Senior health studies show that social isolation is as important health as flattening the Corona-19 virus infection curve in seniors.
OPINION: It’s Time to Flatten the Loneliness Curve for Older Americans, by Marc Freedman and John Gomperts, was published in Next Avenue, April 20, 2020. The article discusses the impact of social isolation on elder health. This factor was an issue before Covid-19. However, the quarantine has made their social isolation even worse. The article references other countries’ methods of recognizing and responding to social isolation and encouraging elder social engagement. It offers several possible methods to facilitate the development of programs in the USA as engines to promote a better quality of life for seniors and for society in general.
Did you know that grants were made last year to develop a Social Isolation Task Force and create a public education program? These grants were offered to all the state agencies that operate under the mandate of The Older Americans Act.
I was on one of those task forces in my state. The assumption was the public wasn’t aware of the magnitude of social isolation amongst elders. Another assumption was the public wasn’t aware of the effects of social isolation on senior health and cost of care.
Covid-19 changed all that. We‘ve all had a crash course in the experience of social isolation: the Stay-at-Home orders. We’ve seen people reacting, sometimes threatening violence, in a push-back against such measures. Children have suffered socially, emotionally and in their education as a result of being isolated from friends and school. To combat Covid-19, social isolation was one of the few measures we could employ. While we intended to combat the virus with isolation, we didn’t intend to isolate elders before Covid-19. Our society’s systems just didn’t address elder social isolation.
Our society did not face social isolation before because of three factors; our original population, our history, and our lack of a collective memory experience.
Our population was largely imported, usually young adults and their children. Later, they might send for the elders in the old country, or not. A sea voyage could be quite stressful on an older person. Thus, young people settled here. Later, another generation of young people left for the next new frontier. Our history shows that elders were left behind; again, and again. As a result, our focus was a succession of new frontiers. The USA never developed a role or task for elders. Today, our old frontier is closed. It’s time to bring society into the new social frontier: one in which we recognize we are a multi-generational country. There are gifts from each generation. We need to develop a role, and a function that recognizes the value of elders: a living history, perspective and experience.
We also lack a collective memory of the elder’s journey. We all remember things from our childhood; many of us may not “remember” things from our elder hood; unless we have made that journey ourselves. Society hadn’t experienced certain aspects of aging, like social isolation, until now. We should view stay-at-home orders as our chance to learn what life is like for seniors who are forced to stay-at-home.
What puts elders in that position? Their health may not permit frequent trips outside the home. Other elders are trapped at home because they can no longer drive. Public transportation may be too infrequent, too strenuous, or non-existent. Some elders find that vision or hearing problems interfere with socializing. We have few forums in which all generations come together. Religious institutions fill some of that gap but they can’t cover all the bases. Our neighborhoods are often age-segregated. Schools group children into smaller age cohorts: this is not the era of the all-ages, one-room school house. We build age-segregated housing only for elders. How is anyone to learn about the elder journey if our opportunity for observation and interaction are taken away?
Covid-19 has given us a gift in disguise; we all shared some of the elders’ social isolation predicament. We reacted vehemently to these restrictions on ourselves. Now we know what they feel. The recommendations made in this article should be implemented. Let’s learn from this. As the old song says; ”Someday, some d-a-a-y, we’ll be together. Yes we will, yes we will...”
Does Covid Expand Caregiver Guilt?
Has this happened to you? “I took groceries to my Mom. She wanted have coffee with me. I’ve tried to tell her I couldn’t, but she just doesn’t get it! I don’t know what to do”!
Caregiving is a demanding process and Covid-19 adds more demands. Caregivers still try to respond to their loved ones even under new circumstances. In the past, the caregiver could might take the elder shopping; not now. Shopping was an outing, a chance to socialize, and a chance for the caregiver to assess how the elder was doing. Now, we wear masks and are encouraged to shop as quickly: a-l-o-n-e. We only have a fleeting glance at our loved one on food drop-off. We can’t just pop in the house or care facility to check on things for ourselves. We must rely on reports from our loved one, the staff or (sometimes) the news. Imagine reading the news and learning your parent’s facility has a Covid-19 outbreak! Caregivers revealed they felt guilty before, it’s especially true now. Some guilt seems to be rooted in the feeling, “I can’t do anything!”
Yes, you can.
Caregivers used to worry about elders taking medicine properly or eating regularly; now worries include possible exposure, illness & death. To add to these concerns, seniors seem to want more from the caregivers. They ask caregivers to run more errands or ask for things not appropriate to their diet or welfare. An elder asked me to try to take money out of an ATM with his bank card!
Why are elders making more or different or even illegal requests? There are a couple reasons. First, caregivers make the distinction between the Covid-19 as the cause and the changes in our lives as the response. Sometimes, that distinction is not as clear to the elder. “They just don’t get it”; is a sign to caregivers that the senior hasn’t understood in the first place. Everybody has studied something that felt very different when actually experiencing it. Think of your first time behind the wheel of a car. No instruction manual prepared you for that feeling of your foot on the accelerator. Childbirth classes help, but they can’t communicate what it feels like to give birth to a child. After the experience, we “got it”. Making it real,related to the senior’s early experiences, helps them to “get it”.
Second, caregivers understand the impact of this pandemic process. So, instead of doing more errands, we need to take the time to help seniors grasp the process. We feel guilty because we can’t take them out, or can’t give them a hug. So, when they ask for more and more, we do it because it makes us feel better. Have you noticed that more errands just aren’t enough? That’s because errands don’t fill the senior’s real need: finding meaning and support. A conversation, in which you focus on their early experiences, such as quarantine, helps them feel the reality of current circumstances. Explanations don’t work as well as a trip down memory lane. Just making the effort to help them understand the experience will fill their need for direction and support from you. Your senior relies on you in ways they can’t express. When they feel like the world has gone crazy, they look to you. When you show effort to help them understand (not expertise) they become calmer and you’ll feel better too.
Third, just saying NO, puts limits into their lives and is another way to calm your senior. When times are uncertain, a clear guide creates a sense of stability. They sense that you are looking out for them and you are their leader through these times. Your firm guidance gives them clarity.
Then, you have more time and the emotional space to feel less guilty.
Caregivers need not do e-v-e-r-y-t-h-i-n-g; just the right things.
Fourth, a rule of thumb for elders with dementia is; the more dementia, the longer “emotional antennae”. Your seniors are highly attuned to your moods. They just can’t process the information the way they used to. Covid has shifted everyone’s life. Elders sense that you are struggling to adjust your lifestyle. Caregivers may not want to show these struggles. They feel guilty these the elders depend on their care. The elders already know. When you put words on your feelings, it’s like putting on an oven mitt; now you can handle hot stuff. Your words become the elder’s way to express their own feelings. Keep it simple but keep sharing. Remind them of any major adjustments they had to make in the past: WWII rationing, Great Depression job losses. Emphasize how they made it through hard times and the example they were to you. Thus, the caregiver becomes the mirror that reflects the senior back to their best self.
Finally, remind the elder this is only for now, it will not last forever. As the old song says: “Some day; s-o-m-e-d-a-y, we’ll be together (yes we will)!
Holiday Visit Guidelines
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
Has Your Senior Outgrown The House?
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.
If you would like our Free Has Your Senior Outgrown The House? Checklist please check mark your request below, and submit.
I Forgot To Tell The Doctor
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?
"A Senior Moment" is written by Ms. Sara Lieber, owner of Senior Sidekicks. Ms. Lieber has over 30 years of experience in senior care.