Saturday, February 04, 2012

Archive for January, 2008

Brain Aging

“Cure when possible…Comfort always”

Hippocrates

I just finished a new book by Dr. Peter Whitehouse entitled The Myth of Alzheimer’s Disease: What You Aren’t Being Told About Today’s Most Dreaded Dreaded Diagnosis. While the title has a sensationalist ring to it, the book is a landmark discussion on aging, brain changes, dementia, and our new created obsession with Alzheimer’s disease.

Dr. Whitehouse is a respected neurologist who has been at the forefront of the “Alzheimer’s movement” for almost thirty years. But as the title of the book suggests, he now has deep reservations about where this work has taken us. He insists, with good cause, that we are chasing an expensive illusion that Alzheimer’s disease is a single pathology that can be checkmated with a drug or a vaccine. As important, he feels our profound fear of all aspects of “normal brain aging” has given us two unsavory byproducts:

1. It has once again made aging, the natural changes that are programmed into the human life span, a pathological event. The shame of aging has been intensified by the shame of anything less than perfect brain function. There is no middle ground. We are summoned to a war against poor brain behavior at almost any cost. It is a fear that might convince us to “pre-medicate” the normal drift of forgetting names or reduced multi-tasking as a containment strategy.

2. It has created a twenty-first century “leper syndrome” at a time when 125,000,000 adults are struggling to get through the second half of life. Once the first “mental lesion” a change in brain function is detected, the outcast process begins. A flurry of scans, exams, and lab test mark the official entry into the dementia colony.

In his book, Dr. Whitehouse is not ignoring the reality of dementia. Hardly. He has treated it for decades. But the experience has changed his mind about what treatment means. He argues that the billions we throw at research for a “cure” could be better spent in creating non-clinical support networks that offer adults with accelerated brain aging a humanistic approach to quality of life management. He also argues that a portion of these funds could be used for the most important weapon we have against dementia: lifestyle-based prevention.

I am sure this book will provoke intense debate, and I see that is a good thing. As boomers begin to fill up the ranks of “sixty something,” they need a new way to think about brain aging, one not based on abject fear or another reason to hate being old. Rather they need a compassionate vision of the give and take of aging and the opportunity it creates, amid the comfort of friends, creativity, and purpose, for a meaningful and rich life until the end.

When Everything Falls Apart

“Remember that there is nothing stable in human affairs; therefore avoid undue elation in prosperity, or undue depression in adversity.”

Socrates

The world of aging parents is a complex system. This is not simply a scientific observation; it is a critical point that most of us gloss over on the way to getting things done. We adult children are doers, and it is in our middle age blood to make things happen. Not fully appreciating the implications of trying to manage a complex human system can crush our expectations and send us reeling in reverse.

Complex systems come with certain rules that define their nature, the immutable laws of how they work. One that is especially significant to adult children and their aging parents is the “disproportionate” rule: minor changes can produce major consequences.

All of us have experienced this painful reality but maybe thought it was bad luck or unfortunate timing. It wasn’t. It was the nonlinear ricochet of a system always on the verge of disproportionate behavior. Why is this useful?

First, it reminds us that there are no “little” changes in the world of aging parents. Any action, throwing out old magazines, scheduling an appointment without telling them, or not including a sibling in what seems a minor decision can trigger a temporary “system shut down.” This is the innate, chronic turbulence of aging parents-family systems. To expect anything else is to make an already challenging situation nearly impossible.

Second, it allow us to set realistic expectations for all parties involved in the drama. No amount of planning, effort, or hyper-vigilance can overcome the disproportionate rule. If you are defining success as an adult child in terms of perserving system stability, then the odds of of being successful are close to nil. Better to define success in terms of “caregiver aikido,” how well you flex, adjust, and rechannel the predictable upheaval of disproportionate events until they run their course. This gives you a fighting chance to reduce the impact of these irrational dramas that take a nasty toll everyone who gets in their way.

The Sibling Dilemma

“But things in this life change very slowly, if they ever change at all”

The Eagles from Sad Cafe

In David Rico’s book “The Five Things We Cannot Changeone of the immutable laws of living on earth is that “life is unfair.”? Nowhere is this more obvious than in the interaction of siblings over the issue of their aging parents. We are tempted to believe that when adult children are asked to rally around an aging parent, the unresolved sibling issues of childhood would be set aside, and “the kids” would stand ready to partner for the common good. The truth is usually far different and more painful. What we see time and again is that the inconvenient occasion of aging parents simply reconvenes a family drama in which the players continue their previous roles and with an all too familiar outcome.

As much as we wish it were different, family roles for the most part are cut in stone. This is not a lament but simply a fact. Birth order, hair color, personality type, and timing all cast us in a role from our earliest years that follows like a shadow. If we start out as the outsider, the favorite, or the conscientious one, that’s were you will usually find us at sixty. How we feel about this is less important then its tactical significance. Knowing this fact about family systems allows us important choices when we find ourselves in an involuntary alliance with our siblings to address the predictable dilemmas of our aging parents dilemmas. How?

First, it allows us to stop trying to change our siblings who for the most part really resent us for having the audacity to think that we need to “fix” them. Most of us have been trying this from childhood with poor results.

Second, it allows us to accurately access to what our siblings will and will not do. While we may think guilt, shame, anger, and manipulation can help us to get them to carry their weight, this strategy never works in the long run. Even worse, it takes a heavy toll on us and them. Better to be blunt and admit that if their contribution is zero, then zero it is and move on.

Lastly, it allows us to invest our time and money in creating a non-family support system for our aging parents. One of the essential strategies for being successful with our aging parents is a concerted, relentless effort to piece together a support system. It is journey filled with false starts, dead ends, and false hopes. But it is also a journey of numbers. A steady, disciplined effort at building relationships yields good people, people that our aging parents need in their lives. This should be the logo on the T-shirt of every adult child working with an aging parent: steady effort.

If you are blessed with cooperative, helpful, and collaborative siblings count your blessings and let them know how much they mean to you. If your siblings abandon you to fend for yourself, then use the occasion to enhance your networking skills. Either way, you get the friendships, support, and resources you need to deliver a “steady effort.”

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Communicate

No Money: No Comment

I was recently asked what to do about aging parents who had little or no savings but refused to discuss any aspect of their “money issue.” It reminded me that our role as adult children is not necessarily about problem solving; it is about compassionate containment. So many of the issues we feel compelled to “fix” have no clear answers. The best we can do is sort out what to accept from what we can actually change. Here was the advice I offered:

The issue of money, like so many other issues in the last phase of life, is about control. The best way to approach it is to reframe money as means of maintaining control. Lack of money takes away control. This link http://www.dsolie.com/articles/reframing.html will take you to an article I authored on “communicating touch choices” that offers a practical strategy for how to do this.

You may also want to consider three strategies that will help you “hedge” your parent’s financial risk:

1. Buy a long term care policy with a two years home care/two years nursing home benefit. This assumes they will cooperative with the process (i.e. signing the applications and answering questions).

2. Start funding a dedicated “side fund” for expenses that a long term care policy will not cover.

3. If you parents own their home, become familiar with how “reverse mortgages work and when they make sense.

Lastly, you need to began discussions with local area agencies on aging to determine what, if any, community resources can assist your parents if they run out of money.

This is a tough end-game, especially if you parents don’t want to talk about. The article will help you frame your conversations. Be patient but persistent in your discussions about control and your desire to help them maintain it.