Posts Tagged ‘David Solie’
Last Updated on Saturday, 24 July 2010 10:39 Written by David Solie Saturday, 24 July 2010 10:36
Sooner or later aging parents get swept into the complex currents of transitional healthcare. It may be a simple back and forth between the primary care provider and one or more specialist, or it could be a major health setback that sends them into a crisis cycle of hospitalization, rehabilitation care, and finally back home. Big or small, acute or chronic, all of these transitional events require multiple “handoffs” between medical professionals, hospitals, skilled nursing homes, and caregivers, and there’s the rub.
The stories of what can and does go wrong with these transitions are legendary, maddening, and in most cases preventable. The sad truth is that older adults many times wind up back home with defective marching orders regarding their medications, recovery plan, and follow up care. Given the frequency and severity of the problems surrounding transitional events, what can make this better?
The good news is that Dr. Eric Coleman from the University of Colorado Health Science Center has a compelling answer: The Care Transition Program. His program is based on what he calls the Four Pillars?, an integrated transition management system that prevents medication problems, insures information continuity between handoffs, clear, follow up orders, and a protocol that identifies red flags that could crash the process.
It is a practical, brilliant solution that is gaining a growing population of followers across the country.
One key element critical to the program’s success is a Transition Coach?. This is usually a geriatric nurse practitioner that provides in-hospital coaching to both patients and their caregivers to help both parties prepare for the transition. As important, the Transition Coach? does follow up visits to skilled nursing facilities or the patient’s home to insure continuity across the transition.
To learn more about Dr. Coleman’s remarkable program and download a copy of his “Transition Survival Skills,” click here: http://www.caretransitions.org/transitionskills.asp
Tags: aging parents, David Solie, Dr. Eric Coleman, How To Say It To Seniors, The Care Transition Program | Posted under Aging Parents | No Comments
Last Updated on Monday, 21 June 2010 01:54 Written by David Solie Monday, 21 June 2010 01:49
Even the best laid plans of aging can fall apart. Katy Butler’s recent article in The New York Times, What Broke My Father’s Heart, tells a painful tale of the unwanted impact of medical technology in the last and most distressing phase of life (http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=1&ref=homepage&src=me).
But this is no ordinary article about a bad outcome involving aging parents. This is a seminal article about a new and quite sobering level of vigilance that attends our role with our aging parents. The rapidity of events and the ever present pressure of “medical necessity” in the last phase of life can push families into decisions they not only regret but, as Ms. Butler so eloquently and heroically portrays, resist our best efforts to unwind them. If there was ever an article on this subject to read in a quiet, non-distracted moment, this is surly the one…
Tags: aging parents, Boomers, David Solie, end of life, end of life issues, How To Say It To Seniors, pulling the plug | Posted under Aging Parents | No Comments
Last Updated on Saturday, 22 May 2010 07:35 Written by David Solie Saturday, 22 May 2010 07:35
This is the third of three posts from my new book Riptide.
Primary Current Number Two: Internal Forces
While the external currents of the middle age challenge the capacity of boomers to handle complex and unpredictable life events, internal currents usher in an existential house cleaning that questions the purpose and meaning of the second half of life. Ironically, this involuntary reconsideration of the future comes at a time when so much has already been accomplished. But while boomer successes are a testimony to the faithful completion of the first-half life mission, they inadvertently lead to a developmental dilemma about what is to follow.
The mission of the first half of life is the steady pursuit of accomplishments, a long and noble list of all consuming life goals that are intense, quick paced, and well defined. Entering the first half of life stadium, young adults hear the cultural cheer of the rest of society encouraging them to on to greater accomplishments that include:
Growing up and taking their role in adult society
Getting an education as a prelude to a meaningful career
Finding a life partner to create a new family unit
Finding the right career to become successful
Starting a family to usher in the next generation of children and grandchildren
Becoming successful as a means to a secure future
As young adults immerse themselves in the first half of life journey, these goals are repeated at every turn in the questions they hear from family members, colleagues, and society as a whole. Did you get that apartment? Are you going to graduate school? Are things getting serious between you and her? Did you get that promotion? Are you two thinking about starting a family? Are you going to buy that house? The litany of goal-crafted questions offers definition, structure and much needed encouragement. The purpose and direction of the mission is never in question. But surprisingly and with little fanfare, the mission begins to change just at the point when so much has been done.
The second half of life journey does not share the same sociological advantage or clarity as the first half. Entering the second half of life stadium, boomers are surprised at how small the crowd has become and that it is surprisingly silent. Even more concerning is that the laundry list of first half goals has not been replaced by an equally compelling list of second half goals. In fact, goals have been replaced by social encouragements such as “you look good,” “stay healthy,” and “find something you enjoy.”
