Compassionate, informed advice about healthcare decision making

Posts Tagged ‘aging’

It’s Your Choice: You Can Change Your Views of Aging and Improve Your Life

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I seldom picture myself becoming a demented, incontinent, and disabled patient in a nursing home. My future may indeed look like that because both of my parents ended up in such a state. On top of that, I cared for hundreds of such patients as a chaplain. Many of them were my current age (74) or younger. Why not me?

I did prepare for such a future, having bought long-term care insurance twenty years ago. Again, my parents’ aging convinced me to get the policy. They both used every dollar from their nursing home insurance benefits.

Choosing more positive aging

An article I read recently prompted these thoughts. It was titled, “It’s Your Choice: You Can Change Your Views of Aging and Improve Your Life.” Here is how it starts:

Becca Levy, a professor at Yale University, studies the way our beliefs about aging affect physical and mental health.(JULIA GERACE)

“People’s beliefs about aging have a profound impact on their health, influencing everything from their memory and sensory perceptions to how well they walk, how fully they recover from disabling illness, and how long they live.

“When aging is seen as a negative experience (characterized by terms such as decrepit, incompetent, dependent, and senile), individuals tend to experience more stress in later life and engage less often in healthy behaviors such as exercise. When views are positive (signaled by words such as wise, alert, accomplished, and creative), people are more likely to be active and resilient and to have a stronger will to live.”

Being blind is “wonderful”

I remember asking an 80-something-old patient at the nursing home what it was like being blind. She said, “Wonderful. You learn so much being blind. I can tell who is coming into my room by the sound of their footsteps. I listen to talking books. It is just one learning experience after another.” That lady would be one of those resilient folks mentioned in the article.

Judith Graham of Kaiser Health News interviewed Yale professor Dr. Becca Levy about her newly-released book, Breaking the Age Code: How Your Beliefs About Aging Determine How Long and Well You Live. The bottom line is that if we have a more positive and hopeful view of aging when we are younger, we will more successfully move through those years to the end.

In the interview, Dr. Levy gives several suggestions on assessing our attitudes and how to develop more positive ones. Maybe someday I, too, can say being blind is “wonderful.”

 

 

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Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

Curious After Seven Decades Above Ground

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Hank and his sister Janice with their brother Dennis two weeks before he died

My birthday passed last week. Number 74. Now, a bitter-sweet day.

Bitter-sweet because I miss my younger brother, Dennis. He died on my birthday five years ago. When his wife called my sister to tell her Dennis had died, she said, “Don’t tell Hank. It will ruin his birthday.” She was right. My sister immediately called me, and it ruined my birthday.

The day now brings the appropriate mix of gratitude for another year of life and grief that my brother is no longer here to call me with birthday wishes. Bitter-sweet.

I find I’m getting more curious about myself as I settle into over seven decades above ground.  What am I curious about? About me. My thinking. My spiritual beliefs. I’m curious how can I still find new ways of thinking about and experiencing things spiritual. Curious how I find new ways of verbalizing these experiences.

An old man listening to books

Hank’s 74-year-old self

Last week, I told the story of an old man at the nursing home where I was the chaplain. I was in my 30s and he was in his 90s. The story was about his loveless marriage (according to his wife), but I mentioned that he listened to recorded books.

Every day, he’d be bent over in his wheelchair, leaning down, straining to hear history books being read on a record player. As a young man, I thought, “What is he doing? What is this 90-year-old man going to do with this new knowledge?” He talked very little. He was years past teaching children, or anyone for that matter. He just sat in his room and listened as the day crept slowly by. Now, I think, “I am the old man!”

You start dying slowly

Late last year I was introduced to the poem “You Start Dying Slowly” by Martha Medeiros. In Portuguese it is A Morte Devagar — “A slow death”. This poem meant so much to me that I printed it out and glued it to the inside of the journal I just started in November.

Here are a few lines:

You start dying slowly…
If you do not risk what is safe for the uncertain,
If you do not go after a dream,
If you do not allow yourself,
At least once in your lifetime,
To run away from sensible advice…

Referring to the poem, I wrote in the journal on November 21, 2021, “I am profoundly moved by this piece. I still marvel that, at my age, I am still wanting to make something of my life. I still struggle with taking risks.” Weeks later, on January 4th I wrote, “‘Who are you God and who am I?’ St. Francis said and I BOTH say. I am almost 74 and have not settled this.”

