“Nothing Changes, And Yet Everything Is Completely Different” * Health Issues and Senior Adults
By Ellen Gilbert
* “The charm of history and its enigmatic lesson consist in the fact that, from age to age, nothing changes and yet everything is completely different.” – Aldous Huxely
The very funny journalist Joyce Wadler defines “old age” as the time when the number of items in your medicine cabinet exceeds the number of hair-care products you use. Most people are familiar with the litany of ills that befall us as we age; if they don’t already, it is almost certain that, eventually, they will.
The list varies only slightly from website to website. Federal and State agencies charged with responding to the health care needs of aging Americans more or less agree on the same three or four primary challenges: dealing with Alzheimer’s; chronic disease self-management; fall prevention; and personal emergency response.
The buzzwords among are similar, too. Professionals who work with seniors and their families these days are using the words “continuum of care,” and “patientcentered care.” These refer to customized programs implemented at home and in residences that enable aging adults to transition as seamlessly as possible through changing circumstances. “I help senior living management during periods of change- -which is constant in our field,” says Stonebridge at Montgomery Executive Director Jean Brophy.
HOME SWEET HOME
Most people are inclined to want to live at home for as long as possible as they age. Area agencies like the Princeton Senior Resource Center (PSRC) and Buckingham Place Adult Center in Monmouth provide daytime services that can include things like home-delivery of groceries and transportation to shops, and medical appointments. Home health aids can be live-in or paid on an hourly basis. While they offer some measure of companionship, Murray points out that aids’ “primary role is to ensure safety at home.” This aspect becomes especially important when there is cognitive impairment and, says Murray, 75 to 80 percent of our clients have some form of memory loss.” Agencies like Buckingham often offer a home health safety assessments, suggesting that throw rugs be tossed out and introducing clients to medical equipment they might not have known about, like raised toilet seats or “life-line” pendants. “It’s as much for the caregiver is it is for the participant,” observes Murray, noting that it doesn’t have to be everyday. Leaving a stove on when someone isn’t there, though, is a red flag.
At some point “reality intervenes,” and it’s time to rethink the situation, says PSRC Executive Director Susan Hoskins.
“Falls are a very big concern,” reports Brophy. However well a home is outfitted with good lights, handrails, and bathtub assists, people fall and, according to Brophy, it’s “a life-changing event.” A broken hip or femur means a degree of immobility and discomfort that often leads to additional health issues and, as a result, depression and a tendency to “give up.” There’s statistical evidence that the elderly death rate rises in the 12 months following a fall.
“Everyone wants to stay at home,” agrees Greenwood House Executive Director Richard Goldstein. In Home-centered Health Care: The Populist Transformation of the American Health Care System physician Mike Magee examines “the intersecting megatrends of aging, consumerism, and the Internet, leading those paths to a single common destination – the home.”
It’s difficult, though, to stay at home if you don’t have a support system, Goldstein notes. “For people of modest means, help that comes in a few hours a week for bathing and dressing is not enough.” Like Stonebridge, Greenwood House offers home care services as well as assisting living options, as well as hospice care.
“Older people want someone who can be there when they have doubts,” suggests Grace Asagra Stanley, a holistic nurse who works at Buckingham Place while also maintaining a private practice. Stanley is a veteran of 20 years as a critical care nurse, but she also describes herself as a “hilot,” a practitioner of the ancient Filipino art of healing. Hilots today typically offer massages and other stress-relievers like the placement of suctioning cups, but sometimes, Stanley says, just “a touch on the head” carries a soothing message. While acknowledging that her practice is only “part of the health care mix” and does not preclude getting traditional treatments, Stanley says she’s always interested in the whole person. “Once you’re holistic, you’re always holistic. It influences how you talk, how you communicate, how you listen.”
Being seen and heard on a regular basis is no small thing, say experts on aging. The six “points of wellness” that provide the framework for PSRC programs include physical well being, of course, but also social cognitive, emotional spiritual, and vocational concerns. Hoskins says that it can be as small as an instructor asking a class “where’s Gloria today?” and thereby reassuring students that they too would be missed if they didn’t show up one day, or, as Brophy points out, the ongoing social engagement provided by residential living. “Neighbors look after neighbors,” she says. The friendliness of the community and formal and informal opportunities to sing and hear or play music all “promote health.”