This surprising and disturbing loss of sociological scaffolding provokes an existential moment where boomers realize they have permanently moved into the “self-service” zone in terms of discovering their second half mission. While it is obvious that one set of goals is not enough for a lifetime, the question becomes what is the second set? Forced into an involuntary, midlife reinvention, boomers are unprepared to easily define the purpose and direction of the rest of their lives. Despite the unprecedented frenzy of modern life, part of them that feels adrift, eerily disconnected from the social agenda that has kept them on course for most of their adult life. Trying to resolve this dilemma is made more difficult by the tangible and unavoidable shadow of a sobering future. The futures of the past for middle age adults have always been multilayered, ten or twenty year segments that cascaded forward and offered ample “staring over” opportunities. The future of today’s boomers is smaller and time constrained, in most cases being played out before them by their aging parents. It is also less forgiving, with little room for error and or starting over. This time compressed future coincides with boomer’s new appreciation of their mortality.
Life and death is nothing new for boomers. Their generation ushered in a revolutionary social commentary on life and death issues that was markedly different from the generations that preceded them. But all the talk of life and death during the boomer’s youth was at an arms length from the humbling reality of middle age, a difference between discussing an illness and actually being diagnosed with it. Boomers are now living their mortality where the loss of parents, siblings, partners, and peers has created a new and sobering awareness of their own vulnerability. It is an experience that replaces the occasional tragedy of past where people were “gone too soon” with the more common occurrence of friends and family members simply passing away. This changes the urgency of the search for a new set of goals. Second half goals turn out not only to be a necessity for crafting a productive and meaningful life; they represent that last opportunity for most boomers to fulfill life long dreams and ambitions. It is a nagging reality that whispers to boomers, “if not now, when?’
The unsettling disorientation of the internal currents defines the second primary developmental task of middle age, which is to “discover purpose and direction for the second half of life.” This was the second hidden current that Linda did not see coming. Not only did her world become unstable, but also her role in this volatile landscape became unclear. It wasn’t a question of shrinking from her responsibilities; it was trying to determine what really mattered at this turning point in her life for the journey ahead.
These two tasks make up the mission of middle age: preserve stability and orchestrate reinvention. To do this boomers have to discover effective strategies to manage the onslaught of external currents while at the same time find purpose and meaning in their lives.
How do boomers navigate these formidable and intimidating currents? Is it simply the luck of the draw, with some having better outcomes than others? Or are there steps that boomers can take prior or during the riptide that can improve the quality of their journey. This is what Linda wanted to know. What needs to change to make things better? Fortunately there are strategies that improve boomer’s chances for a successful crossing. This is what the remainder of Riptide is about. It is about which navigational tools will help boomers successfully complete the mission of middle age and arrive well-prepared and ready for old age.
Navigation tools are designed to keep travelers on course. This is the goal of Riptide: keeping boomers on course. Understanding the currents of middle age is a critical first step, but knowing the developmental risk of middle age is only half the battle. Learning how to successfully navigate them is what determines outcome. Riptide presents boomers with a small but powerful group of navigational tools that are designed to keep them on course in the face of adversity and setbacks. All travelers will have difficult periods and their needs will change with changes in circumstances. The tools presented in Riptide arm boomers with the resources they need to overcome the challenges of aging. There were selected primarily on their ability to increase stability and facilitate reinvention. It not necessary for boomers to use all of them, only the ones that address their current navigational needs. As important, the themes of tools are familiar, topics boomers have heard from other sources as being important to preserving quality of life. What is different about Riptide is these themes have been reframed in terms of developmental utility, a unique approach that makes them “task friendly” and, as important, offers boomers new motivation to integrate them into their lives. It is an emotional reframing that resonates deeply with boomers offering them encouragement and much needed hope for the difficult stretches ahead.
Tags: aging parents, Boomers, David Solie, How To Say It To Seniors, middle age, Riptide | Posted under Aging Parents | No Comments
Last Updated on Saturday, 22 May 2010 07:37 Written by David Solie Sunday, 9 May 2010 08:50
This is the second of three posts from my new book Riptide.
Boomers need to understand the nature and magnitude of their mission. The developmental journey through middle age is best explained as a psychological riptide, complex and confusing currents that undo so much of the success of the first half of life. From the perspective of young adulthood, middle age doesn’t seem so bad. Boomers are a confident, can do generation; they have navigated complex social transitions in the past. Middle age appears to be no different. Even the first encounter of actually being middle age gives no clue as to it true nature, something Linda soon discovered. But once the impact of the riptide begin to surface, it quickly becomes clear that a fundamental and irreversible shift in the tenor and direction of life has occurred. Equally concerning, this shift brings with it a new level of complexity and ambiguity that starts to dissolve boomer’s quality of life.
This psychological riptide of middle age is comprised of two developmental tasks, the primary mission of middle age. Together these two currents produce a turbulence that can quickly knock boomers off balance in unexpected and devastating ways. It is a non-linear turmoil that is characterized by clusters of problems and conflicts that defy quick fixes or easy solutions. As boomers start to experience the impact of these currents on their lives, they discover that it will take a deliberate and sustained effort on their part to head off a poor outcome.
