Posts Tagged ‘disability’
Last Updated on Monday, 11 February 2013 12:50 Written by David Solie Wednesday, 5 September 2012 12:12
The best way to predict the future is to invent it.
It’s 2026. The future is here, 14 year later. We are taking a sneak peak into the lives of two baby boomer couples that are now well into their late seventies. Both couples live in Southern California. Both couples have worked hard and saved diligently for retirement. Despite the similarities of location and financial dedication, decisions each couple made in their mid- 50s have created very different futures they are now living 20 years later.
Couple number one, Linda and Ted, live in a retirement community north of Los Angeles that offers many levels of care. They have lived their lives using the “coping” approach, which meant adjusting to health problems as they arise but not venturing far from a lifestyle they chose 20 years ago. Linda and Ted stuck to what they knew and how they wanted to live their lives.
Ted has been in the assisted living unit for a couple years and would like to see Linda more frequently. Sometimes he gets depressed and cries. Ted has been overweight for over 30 years; 20 years ago he developed diabetes. Now he’s suffering from multiple complications of diabetes including advanced heart disease, poor circulation in his feet and lower legs, and poor vision. He is being transported to the hospital today for amputation of his left foot below the knee due to gangrene of three toes. Although the staff did their best to monitor his health, his lack of feeling in his feet due to his diabetes and limited ambulation due to his sedentary lifestyle allowed the gangrene to take hold of him. His vision problems caused by his poorly controlled diabetes resulted in him losing his drivers license many years ago. The demands of his poor health take almost 100% of his coping mode just to get through each day. Each day is a struggle for him depending on others for the most basic daily living activities. It takes almost 2 and half home care providers 7 days a week to assist him with his daily activities of living (ambulation, bathing, food preparation and eating, and visits to the doctor). His prognosis is poor and he is unlikely to survive another year.
In another part of the same retirement community, Linda and their kids are sorting through the couple’s belongings as they prepare for Linda to join Ted in the high level assisted living center. Linda had been a smoker all her life and after the development of emphysema stopped smoking 10 years ago. Unfortunately 80 pack years of smoking (40 years of smoking 2 packs a day) took its toll on her lungs. She has a constant hacking cough and audible wheezes with each respiration. Her face is covered in deep wrinkles especially surrounding her mouth accompanied by her raspy voice as she gasps for air in her tiny apartment. Her emphysema necessitates both a portable oxygen unit for day trips with her kids and a larger unit at her bedside. Between the emphysema and heart problems, she has to sleep with her oxygen on in a sitting up position or she experiences a worsening cough and heart palpitations. She curses those “damn cigarettes” daily. Her daily regimen includes taking seven medications and frequents visits to her cardiologist, pulmologist, and internist. She can no longer cook or take a bath unassisted. She is just too tired and out of breath all the time. Sally will follow Ted within 12 months of his death. Although good savers all their life, their health problems bankrupted both their quality of life and bank accounts.
Couple number two, Heather and Jack, live in the same house they have called home for over 40 years. They have lived their lives using the “upgraded” approach, which meant in their mid-50s they added good health as a goal for the rest of their lives. To reach that goal, they had to change their lifestyle, acquire a new set of habits.
Jack just celebrated his 79th birthday. Jack loves life. He is a deacon at their church, leads a men’s group on Wednesday mornings at the local coffee shop and walks three miles daily with his wife Heather. Heather and Jack cherish their 50 plus years together. Each morning as they walk, they catch up on their plans for the day, discuss the grandchildren and talk about various projects they are working on. Heather reminds Jack they need to decide if they are returning to the same small village in Mexico for their volunteer vacation next year. Heather has already talked to their granddaughter about house and pet sitting while out of the country. After their walk, Heather, who just turned 75 years old takes care of the dog, two cats and the household parrot. Later today, they are scheduled for visiting pet nursing home rounds at a retirement home with Winston the parrot and Carmella, their fat orange tabby cat. The staff and residents look forward to their biweekly visits. Jack and Heather bring a sparkly presence and a new story or two about the animal mischief in their household each visit.