“I entertain fantasies of going out in style, but the fantasy requires that I not lose much more if ‘it’ than I already have.” — William Ian Miller
A sense of humor always comes in handy—no less so when you are contemplating the possibility (or reality) that you or someone you love may have Alzheimer’s Disease.
The Alzheimer’s Organization puts it simply: Alzheimer’s is a disease that attacks the brain and is the most common form of dementia. So what is dementia? “Dementia is a general term for a decline in mental ability severe enough to interfere with daily life.” Goldstein and his colleagues are quick to point out that the fact that people are living longer these days is increasing the likelihood that they will experience at least some dementia.
William Ian Miller is the author of Losing It (in a recent interview he joked that many people bought the book assuming it was a weight-loss guide). The tongue-incheek subtitle of Losing It announces that it is a book “in which an aging professor laments his shrinking brain, which he flatters himself formerly did him Noble Service” (on the book’s cover it shows up, appropriately, in broken, 18th century typeface). “It is,” Miller continues wryly, “a Plaint, tragi-comical, historical, vengeful, sometimes satirical and thankful in six parts, if his Memory does yet serve.”
Joking aside, Alzheimer’s is number one on the Administration on Aging’s list of priorities. The Agency’s Alzheimer Disease Supportive Services Program (ADSSP), which was created as a result of the 1965 Older Americans Act, delivers “supportive services and facilitates informal support for persons with Alzheimer’s Disease and Related Disorders (ADRD) and their family caregivers using proven models and innovative practice,” and “advances state initiatives toward coordinated systems of home and community-based care – linking public, private, and non-profit entities that develop and deliver supportive services for individuals with ADRD and their family caregivers.”
In practice, area agencies are drawing widely from ADSSP directives as well as from other resources to create programs that address Alzheimer’s and other senior health concerns. Less attention is paid, unfortunately, to the infirmities people are more reluctant to talk about, like urinary and fecal incontinence. “Buried in a new report from the National Center for Health Statistics is an astonishing figure,” a recent New York Times article (“Big Burden, Little Said”) noted “Thirty-seven million older adults who live independently have some type of incontinence.” Not surprisingly, the numbers increase as adults age; the report finds that in nursing homes, 76% of the population is affected.
TAKING THE INITIATIVE
While many people think that incontinence is a natural outcome of aging and there’s not too much one can do about it, experts report that it can be treated with success through exercise, medicine, or surgical intervention. The same is true for other areas on physical decline.
Richard Goldstein counsels people to “see your doctor regularly; deal with issues right away; take your medication; and move around and exercise. “ Healthy eating habits are critical, too; many facilities have dieticians on staff ensuring that residents’ meals are nutritious and, in some cases, customized for those with special diet needs. For non-residents, there are programs offering advice on sensible grocery shopping and healthful cooking.
While a number of facilities offer on-site rehabilitation services, Hoskins and her colleagues encourage people to do something before they have that debilitating fall. Starting a program of regular physical exercise is a good idea at any time, and many facilities have health centers—including swimming pools—to ensure that workouts continue even after people leave their former homes. A number of facilities offer regular visits from medical specialists in podiatry, optometry, orthopedics, and dentistry.
For some facilities, like Greenwood House, the challenge gets greater as people age. “We see lots of people approaching 90,” says Goldstein, but even then, “the goal is to keep them moving as much as possible.” Sometimes that means simply paying frequent attention to repositioning those who are confined to their beds.
The intellectual and cultural institutions that engage Princeton’s younger population are there for seniors to enjoy as well. Visits to the McCarter Theatre, Art Museum, public library, and favorite eating spots enrich the lives of both residential and non-residential seniors, along with opportunities to do volunteer work.
“Many people think they’ve earned the right to do nothing as they get older,” observes Hoskins. “People have to choose to take care of themselves.”