As we approach the holidays, we consider visiting elderly relatives or arranging for them to visit us. While I cannot offer a guarantee of a pleasant visit, here are a few things to keep in mind to avoid some of the pitfalls
How do you know when this old house is the wrong house now? Seniors who are reluctant to move may refuse to leave.
One senior refused to leave her old neighborhood even though the neighborhood had changed. As she left for church one morning, she was shot in the heart by a stray bullet. Waiting to move until there’s a crisis means the senior loses control of the move. The senior who was shot was moved by others. They didn’t know what she had wanted to take with her; she lost some things which made her very sad.
Taking your senior on a decision-making journey helps them to see for themselves that things have changed. A senior realized a move was necessary when she needed more medical care. The house by the lake was too far away. She spent anxious moments waiting for first responders to arrive when she was in need.
A house is not a home, even though some seniors think they’re the same. One senior wanted to keep e-v-e-r-y-t-h-i-n-g, including the china hutch. She measured her new apartment to show it would fit. However, the movers couldn’t get it through the front door. Perhaps it doesn’t fit after all. What else won’t “fit”? We move into a house and we make it a home.
What’s really important to your senior? It’s probably not the kitchen sink or the screen door. Important things, like photos and mementos, can go anywhere. These can go to the next housing phase. Senior won’t lose the important things: their history.
One family referred to the next phase of housing as a new “home”. Their senior dug in her heels and refused to do anything! The family called for my help. I asked the senior to define the word “home”. She described an early 20th century county old age home! I explained that the last of those had been torn down years ago. I offered her a different option; her own apartment with indoor mail box and a grounds crew to mow and shovel. She was willing to learn more.
How has your senior’s old neighborhood changed? Sometimes they need to see it for themselves. I took my Grandfather out to his front porch. Together we remembered the old neighborhood. He talked about the people who once lived there, the streetcar track, and the horses stabled at the end of the street. Each time I asked him, “Where are they now?” At the end he was silent for a moment. Then he said;”They’re all gone”. I offered that if all the people and horses had left, maybe it was OK for him to move on as well. “I like my front porch!” my Grandfather said emphatically. “You’re right; your next place MUST have a front porch!” I said just as emphatically. Then my grandfather pointed to the two trees in the front yard. “I planted those to shade the house”, he said. “They do a great job”, I told him. “100 years from now, they’ll stand as a testament to your efforts”.
Referring to changes as; the next phase of life, works better than to call it; giving up your home. One of my clients was forced to move when she was robbed at home, twice! Even so, she was very upset about leaving. I took her for lunch and a tour of a senior apartment building. She gazed in awe at the beautiful chandelier in the lobby. She did a double-take when a uniformed waiter asked for our luncheon order. After lunch, we toured several apartments. As we drove back to her house I asked her what she thought. “It looks so nice”, she said, “When can I move?”
Another senior had been a great gardener. He was unhappy about leaving his garden. I contacted a newly-constructed facility and asked about gardening plots. On our tour, they pointed out future space for residents’ gardens. The senior explained that the area had too much shade and offered another part of the yard. Since the plots were not yet set, the staff agreed to consider his idea. He would be their gardening consultant! He moved.
Seniors may see a change of housing as a loss of who they used to be; show them how they keep their interests, their memories and mementos.
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One of my patients recently complained. I asked her what her doctor said. She told me she had forgotten to tell her doctor. She told me that she had become used to the problem and “accepted” it. Many senior-related articles advise writing down symptoms and questions before visiting the doctor. Good advice; as far as it goes. It’s the stuff that falls off the radar that could be the most important. The doctor needs information from the patient or the patient’s advocate. That information is the basis to decide which questions/tests to pursue.
What kind of information doesn’t get to the doctor?
Imagine you’re sitting quietly in a meeting or religious services; suddenly your heart starts pounding. You feel like your blood is coursing through the veins in your arms and legs. It’s bewildering and scary: Why?! There is nothing about this setting that calls for such a reaction. Yet, you have this reaction. It is important that caregivers understand what leads to this reaction and what they can do about it.
It’s a “fight or flight response gone wrong. It developed when we had to run away from Saber Tooth Tigers. Our ancestors were successful, that’s why we’re here. Those ancestors passed down to us their methods of coping with their world. Our modern world doesn’t have the same kinds of stressors, especially for caregivers. Our stressors are less clearly defined And they last longer. Our stressors change shape; one minute we’re dealing with the house-the spouse-the kids-and-the job. Then there’s a crisis and we’re caregivers for Mom! From that point forward, our caregiving increases but with no way to know when the need will become greater or how long caregiving will last.
Our bodies respond as our ancestors’ once did; we produce Cortisol to rise to this crisis. The process goes like this: Stress causes the Hypothalamus to secrete. That triggers the Pituitary Gland to secrete. The Adrenal gland secretes Cortisol. This process has several names: HPA Axis, HPA Cascade or Syndrome X, or AKA Insulin Resistive Syndrome. (Wouldn’t it be helpful if we could all agree on one name?) It’s not the crisis that’s the problem. It’s the crisis that doesn’t end that creates bad effects on caregivers.