Primary Current Number One: External Forces
The external currents of the riptide arrive in clusters, picking up intensity and depth as boomers move from fifty-something to sixty-something. They strike at the heart of the boomer’s family system and set into motion a new set of experiences that are foreign to the first half of life. Taking center stage in this transition drama is death.
A death in the family signals an irreversible change in the life’s DNA for boomers. While it is usually a parent or an older aunt or uncle, it can also be a sibling, friend, or colleague. Even if the death is intellectually expected, it nevertheless ignites a chronic mortality crisis, not just about important older adults who are at risk for dying, but for boomers themselves who feel disturbingly vulnerable. Part of this is the loss of bigger than life figures from childhood that are suddenly brought back to earth and pass away. And part of it is simply a wake up call that life after fifty ushers in a new set of rules about who survives and who doesn’t. It also signals that the rules of illness have also changed.
Illness takes on a different look in middle age even if it is not life threatening. Chronic disease emerges as a dominant theme, health problems that show up and refuse to go away. Hypertension, diabetes, heart disease, and joint disease bring with them the need for new medications and ongoing medical care. By contrast, the illnesses of the first half of life tend to be self-limited pathologies that have a distinct recovery and conclusion. The invasion of chronic illness creates complex and unpredictable problems for both boomers and their family systems. The increasing burden of “affording” health care costs, the need to “second guess” health care decisions, and the realization that these issues are here to stay extract a heavy toll on the quality of life. Then there is the issue of aging parents.
Middle age brings boomers come face to face with the reality of aging parents. Even if their parents are fit and independent, boomers experience great apprehension over what lies ahead. Part of this stress is structural. The communal world of their grandparents has been replaced by post-WW II dispersed society that is in constant motion. Long-distance care giving is becoming the norm. Part of the stress is capacity. Boomers live complex lives with great transaction density. Their overbooked lifestyle leaves little capacity for the complex and escalating needs of their aging parents. Any number of the “predictable dilemmas of aging” can send the entire family into a tailspin. This includes the loss of a spouse, a change in health, or a financial setback.
Added to this is the volatile nature of family systems. As Dan discovered with his brother, siblings have their own opinions about what role they should play with their aging parents. When conflict ensues, the wide reach of one family system into another expands the impact of an already stressful situation. But aging parents are one half of the generational sandwich boomers must navigate. The other half is their children.
Like their parents, children of boomers are in constant motion. This holds true for those who are still living at home, have returned home, or are living on their own. This motion reflects the new economic reality that children of boomers face in a “global economy.” The upward trajectory potential of their parents has been greatly attenuated. Boomers provide their children with a more elaborate support system to weather change, set backs, and failed relationships than previous generations. The upheaval of dreams is not limited to boomer children. It also takes center stage in the careers of middle age adults.
Boomers have lived through the transformation of the world economy. While it has brought prosperity, globalization has also triggered a deep sense of instability in the work force. Linda’s husband saw first hand the impact of the sale of his company on his colleagues. It was painful, and it was frightening. For those who were ready to retire, it became a timely exit strategy. But for most of his boomer colleagues who still needed to work, it spelled career disaster. The financial losses of being laid off were compounded by the reality that a replacement job of equal quality was unlikely. The financial stress of career displacement takes its highest toll on long standing relationships that can easily crumble on the strain of a financial meltdown.
Boomers have lived through the transformation of marriage in American culture. The “right” to leave a dysfunctional relationship has replaced the taboo of divorce. As the external currents extract their toll on long standing marriages, many simply fold or die in place under the pressure. Children moving out the house, retirement, and financial problems can trigger a marriage crisis that has been simmering for years. It can also quickly lead to divorce.
Divorce also paves the way to remarriage. Reconfigured family systems, many times with both middle age adults having children from previous marriages, can add a new burden to boomers. Cross-family events like holidays, birth of grandchildren, and the death of relatives test the ability of the new system to survive these events.
Given the magnitude and diversity of the external currents, it is not surprising to discover that the one of the two primary developmental tasks of middle age is to “maintain stability in a world of increasing personal volatility.” This was the first lesson that Linda discovered about middle age; she saw her life become unstable before her eyes. She also knew in her heart this was not a temporary set back. The landscape of her life was undergoing a fundamental change. Boomers quickly realize that the external currents of middle age are darker, less forgiving, and a harbinger of what lies ahead. Like other boomers caught up in the riptide, Linda felt personally vulnerable. And like them, she was looking for ways to regain stability for herself and her family.
Tags: aging parents, Boomers, David Solie, How To Say It To Seniors, middle age, Riptide | Posted under Aging Parents | No Comments
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Aging Parents Insights, hosted by David Solie, is a blog radio show that provide listeners with "new ideas and strategies” for understanding and communicating with aging parents.