Aging and Identity Part III: We’re Not Dead Yet Stan Goldberg May 12, 2014 Aging, Illness, and Caregiving 15 Comments In Aging and Identity Part I, I maintained the role of identity may be critical in understanding how we react to aging; including the many desperate decisions we make, such as an obsession with appearing youthful, painful tummy tucks, and foolishly engaging in a multitude of activities our bodies are no longer capable of doing. In Aging and Identity Part II, I suggested a few strategies for dealing with our changing identities. In this final article, I’ll offer suggestions for those who are confused how to deal with us “older” folks. We’re Not Dead Yet We may be changing, but we’re not dead yet. I think people who are younger than us—like our adult children—are often confused about how to react to our diminishing abilities. I remember my son insisting on carrying a chair I was prepared to move across the room, believing I no longer had the necessary strength. Although I viewed his offer as an act of kindness, it could have been misinterpreted as a judgment I was sliding into infirmary quicker than I acknowledged. Our children, friends, and colleagues often decide to be helpful without understanding the effects of their actions. What they see as considerate—whether that involves something as simple as lifting a heavy object or as critical as making sure an aging parent is ingesting enough nutrients to continue living—can easily be thought of as the mistaken belief we aren’t responsible to make our own decisions. Ask, Don’t Assume When I served as a bedside hospice volunteer, I learned about the importance of independence from patients who experienced dramatic declines. They were dying, and even though their independence dwindled on a daily basis, it was important for them to do whatever they were capable of without help. As a caregiver, that translated into either giving options (e.g., would you like to feed yourself or would you like me to hold the fork) or asking direct questions (e.g., Do you need help getting into bed?) For those of us who hope that many good years remain, our need for independence is still important. The adult son of a patient constantly tried to anticipate his father’s needs. He said to me, “To wait until he is in trouble would be disrespectful,” What he didn’t realize was the constant anticipation had the reserve effect. We’ve Made Important Decisions Our Entire Lives Trust us to make rational decisions, even if you don’t understand them. I’m often struck in my counseling of caregivers on their insistence their loved one is no longer capable of making rational decisions. The justification is rarely because of dementia. It has more to do with not understanding the reasons for a decision. After all, why would someone near the end of their life want to buy a new car or spend a fortune on remodeling the house they will use for only a few months? Two of my patients made these “irrational” decisions, not because of delusions, but rather from a need to control small aspects of their lives. Understanding our decisions requires a multi-dimensional approach. If the focus is only on the surface meaning, the decisions may appear irrational. But if you ask, “what does this mean?” a new level of understanding is gained. We Know More Than You Think In 2010, I wrote Top 10 Insults for Old People, an article in which I listed the ten most annoying things younger folks do because of not understanding aging. For me, the worst is the routine dismissal of what we know. Mark Twain said, “My father was an amazing man. The older I got, the smarter he got.” Many of us look at what’s new as having no relationship to the past. But we live our present through the past. What gives the present meaning is reference to what we know or experienced—our past. The hesitant acceptance of a new idea may not only be related to fear of change, but also something that we experienced many years ago. My mother’s reaction to anything German was based on the holocaust experiences of her family. When I bought my first car—a Volkswagen—I couldn’t understand why she refused to ride in it. Even though she related family stories of persecution in Poland, I thought, but “that that happened in the past.” When I became an older adult, I began to understand many of my mother’s behaviors when I became out-spoken about discriminatory practices because of my experience as a child in a small anti-Semitic town and encounters with white southerners during the voter’s rights movement in 1965. We can’t escape our history. We live, modify, and sometimes unsuccessfully close our eyes to it. With age comes an increasing number of life shaping events. When we respond in a way you don’t understand, before think about our lives before you judge, and if you’re unsure how it’s related to a present decision, just ask. You’ll be amazed how willing we are to talk about our lives. Conclusions Aging is a natural process rarely understood until you are on that path. It involves changes in identities, reassessment of goals, coming to terms with our past and realization that our future is rapidly ending. Many of the decisions you make will either ease the journey or lead you being pulled along kicking and screaming to something that is inevitable. A few useful choices among many you can make are: Understand the role of identity Adapt to the inevitable Accept help as a form of compassion Simplify life Forgive and ask for forgiveness Accept change Understand you experience the present through your past You can’t think your way to happiness; do something joyful every day Postscript A three-part series of articles is hardly enough time to comprehensively write about aging—especially when I’m caught in the middle of it. I