The effects show up in different ways. Cortisol encourages promotes fat deposits in the outer layer of the body, especially the waist. Some caregivers gain weight. We can measure this effect by doing a BMI (Body Mass Index). Other caregivers have different conditions; heart disease, Type-2 Diabetes and Stroke. We can measure Cholesterol levels through a C-Reactive Protein lab test. We can also do a cheek swab to check Cortisol level. However, how many doctors don’t even ask patients if they are caregivers. The tests are there but they are not used to evaluate identified caregivers at this time on a general basis. You need to ask for them.
When our bodies rise to meet a crisis: they must also let down. Even Saber Tooth Tigers would give chase and then give up. The caregiver’s duties do not end the same way. In fact, they do not “end” unless we place some “ending points” into the caregiver’s life. That is the role of self care, to provide end points such as respite and small moments. That’s why it’s necessary to spread the caregiving load so it doesn’t fall on one person. That is why we need to enlist family to give caregivers this kind of support. Otherwise, the caregiver can be sitting quietly in religious services and the Cortisol response “alarms” for no exterior reason. We need to advocate for caregivers to be recognized in the medical arena. Learn more by taking our course; Preparing to Parent Your Parent.
If you developed symptoms such as poor sleep, changed appetite, or more serious conditions, you’re not alone. According to The Executive Summary: Caregiving In The US 17%-35% of caregivers report poorer health.
Caregiving creeps. At first it’s the occasional errand. Then it’s dealing with financial matters. Other senior caregiving issues pile on; unpaid bills, medications ignored, and inaccurate reports about doctor appointments. You find that you’re monitoring medications, and accompanying your senior to the doctor. All the while, there are other parts of your life; your spouse and children, your job and home. Trying to do all these tasks as a caregiver while also keeping up with your own life becomes a monumental job! Something has to give.
Where are you in all these duties? Many caregivers believe they can take care of themselves “when they have time”. Caution: caregiving you have no more time. Self care is vital to preserving yourself, your family, your job, and your sanity. Senior Sidekicks’ course; Preparing to Parent Your Parent explains why caregivers need to do self-care. Senior Sidekicks knows how busy you are. This course is convenient; delivered to your area: your church. We offer it at convenient times; evenings, weekends, or lunch hours. You receive 5 classes and a manual for one low price. If you bring your significant other, they pay half price. Call Senior Sidekicks today to learn more. 217-787-5866.
We have seen how caregiving creeps until it fills one’s daily life and affects one’s job. What about the people in your immediate family? Do your children behave differently? Are they withdrawn or act out? Have you received school reports about problems? We expect sibling rivalry when a new baby comes home. What if the one who demands the parent’s attention is not a baby; it’s Grandma? That’s not what most caregivers anticipate. Yet, a distracted parent is still a distracted parent.
What about your spouse? The marriage vows cover sickness and health, richer or poorer. They don’t include vows to care for your parent and mine. Perhaps we should add new vows should since caregiving now involves 43.5 million people; according to Caregiver.org/Statistics and demographics. That number will continue to climb! Most couples haven’t considered caregiving the same way they considered where they would live or how many children to have.
Yet, caregiving affects many households as well as individual caregivers. Isn’t it time to address caregiving together, just as couples do with other life decisions? Senior Sidekicks’ course, Preparing to Parent Your Parent, is designed to get spouses into working with each other. Those who enroll can bring the spouse at half price. Together, you will learn about handling various parts of caregiving and compile a manual for future reference. You can arrange the course for a location near you; like your church. Senior Sidekicks will deliver the course at times convenient for both of you; evenings, weekends, lunch hours, or days. Call us today at 217-787-5866.
While standing in a checkout line, I struck up a conversation with an elder. He said his house was too big but wouldn’t move because he would need to downsize first. The elder said that he had decided not to clean out, instead, to leave it for his kids. Really! That’s an unwise choice for many reasons:
“I lost so much time from my family”.
“It cost me my job (or promotion)”.
“I had to stop my education and it was harder to go back”.
“I felt so alone, like my parents had abandoned me to this task”.
“I felt overwhelmed”.
“I developed high blood pressure”.
“My sibs and I fought about sharing the work, it’s still hurts”.
So, what will be your legacy to your children?
Once upon a time there were two sisters. Mary built a cabin by the lake with her husband. They sold their house in town upon retirement. The other, Beth, also wanted a “cabin in the woods”. She and her husband planned to retire there as soon as their youngest child finished college.
Things did not turn out as planned. Mary developed lung cancer. She needed to be closer to medical care. Those winding lake roads were not plowed in the winter. She wrote that “The bugs never stop” at the lake. Her condition made it hard for her to keep up with such a house. Since the lake house was new, they had almost no equity yet, and they had to sell. They took a loss as they moved back to town.