Jack has a little arthritis in his back and hips but otherwise is in good health for an “old guy”. He continues his annual birthday health screening visits with his physician. Together the couple enjoys a high vegetable, fruit, and whole grain diet with small servings of animal protein. Both Jack and Heather maintain normal weights and blood pressures.
When Heather was age 60 during her annual health screening an early breast cancer tumor was found in her right breast without lymph node involvement. A lumpectomy and short round of chemotherapy put her into remission now in its 15th year. Heather’s biggest current health problem is her diminishing hearing. She just visited the audiologist as part of her annual check up and is excited about a new hearing aid that is almost invisible but will provide near normal hearing.
Does this example sound too extreme? Are we overstating the poor outcome of Linda and Ted? We wish that were the case. The fact is that these stories reflect what really happens in the journey from 50-something to 70-something. They portray the uncomfortable and painful truth about quality of life: you either define it or it defines you. That’s what happened to these two couples. Over 20 years ago they set off on very different paths as they invented their future in their mid-50s. Linda and Ted opted for the coping approach to embrace their senior years because they did not want to change the way they lived. Although they worked hard and planned for retirement, long term planning to preserve health and minimize disease was, in most cases, left to chance. Jack and Heather chose the upgraded approach as part of their planning for the second 50 years of life. It required change. It required dedication to a new direction in the utilization of health care, diet, physical activity and exercise, community activities, their spiritual life, and their attitude towards the stress of everyday life. These changes did not happen overnight. They were the end product of a series of “baby steps,” small but ultimately profound changes in key areas of their lives that paid huge dividends in the quality of their life today. Nor was it all smooth sailing. Despite a few detours along the way, it is clear they are experiencing a better quality of life than 20 years ago. And that is payoff, the key to even considering upgrading or reinventing our futures.
Both couples had satisfactory lives in their mid-50s. They had success and hope for the future. But their future was actually in the midst of a profound transition, one in which there would be little room for error, few if any second chances. It is hard to believe in our mid-50s that such an intense and unforgiving storm is just around the bend. But it is. Linda and Ted saw it one way. Heather and Jack saw it another. Both couples made choices and set out to live their choices. 20 years later those choices point out two crucial elements about quality of life beyond 50-something:
1. The individual has immense power to reinvent their future.
2. Modern medicine is has limited power to reinvent a poorly structured future.
Quality of life is not based on cosmetic surgery, new drugs or the latest medical procedures. The clinic cannot save us from bad choices or poor game plans. It all starts with us, but we need a plan. That is where many of us get stuck. When we look for a plan, the choices are overwhelming. Do I eat organic food and meditate? Should I sign up for a marathon? What are the good “carbs?” Should I take St. John’s Wort to handle stress? Did I need a body scan? Just finding a plan more proves more complicated than just doing what we have always done. Surely not all of the thing we have been told to do for our health, our quality of life, can be right? How do we know what is right? What’s the plan?
We have asked ourselves this question for many years, both for ourselves, for family member, for friends and for patients. What plan is simple, easy to work with, offers realistic baby steps and, most importantly, actually works? By works, we mean, a plan that has been around long enough to validate its effectiveness, meaning real people have used it with great success. For a long time we used a variety of approaches, a mix and match approach to our own health and the advice we gave others. And then by chance we discovered a plan by the most successful group of people to ever use them. We discovered the centenarians. The centenarians are people who have lived to 100 and beyond. Who better than those who have actually lived the journey with good health and great engagement to provide us with insights and strategies to obtain both quality of life and the potential for longevity? We were intrigued, but we wanted to know more. Here is what we found.
Currently in the US, we have 58,000 individuals who are at least 100 years old, a number that will increase to 1,000,000 by 2050. Some of the centenarians are fortunate enough to have longevity genes (usually evidenced by a family history among family members of long lives), but many have achieved long lives by a healthy lifestyle, even in the face of major medical problems. How did they do this?