My 24-year-old self meets my 74-year-old self — it is not pretty

Hank’s 24-year-old self

Fifty years ago, if my 24-year-old self met my now 74-year-old self, he would have called me a heretic. I was so certain about things at 24. Now, being “right” is less important. Rather, following the teaching of Jesus, right action is more important that right theology.

Now, questions are more important than answers. Curiosity feels better than certainty. I am the old man listening to books. I listen not to know more but to be comfortable with not knowing. The mystics are my favorite guides. Thomas Merton summed up, for me, the mystery of knowing and not knowing God:

 

Thomas Merton

“Your brightness is my darkness. I know nothing of You and, by myself, I cannot even imagine how to go about knowing You. If I imagine You, I am mistaken. If I understand You, I am deluded. If I am conscious and certain I know You, I am crazy. The darkness is enough.”

 

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Chaplain Hank Dunn is the author of Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures and the Patient with a Serious Illness and Light in the Shadows. Together they have sold over 4 million copies. You can purchase his books at hankdunn.com or on Amazon.

Aging as a Spiritualizing Process — Part Two

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The aging Presbyterian minister prayed, “…God, forgive us for our anger when the nurses do not answer the call bell. And for our annoyance when the food is cold. And for…” This went on for a few minutes. OH MY.

I thought it was a good idea. I was preparing to lead the nursing home’s Sunday morning worship service. I asked one of the residents, Horace, to give the morning prayer. He had pastored for well over 50 years and even performed a wedding for a nurses’ aid while he was a resident. Always the pastor.

So, I stood next to his wheelchair and handed him the wireless microphone at the proper time. He started well enough, “Dear Lord,” followed by some nice things to say about the day and the good Lord. Then the more honest prayer kicked in.

This was not what I had planned.

Then again, I had no idea what it was like to be so dependent on others, especially when those others let you down.

Aging forces us to grow spiritually

Last week, I started exploring “aging as a spiritualizing process.” My plan this week was to unpack an article in theJournal of Religion & Aging on this very topic. I first read that article around the time of the above-mentioned “honest prayer.”

That piece, “Aging as a Spiritualizing Process,” suggests that aging forces some spiritual practices and virtues on us that we should have learned years before. Here are a few bullets from that article:

  • Doing vs. Being: When physical limitations restrict our activities, we finally learn this lesson of the importance of just “being” rather than always “doing.”
  • Contingency: Intellectually, we all know we are going to die. As we age and more of our contemporaries die, it starts to sink in that this fact of death is beyond our control. We “take nothing for granted—thankful for even the next breath.”
  • Enfleshment: Aches, pain, and disabilities bring home the most basic Hebraic biblical understanding that “We do not have a body, we are a body.”

Not Pollyanna

This is no “Pollyanna approach” to aging and disability — no unflagging optimism, no “let’s see what we can be glad about.” And that’s okay. We can also express the honesty of my friend, the praying pastor, who was having trouble with the tardiness of nurses and cold food. Elisabeth Kübler-Ross did list “anger” and “depression” as aspects of dying.

No one put this more eloquently than Flannery O’Connor, the great writer of Southern fiction, who suffered from lupus for 13 years before she died at age 39 in 1964:

“I have never been anywhere but sick. In a sense, sickness is a place, more instructive than a long trip to Europe, and it’s always a place where there’s no company; where nobody can follow. Sickness before death is a very appropriate thing and I think those who don’t have it miss one of God’s mercies.”

Aging as a Spiritualizing Process — Part One

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“Growing old is no good,” the 95-year-old nursing home resident told me. I asked her when it got to being “no good.” She thought for a moment and then said, “About 80.”

“What made it ‘no good’ at that time?” I wanted to know. Without hesitation she said, “When I couldn’t do things for myself anymore.”

I told her daughter of this conversation and she said, “Oh yeah, it was about that time I came into her home, and she was standing on the kitchen table changing a light bulb in the ceiling fixture.”

This resident perfectly summarized the fear of aging; the issue is really the loss of independence. Who wants that? But decline and dependence is the future for most of us, except for the few who will die suddenly while still active.