am working on a book about aging that expands on the articles and hopefully can be used as a guide for those of us who are on this unsettling journey. It will be the last in a reverse trilogy of books. Lessons for the Living was my memoir as a bedside hospice volunteer. Leaning Into Sharp Points was written to caregivers trying to find the most compassionate means to serve loved ones. The last book will be an atlas of meaningful aging, written with humor and from the perspective of someone who vacillates between acceptance, adaptation, kicking and screaming, and joy. Share and Enjoy 15 Responses Charles (Chuck) Maack May 12, 2014 Hello Stan, Somewhat different situations are going on with me. Since starting the medication Zytiga/abiraterone acetate 32 months ago that has totally shut down my testosterone production, I have as total a loss of energy and constant fatigue. I am unable to walk any distance without tiring and all the many things I know need doing, I just cannot due. In my case, I wish my children and grandchildren would offer to do these many things for me. I otherwise feel quite well, but fatigue just shuts me down. And, I am caregiver for my wife who has difficulty doing any walking, thus I’m cook, laundryman, and whatever else that needs done that I can do before getting to tired. I need more of their help, but feel that if they can see and don’t offer it, I would just as soon not ask them. So, there is that side of aging where we really would like the help, but it isn’t offered. I guess I’ll have to make a list of what I would appreciate being done on my behalf and hand it out to them. Reply Stan Goldberg May 13, 2014 Hi Chuck, I’m sorry to hear that you are having problems with the lack of testosterone. I too have similar symptoms but I know not to the extent you’re having them. I’ve come to realize that often what I think is obvious to others, isn’t, so I would suggest you might want to rethink your feeling “I need more of their help but feel that if they can see and don’t offer it, I would just as soon not ask them.” Your children and grandchildren may indeed be uncaring, inattentive louts. But, what if they aren’t? What if their reluctance to offer help is based on something else, such as a mistaken belief that you are fiercely holding on to your independence and would be annoyed by their help. Or at a more sublime level, that offering help means you’re getting closer to death, something they may have difficulty accepting. It’s often hard for others to see what we see (especially those of us who have chronic medical issues) if they’ve never “walked the walk.” They can guess, assume, and try to anticipate. But I’ve found most of those theoretical approaches pale when they are directly told what is needed by a loved one. I would suggest being direct and honest about your needs and limitations. Ask for help on one specific thing and honestly explain why it’s needed. What’s the worst that could happen? They would just continue doing what they haven’t been doing. Take Care, Stan Reply Dorothy Cafran May 12, 2014 I look forward to your third book as I thoroughly enjoyed the first two. You articulate your points so well. Reply Stan Goldberg May 13, 2014 Thank you for your continuing support Dorothy. I hope the third book won’t disappoint. Take Care, Stan Reply Jan Bergmans May 13, 2014 Dear Stan, my dad is now 88 and in the late stage of dementia Every day is a struggle but the principles you describe dealing with the elderly still apply. Thanks for your continued insights,namaste,Jan B. Reply Stan Goldberg May 13, 2014 Hi Jan, Thank you for your kind words. If something arises that would like to discuss privately, please feel free to contact through my email address. Take Care, Stan Reply Ken Stofft, MA, CSB May 13, 2014 We are our history and more than our history! Your example of your Mom, refusing to ride in a Volkswagen, makes sense. The dilemma is when we take our history into our present and simply refuse to take or understand another perspective. We more than often create our own suffering! And, too many older folks stumble into elderhood kicking and screaming, and some of us never seem to “grow up” emotionally or mentally! It’s today when we need to start, not tomorrow. We need to challenge all of our beliefs on a daily basis, and become aware of where we want to be and where we’ve just missed the mark so that we can change course. Reply Stan Goldberg May 13, 2014 Hi Ken, Important thoughts! I’ve found that although we can never “escape” our history, we do can decide how it will effect us. Unfortunately, there are some who look at their personal history as wedded to granite, and not something through which we see the present. TAke Care Stan Reply Patricia Mastroddi-Emond May 14, 2014 Hi Stan….thank you for these thought-provoking words. I have been in contact with thousands of prostate cancer patients since starting Pulse Nutritional in 1998 and have found all sorts of problematic situations- some I could assist with – others I sadly could not. I am blessed to have a dad that is almost 92 and still golfing, driving, shopping, reading, going out with my mom and family and his brain is razor sharp. Amazing and Blessed. BUT…he is almost 92 and I see the fragility that sets in and the once over 6 foot robust man is now about 5’9″ and thin and while he looks younger than his years, he is indeed not the Dad I remembered….our past truly does come into play in our future thoughts, remembrances perception. I pray my Dad is still golfing for years but I do not delude myself either about the “pitfalls” of every passing year regardless of his current condition – or any of our conditions. But I offer to do thing in moderation for him as he is capable and with my mom, who