The how is what this book is about. Not about the “how” to live to 100, but rather the “how” of their game plan that took them through the passage from their mid-50s through their 70s and 80s. This is the most likely passage for the majority of baby boomers. Some of us will get to 100, but most will get to between 70 and 90. This is our focus. How we can get to 70-something with the best quality of life.
Our research on the centenarians demonstrated that as a group they share common traits that impact the quality and length of their lives. Despite their diverse backgrounds and experiences, their lifestyles follow a common path, a common set of habits that offer a plan, a road map that is both profound and yet surprising simple in design. We call their common traits the “centenarian markers,” the unique building blocks that account for their impressive quality of life. Taken as a group the centenarian markers offer up a game plan that is both an assessment tool and a coaching tool. It can tell you what’s working and what can benefit from an upgrade. It offers the global view we need to see the big picture as well as the practical coaching tips we need to make changes. It addresses life, as we know it.
It is easy to forget with the avalanche of health messages we get from the popular media that we are more than blood pressure readings or cholesterol levels. Our lives are embedded into a complex landscape that has children, grandchildren, older parents, challenging jobs, marriages, and uneven health. Any road map that does not give us the tools to manage the whole process, life as we really live it, can’t help us. We don’t need a diet as much as we need a clear view of how the physical and psychological issues of our lives either work for us or against us. This is the value of what the centenarians have to teach us.
The goal is to upgrade the quality of our lives. Knowing the whole plan makes upgrading the parts so much easier. Why? Because we see how they are connected together in way that makes sense to us. Because we see how even a small step in one area yields huge results in the other areas. Because we see that one part of the plan does not replace or overshadow the other. Because we finally see that no doctor, no diet book, no fitness program can provide us with the invaluable perspective from the end of the journey, the advantage of looking back at what worked and why. This is the centenarian’s gift to us, the one they lived and now pass on to us to help us invent our future.
We wrote this book to provide you with a clear understanding why the centenarian markers are so crucial to quality of life and how they provide a clear road map that anyone can adopt at any age to upgrade the quality of their life. Knowing the centenarian markers is one thing; putting them into practice is another. The value of the book lies in its common sense approach to incorporating, most of the time in baby steps, this wisdom into our lives. It is not the big decisions that influence our lives so much as it is the small, determined decisions that yield profound influence over what we become. We are big on baby steps.
So as millions of baby boomers navigate 50-something, they are traveling through a critical period of time that will determine their future, the last major 20-year segment they have to invent a different outcome to their health story. For a larger portion of baby boomer population, this is a wake up call, like it or not. Which brings us to another important aspect of this book. It offers a plan that allows anyone to upgrade the quality of their life, on their own time schedule, in the order that suits them best, and in the manner that reflects who they are. Like we said, we are big on baby steps. Just choosing one new habit, one new goal from the nine markers we outline in the book can have a dramatic impact on the individual and those around him or her. This is what happen to Alan.
Alan heard us give a presentation on the centenarian markers. He can up afterwards to discuss a number of issues. Alan was looking for an upgrade in many areas of his life. Where to begin? What is the one step you can take in the next 90 days we asked him? Maybe a health check up he suggested. He was 55 and was long overdue for a physical. He decided to take that baby step and get a check up, colonoscopy and all. To his relief, everything was normal. He was relived and inspired. He opted for another small step. He began to test ways to get better connected in his community. Baby steps, piece by piece, building an upgraded future, on his own terms, piggy backing off of one goal after another, using the centenarian road map for keeping on course, remembering how the whole game was meant to be played.
While this book incorporates the wisdom of those who have lived to a 100 and beyond, it is not about longevity. Life is not a contest to see who last the longest. This book is about quality, about a balanced life that is more meaningful and satisfying. We won’t promise you that following the wisdom of centenarian markers will get you to 100, but wouldn’t it be wonderful as you approach 80 years of age and older to be like Jack and Heather? That is the purpose of this book, to provide you with a set of tools and strategies to minimize the development of future disease and to preserve good health, to upgrade your life to the highest quality you can have, for yourself and for those who are connected to you.