Beth had a different set of problems. Her husband developed some odd behaviors after he retired. She found it uncomfortable keeping house with him underfoot. She confessed to her daughter that she was considering a divorce! Thankfully, they had not built a cabin in the woods or they would have had no relief from each other.
Her husband finally enrolled in a program and participated in local archeology projects. One day the Sherriff’s car drove into her driveway. He announced that her husband had died of a heart attack on one of these projects. Now, Beth was a widow with a child still in college! Thankfully, they had not started to build this cabin. How would she have managed to finish its construction and sale by herself? She didn’t want to live so far from town now that she was alone.
What can we learn from these sisters?
Senior depression presents several problems. It appears as “mild” even if it doesn’t affect seniors mildly. Depression symptoms may surface as physical complaints. Seniors grew up in an era when receiving mental help = CRAZY. Each of those problems presents a barrier to treatment. How does a caregiving adult child get a senior to accept the help they need? They really need it. Even though seniors account for 13% of our population, they comprise 18% of all completed suicides! Our society must take senior depression seriously. Medication may not be enough. Religion/spirituality (R/S) may be a treatment pathway that seniors can accept.
Religious and Spiritual Factors in Depression: Review and Integration of Research is a review of literature: a look at 444 research articles on the subject of R/S. All studies were reviewed for their methods. 178 studies were found to be rigorously designed and their data analyzed. Most studies found that seniors who a religious or spiritual practice did better at managing depression or facilitating its resolution. The review found that R/S beliefs may be used to cope/adapt to stressful life circumstances. Seniors certainly face those; life-changing illness, loss of career, loss of home, and loss of spouse/friends. Their lives need ways to adapt.
A second part of this study, found a lower likelihood of mood or psychiatric disorder for those who regularly attended religious services. There was one caveat; if the R/S tradition was very orthodox, the senior may feel more judged than supported by their R/S tradition. You know your senior. You know what type of R/S practice they hold. If there is a supportive faith community; try it. This same review of literature noted that “pastoral counselors spend 140 million hours (doing) therapy each year”. That’s more hours than provided by the American Psychological Association! Since it is part of the counseling media, ask for this help for your senior.
Does it help? The greatest medicine is no good if your senior won’t take it. The same applies to counseling. If it’s socially acceptable to meet with the pastor; use that method.
Health and Spirituality, examined the relationship between health and spirituality. Researchers found that the modern, western era’s response to illness/depression was a departure from other cultures and most of history. In other times, religion was considered an integral part of healthcare. Major illnesses focus the patient’s attention on ultimate meaning, purpose and transcendence. The Nurses’ Study found that women who attended weekly religious services had a lower mortality rate that those who never did. Regular religious attendance was associated with a lower rate of depression. Wow! Does our society need to return to an integrated/ whole person strategy to effectively treat seniors? I believe we should.
Have we become too quick to provide pills to our seniors? The Center for Medicare and Medicaid (CMS) has a “rule of 4”. If the senior is taking more than 4 kinds of pills, their risk of medication conflicts and issues increases. While medicine might be helpful, other strategies could make a difference without raising further medication conflicts.
How many pills is your senior taking? Is it a constant battle to get them to take medicine? I suggest you discuss the idea of trying regular religious attendance and pastoral counseling instead. As you discuss this method with the doctor, please keep this study result in mind. One study gave cancer patients and their doctors a list of 7 factors to rank when making medical decisions. The patients ranked faith in God 2nd. The physicians placed it last. Thus, it is the adult child/caregiver who must advocate for alternative approaches. Always discuss changes with the doctor. Try adding God; He just might help your senior.
Who knew that art might make a critical difference in the treatment of elder depression? In 2001, Dr. Gene Cohen conducted the first experimental study of seniors in cultural programs and its effect on general health, mental health, and social activities: Creativity and Aging.
This study has been citied repeatedly in other works and became a foundation for senior programming. As I researched elder depression, I was struck by three things in relation to this study. First, the date, Creativity and Aging was only done in 2001. We have drawn since we had cave walls. What took us so long to consider the relationship between creative arts and seniors achieving a healthier quality of life? How’s that for an outcome?
Second, the design of the study was notable because it included a control group. How else does one obtain hard data? Once the comparisons were made, it was clear; the arts make a difference. We worry about rising health care costs. Perhaps, we could lower direct healthcare costs by utilizing proven cultural programs. If, as this study demonstrates, cultural programs achieve true health promotion and disease prevention effects, why aren’t we using this method to address senior health issues?
Third, the seniors studied were OLDER that the average life expectancy! Wow, does that mean we could achieve even more positive health outcomes if we started cultural programming earlier, on younger seniors?
It’s something to think about. Medical costs are expanding the way we do things now. I believe it’s time to consider other methods as additions to direct medicine. Think about it.
"A Senior Moment" is written by Ms. Sara Lieber, owner of Senior Sidekicks. Ms. Lieber has over 30 years of experience in senior care.