The minister’s role of “presence and witness”

That conversation, which I also recount in my book, happened over thirty years ago. The young(ish) chaplain who heard those words is now part of the “elderly class.”

So I thought of my own elderly status and that long ago conversation as I read a recent article from Kaiser Health News, “Minister for Seniors at Famed Church Confronts Ageism and the Shame It Brings.”

Rev. Lynn Casteel Harper of the Riverside Church in New York City, sees her role with congregants in their decline as one of “presence and witness.” “Sometimes if people are going through really difficult experiences, especially medically, it’s easy for the story of the illness and the suffering to take over,” Rev. Harper said. “Part of my role is to affirm the other dimensions.”

Harper is right — it’s about presence. I found it was the same in ministering to nursing home residents and hospice patients. I could not take away the pain of loss of independence. I could not lighten the heavy weight that serious illness put on my patients’ psyches. But I could be present.

It was, in a way, easy. I just had to show up.

Acceptance of death without fear — why wait?

I was drawn to another of Harper’s comments. Yes, old folks do worry about what their last days will be like — whether there will be suffering. But she “rarely encounter[ed] a fearfulness about what will happen when someone dies.”

This acceptance of death without fear is common. It may or may not have a religious element to it but, in general, those approaching death have reached a degree of serenity. Acceptance without fear.

I say this acceptance is a spiritual process whether one expresses it in religious terms or not. In a sense, aging forces this spiritual acceptance upon us all. We could do it earlier in life, and many do, but toward the end, after losing independence, we tend to accept and just let things be.

If we could learn how to accept the certainty of death earlier in life, our whole life could be more peaceful. Growing old forces this spiritual practice upon us. This is just one facet of aging as a spiritualizing process.

When Are We Dying?

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Boulder, Colorado

I am here visiting my mother who is closer to the end of life with Alzheimer’s. We moved her here from Tampa a year ago so my sister could be an “in-town” caregiver. My brother and I travel to Colorado every few months to see mom and support my sister, he from Florida and me from Virginia.

Thinking that we all are “dying” is not so helpful

I say “closer” which is not such a helpful term as we all are closer to our dying than we were. So we are all “dying.” Every one of us will die sooner or later. But thinking of us all as “dying” may not be helpful in making treatment decisions.

We make different medical choices for the young and healthy than we do for the old and infirm. When we are young and otherwise healthy, aggressive medical treatment to cure a cancer caught in its early stages seems quite appropriate. Wait a minute! I thought I said we are all dying so why would we treat a dying person to cure cancer. See . . . thinking that we all are “dying” is not so helpful in making treatment decisions.

So, mom, age 92, has been going through the stages of dementia for at least seven years. We have taken over her finances, her medical treatment decisions, even the move to Boulder was all ours. We didn’t even pretend that she had a say in the matter.

When do we say she is dying? I have observed in my years as a healthcare chaplain that we reserve the word “dying” for the last hours or days of a person’s life. Sometimes we even say a patient is “actively dying” which is a strange oxymoron. Often this type patient is nonresponsive, not eating nor drinking . . . doing nothing . . . and we say actively dying. What’s that about?

“The last phase of life,” can last from hours to years.

I now characterize my mother’s condition and those like her as being in “the last phase of life.” This phase can last from hours to years. Like my father before her, my mom indeed has been in this phase for years. Being in the “last phase” informs our decisions about her care. Our goal for her at this stage of life, following her instructions, is to prepare for a comfortable and dignified death.

My friend Dr. Joanne Lynn instructs her physician colleagues to ask themselves, “If I heard that this patient had died in the next six months, would I say to myself ‘I am not surprised’?” If someone’s death would not be surprising then they are in the “last phase.” In addition, they probably would qualify for hospice.

Decisions are easier in the last phase when we are looking to prepare for a comfortable and dignified death. Hospitalization, CPR, surgery, a feeding tube . . . all highly unlikely to be compatible with a comfort goal.

Medical decisions may be easier but the emotional and spiritual work continues. It has been hard to watch our once vital and fun-loving mother wither into a shell of her former self. We have been grieving. But we are very much at ease with the goal of comfort care in this last phase of life.

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