David and Janet Solie
Tags: aging, aging parents, Boomers, Booming On, caregiver, centenarians, Communication, David Solie, David Solie's blog, depression, diet, disability, exercise, Health Coach Advantage, healthy aging, How To Say It To Seniors, Janet Solie, middle age | Posted under Boomers, Health, Quality Of Life | No Comments
Last Updated on Monday, 11 February 2013 01:20 Written by David Solie Saturday, 30 July 2011 10:59
How do we help our aging parents consider making positive changes in their lives? We want to help, and feel we have good ideas that could improve their quality of life. For example, we would like for them to consider:
New support services to enhance their “aging in place” environment
New lifestyle changes to protect and improve their health
New living accommodations to put more fun back to their lives as well as reduce isolation and loneliness
New long-term care options to better prepare them for major setbacks
But many times our attempts to discuss these and other “change topics” are met with extreme push back that includes indifference, rejection, and hostility. Despite the constant media prompting to have “the talk” with our aging parents and despite our best intentions, we wind up sending out the wrong signals that are show stoppers instead of conversation starters. Why is this happening and what can make it better?
An extremely valuable book written for healthcare professionals may hold the part of the answer. It is called Motivational Interviewing in Health Care: Helping Patients Change Behavior. The authors offer new insights and strategies for discussing change topics in a clinical medicine setting. It appears that their approach could be equally useful to adult children of aging parents. Here are some highlights from the book that seem especially relevant for all caregivers.
The Change Dilemma
It doesn’t matter how obvious it seems that change would make things markedly better for our aging parents; it is hard for everyone, period. There is a deep inertia to change that anchors all of us to what we have always done. With aging parents, there is the added inertia to change that comes from their developmental need to maintain control in a world where all control is being lost. Change is a threat to control and is viewed with suspicion. So it is unrealistic and impractical to assume our aging parents will suddenly be “change friendly” just because they are older and have glaring issues that could benefit from something new. But as Motivational Interviewing in Health Care so effectively points out, the real six-hundred-pound-gorilla in all of these conversations is the quagmire of ambivalence.
The insights and practical advice on ambivalence alone is worth the price of Motivational Interviewing in Health Care. It turns out that ambivalence lurks behind all change conversations and can be provoked by our attempts to argue away our parents objections to change. These are those unsolicited lectures we give our aging parents to inform or direct them to do something different. I call this all to common habit of adult children the “better answer” syndrome. This is code for “I know what’s best, please pay attention.”
But instead of consensus, it only provokes the dreaded righting-reflex that entrenches our aging parents into arguing against the suggested change, moving the conversation from uncomfortable to communication gridlock. Thankfully, the authors offer an effective, non-intuitive approach to work around this all too common dilemma.
Motivational Interviewing in Health Care makes it clear that our goal is to avoid triggering the righting reflex and make an honest effort to understand our aging parent’s point of view. This involves finding out what they are actually experiencing and then signal that we are listening and get it. Within this non-triggering conversation environment, we can begin to test open-ended questions about issues where change might be useful to increase long-term control. Here are some simple examples:
How are you doing?
What’s worrying you most today?
What do you think would make this better?
How have you been feeling?
Tell me more…
What’s new with your friends?
What do you feel like doing?
Open-ended question invite our aging parents to choose the direction of the conversation. Once they pick the direction, we simply reflect back their thoughts and comments to indicate we are listening and understand their point of view. Although tempting, we need to resist the temptation to interrupt. Interruptions only make matters worse. We need to hear the whole story on a topic. But as the authors point out, we are listening for more than the story. We are listening for “change talk.”