has RA, I offer more of course and she asks more….but I also treat her like she is like all of us, capable of some things, others not. She is still vibrant in her own way and while seeing the deformity in her hands, feet, makes me sad – and to know the pain she is experiencing due to the RA, – it is hard to reconcile after years of seeing my mom almost like superwoman! I totally understand your view as I also took care of a very smart man with CPOD and a notable woman with Alzheimer’s in Connecticut – the experience was invaluable. I learned that while these once very smart and independent persons were no longer able to do what they once did despite the burning desire to do so, they NEED and DERSERVE to have their dignity upheld. I did what I could to assist them but also with the MIT grad (CPOD) played challenging games he liked and had in-depth conversations about a myriad of things regarding life and his life. It was truly a growing experience for me to see the eyes through the world of a now almost 90 year old with an IQ of 160+ who could not physically be without oxygen every day and could no long sail as he loved to but he still found joy in talking, eating, watching classic movies and the learning channel – as mentally sparing with me!!! He also was amused my me which kept him interested and with a twinkle in his eyes. I think I would have done just about anything to see him return to the mischievous man I knew he was and at times he did…and always he was dignified and intelligent. His bodily limitations did not limit the rest of him and that is what many do not see. I am very grateful for seeing this first hand. With the Alzheimer’s patient, she was very notable in Connecticut and very smart. In the news often, high prestige job in government until the day she could not remember how to get home in her car. Admittedly, I was disappointed in one of her children, who said – “My mother is sick, he does not want to live any longer, etc.” I said – “Any woman that gets up to dance to songs she likes, watches movies and shows she likes, gets her hair and nails done each week albeit hard at times, eats her food and asks you to make crème Brule for dessert is not going anywhere soon! And she did not. While I was at first intimidated to provide certain service for her, I soon realized it was as painful for her as for me. She KNEW what was happening, she remember her career, clothes (she was a fashionable woman) and her husband who passed long ago. She may not remember her breakfast, day of the week, or who was President, but he remembered a lot of her life. One day I found her sitting on the bed not wanting to move. I asked her if she missed her job? She said…yes dear. And that was all. I think many should accept they too are most likely headed down this road and now I am almost 61 and while I may have inherited my dad’s genetics as no one every thinks I am past my 40′s, I KNOW and I realize time is fleeing. It is true that one must keep dancing, reading, interacting, connecting spiritually, and if possible accepting the aging process – - which as much a I love Betty White and the girls, is not always the Golden years. My work allows me to write articles with doctors, speak to many and understand the immune system and how to modulate it and keep it running more like a Ferrari than a broken down Impala (no disrespect to either) and I appreciate that. We are ALL headed hopefully down the road to our final destination – I call my heaven – but it is not always easy to accept the changes we see, even if very small. There is much we can do via diet, exercise, immune modulation, hormone balancing, spiritual faith, etc., but some is beyond our control….BUT what we can control is our graceful acceptance of this aging process and our limitations….and celebrate our strengths! Thank you for making me think about this subject…it is an invaluable one indeed. Patricia (of Pulse Nutritional) Reply Stan Goldberg May 15, 2014 Hi Patricia, Thanks for the kind words and wonderful insights into aging. Take Care, Stan Reply Luke May 14, 2014 Hi Stan, “The road to hell is paved with good intentions!”… So often caregivers (and family members) zereo in on the failing physical capabilities… your example of assistance to moving a chair because, of course, the physical realm is more observable. Then it’s the mental realm because we observe an error in some money issue (“You forgot to pay your cable bill…!) and assume deterioration in that area. Unfortunately (or fortunately) they are connected to the emotional and spiritual realms where the person truly dwells. You can’t muck around in one area and not affect the others. Aging is a whole process. It’s no different than growing and maturing… it happens in a context of wholeness. Can you point me to your article, Top 10 Insults for Old People. It would make a great read in Healthy Living magazine. Thanks Stan! Reply Stan Goldberg May 15, 2014 Hi Luke, Insightful comments as always. Here is the link to the article Reply Ken Stofft, MA, CSB May 15, 2014 I think you’re right, Luke, re it’s the holistic approach that is most needed. I wonder at times why “children” don’t get it? Perhaps it is the same old cycle of parents who don’t get it when they are in their “prime”, and never mentored their children to see the bigger picture of a person. Men in particular are so stymied and shut down, passing on to their sons the same patterns! That chain has to be broken sometime. Who’s going to break it and start a new pattern? Reply Leave a Reply Cancel Reply Your email address will not be published. Name* Email* Website Sorry for adding Captcha, but the volume of spam requires it 6 + = 9 Comment Notify me of follow-up comments by email. Notify me of new posts by email.