Bunce, CSA, is a wonderful local Certified Senior Advisor working at Eldercare Training Associates in Amherst. Janet is a care coordinator with lots of information to share. If you think she can be of help, call her at 413-253-6918 or e-mail her at jbunce@comcast.net

Easing the suffering of Alzheimer’s patients and easing the strain of care giving can go hand in hand. New research reveals that pleasurable experiences make a difference. http://www.nytimes.com/2011/01/01/health/01care.html

Technology can be compared to guns. It can be used for good or evil and everything in between. Technology can protect us and it can be used in ways that are abusive and harmful.

This New York Times article provides lots of useful information and lots of food for thought. Let me know what you think!

I wept twice this week. Me! Who never cries. The first flow of tears was occasioned by a letter from a dear friend. Written in Spanish, it was a thank you note for an e.e. cummings poem I had sent him and a request to help him with the English translation of his own poems. I was so moved – grateful, appreciative, honored.  But more than that! The note touched my soul, reminding me of a long lost self, one I am anxious to recover.

It happened again today! I drove out of the Saab dealership after paying $496 for a repair on my beloved 2001 “Sverige.” They had just informed me that I will need about another eight hundred to one thousand dollars in repairs, but that wasn’t the cause of the tears.

As I left the dealership I opened the two front windows and the sun roof, ready to enjoy the beauty of this June day, and I pressed the play button on my CD player. “Rocky Mountain High” was the song that came on. This was what brought on the tears. “Rocky Mountain High” is one of my all-time favorite songs, evoking memories of the 1968 Summer of Love and the nights I spent sleeping in my sleeping bag sans tent in Estes Park, Rocky Mountains, Colorado. There, just as John wrote, I listened to God and heard his casual reply. There I was young and free and high above and away from the world of family warfare and national strife.

Two songs later on the same CD that played this morning, John Denver sang “I Guess He’d Rather Be in Colorado,” and I mentally celebrated my upcoming return to the Rockies. 42 years later I will again stand on the highest peaks, perhaps once again stand in the snow despite the summer season and I will gaze out over the hills and peaks and valleys of the great, glorious Rocky Mountains.

John is gone now. (How fortunate we are that artists and writers leave us treasures to hold on to!) And I am gone too. The pictures of me at 24 are unrecognizable to anyone who didn’t know me then. Katie has disappeared and Bill took distance. I no longer drive my English Ford and will undoubtedly never again take a three-day all night/all day driving trip to the Bay Area to attend a Be-In, hang out in Haight Ashbury, and smoke some pot. My father is no longer available to call, if my clutch (yes I still drive a stick) burns out during a 3000 mile cross country tour. “This is the last time,” he said, as he wired the money for repair in the summer of ‘68. Of course it wasn’t, but he is gone now too. 

There are many ways to die. I watch some of the most agonizing in the nursing homes where I work. But there are good deaths too and perhaps even glorious ones. John Denver died when his Long EZ experimental aircraft crashed over Pine Grove, California on October 12, 1997. He was alone and he died doing what he loved – flying and viewing the beauty of the natural world.

It seems to me on this perfectly beautiful spring day (“Whatever is so rare as a day in June? Then, if ever, come perfect days,” wrote James Russell Lowell) that John’s music and my memories, my poet friend’s words to me, and his loving kindness were worthy of a few tears. And it felt good to cry.

Peter Jaret’s article in May’s AARP Bulletin is instructive. Of particular interest is his description of the symptoms of depression in older people. Unlike young people who may show sadness, elders may present with a constellation of physical complaints. They may complain of pain, difficulty sleeping or lack of appetite. Jaret, a freelance health writer, rightly tells us that depression impairs recovery from surgery, impairs blood sugar levels in people with diabetes, and can aggravate symptoms of dementia and memory loss. So overcoming depression is very important.

With such serious implications, questions turn to the usefulness of anti-depressant medications. Anti-depressant meds in conjunction with psychotherapy have a high rate of success. But we don’t know if the medications actually work physically or if they are the result of the placebo effect!  To sort this out, I suggest that therapeutic interventions other than medications be tried first.

Here are a few ideas:

1. Start with a depression scale (like the GDS) to see if there really is depression. Many scales are available on line for free.

2. Help the person identify any problems with mood, behavior, thoughts, relationships with other people or physical health.

3. Learn about depression and non-medical interventions. www.yapko.com is a good place to find self-help materials.

If none of this produces a change, be sure to seek help from a licensed professional. Of course, do this immediately if there is any evidence of suicidal thinking!

Depression does not necessarily occur in the senior years and there is help to prevent it!

4/24/10

In a recent research project conducted by one of my students, elders 74-85 shared their wisdom about what it takes to thrive in the senior years. They spoke principally about love, work and service. An octogenarian says that he goes into his studio each morning because there are pictures in his head that he must get down on paper and he speaks of how “lucky, lucky” (he repeats the word 4 times) he is to be married to his wife. Politics (local and national) involve another one of the participants.  Posters on her front door announce her political affiliations and promote her candidates.  When we meet, she is one name short of the hundred names she needs to get her candidate on the ballot. Another, an internationally known scholar and writer, is enthralled with the students she mentors and is still developing new ideas which she shares regularly with her list serve community.

On another front, I meet with patients at the nursing home.  A man prepares to die, another wishes he could. A woman loses thirty pounds with no discernable physical ailment – her official diagnosis – failure to thrive. Many of my other patients exist in the shadowlands, the life force sucked out of them by years spent in the nursing home.

This is not a surprise. Most of us shudder at the thought of nursing homes. When we are young we hate to go to visit Grandma or Uncle Harry, and we pledge that we will never put our parents in that kind of place.  As we age, we let it be known that this is not where we would like to end our lives.  

But in truth, the decline of most of my patients began many years before their nursing home stays. For many, their lack of education and their poverty was the predictor. For others lifelong illnesses foretold the outcome. For others lack of family is the cause.

Nursing homes can be awful; it’s true.  But if the staff is good and the residents are congenial, they are not as punishing as one might think. But the reality is that love and work – what Freud called “the cornerstones of our humanness” are especially hard to come by in nursing homes. Friendships are forged there; it’s true.  And on very, very rare occasions one can find a husband and a wife sharing a room and still proclaiming their love after decades of marriage.

What is invariably missing, however,  is meaningful endeavor. Endeavor that involves residents in service to others. Work which engages the intellect and the soul. Endeavor that taxes and challenges and results in creative outcomes – no matter how small. To play the trumpet or write the soldiers or sketch the sunset or even feed the birds. These are acts of love and work that  sustain a life. Without them we die or we pray that we could.

Losing Your Mind

“I just don’t want to lose my mind!” my mother used to say as she grew older.

I was always confused by that statement, but I tried to be supportive. “Ma, if you lose your mind, you won’t know it!” I would respond, feeling that with those words I was bringing both wisdom and comfort. How wrong I was!

During my visits at the nursing home Mr. Smith grabs my hand anxiously and pleads. “What is this place? I just hope I can get out with my life!” Mr. Smith has begun to lose his mind and has been brought to the nursing home because he can no longer live alone. His children, who must work and raise their children, cannot give him all the time he needs. He has been in the nursing home for eight weeks.

When I saw him last week, he spoke fearfully, yet with some awareness of his situation – “I have a little dementia.” This week he thinks he’s trapped in an old warehouse where they keep you so they can get your money, and he is afraid that he will not be able to get out alive. Some weeks he likes to walk up and down the corridors arm-in-arm with his daughter or his son, and sometimes with me. Other weeks he cannot make it past his bedroom door without trepidation. Holding on to the doorframe, he whispers, “No, I don’t think I want to go out there.”

Losing one’s mind is in fact a terribly frightening process and it is physical, as well as mental, bringing with it a great deal of physical and emotional anguish. But only sometimes! There are moments of peace and comfort as well. “Everyone here is very kind,” says Mr. Smith. There are moments of lucidity. “My mother’s kitchen smelled like the vanilla she used in her famous vanilla cookies.” And then Mr. Smith so clearly describes his mother’s Saturday morning baking ritual that I feel I could reach out and take a vanilla cookie from the cookie plate on her Formica kitchen table.

The course of dementia varies. In the end stages there can be a settling, a withdrawal into one’s self that leaves a kind of peace in its wake. Losing one’s mind is a process. Like life, it is long and sometimes arduous, sometimes filled with beautiful experiences. Sometimes it ends well and other times the end is brutal.

Doing my work as a nursing home psychologist I witness every kind of pain imaginable, as well as all manner of love and joy! And I am reminded of my mother. Is it only after our parents are gone that we remember how much wisdom they had?

The names used in this blog are fictitious. Patients described are not real people but are composite of patients I have known and worked with.

About 20% of older Americans have mental health challenges. Anxiety, depression and cognitive impairments are the most common.

Integrative health care is one good way to meet these challenges. Psychologists, pharmacists, physicians, nurses and social workers should work together to devise the best treatment plans. If your doctor does not work in an integrative way, you can create your own team by including the aforementioned clinicians in your own care plan. To see a copy of the American Psychological Association Presidential Task Force on Integrative Healthcare for an Aging Population. Go to www.apa.org/pi/aging/blueprint.html