This may be the most important benefit caregivers receive from reading Motivational Interviewing in Health Care. Change talk is where aging parents begin to voice some interest in change. It is a soft signal, more a preliminary musing about what if, wouldn’t be nice, I really need to, it would be better if, and I am sure I can, all examples of change talk phrasing. The most important thing about change talk is that our aging parents are exploring the other side of their ambivalence to change, speculating on how or why it might be worth considering. How we respond to these pre-change-exchanges will have an enormous impact on whether or not change actually occurs.
Motivational Interviewing in Health Care offers a detailed explanation and ample examples of how to develop these moments of change talk into positive changes. Despite its focus on clinical encounters for healthcare providers, it offers adult children a compassionate and effective strategy to explore change topics in a non-threatening, parent-centric style. It is an approach could be a game changer for adult children searching for a new way to help their aging parents make positive changes.
Tags: Aging in place, aging parents, behavior change, Boomers, caregiver, communication conflicts with aging parents, communication problems with aging parents, communication struggles, coping, David Solie's blog, death of a spouse, disability, home health care, How To Say It To Seniors, loneliness, long distance caregiving, long term care giving, Motivational Interviewing in Health Care, moving into assisted living, old age, on aging, the elderly, Unlocking the communication code | Posted under Aging Parents | 1 Comment
Last Updated on Monday, 11 February 2013 01:57 Written by David Solie Saturday, 3 April 2010 10:21
This is one of the predictable dilemmas of aging we all wish we could avoid. We can’t. At some point we run out of aging-in-place options and a parent winds up in a place they never wanted to be, a nursing home. It is a painful transition that in most cases is irreversible. But they continue to ask us when they can go home. So how do we respond? How do we help them come to terms with this new reality?
Start with the truth. Tell them the painful truth. Tell that you have run out of options. Their health and care issues requires a new level of support. It’s not what either of you wanted, but it is the new starting point that both of you are going to have to use going forward. You wish it wasn’t so, but it is.
Start with control. Make a working list of all of the choices your parent still retains despite being in a nursing home. Can they choose their own food and when they eat? Can they choose their activities and when they leave the facility on outings? Can they choose pictures to hang, a special chair, music, blankets, and when family and friends can visit? The more ares of control you identify and orchestrate for them to manage, the easier it will be for them to come to terms with the transition.
Start with legacy. Make a working list of the people connected to your parent’s life who can “rise to the occasion” and help with the transition. This could include neighbors, co-workers, friends, clergy, and of course family members. Tell them to come ready with a story, pictures, food, and news. We all want to know our lives make a difference, but when we wind up in a nursing home, it doesn’t seem that way anymore. The more connections you mobilize to interact your parent, the easier it will be for them to come to terms with the transition.
Make ample room for tears. The losses of aging break our hearts and all of us need room to grieve openly. It helps us come to terms with the things we cannot change; it makes room for courage and compassion. Let your parent have his or her feelings and let them see yours. It will provide both of you comfort and deepen your partnership for what lies ahead.
Last Updated on Monday, 11 February 2013 02:01 Written by David Solie Sunday, 13 December 2009 03:04
Caregiver stress is well documented and extracts a heavy toll on both caregivers and their families. In the heat of trying to keep everything together, it is hard for caregivers to find effective strategies that offer some respite from the natural tendency to obsess and feel overwhelmed. Caregivers need a way to take their brains “offline,” to momentarily disengage for anxious, closed-loop thinking, catch their emotional breath, and come back renewed. But how?
Here is my solution: Inspirational Walking. This is a simple, effective strategy that combines walking with a personalized soundtrack. It combines two powerful strategies that change thought patterns: exercise and music.
Exercise clears the mind. Even when we start out feeling overwhelmed, a simple thirty minute walk makes our thoughts clearer, gives us new ideas that help us cope, and leaves us feeling physically and mentally energized.
Music inspires the heart. Music has been a part of lives from early childhood, and we all have personal sound tracks of our lives. We mark people, events and the passing of time with certain songs. In the end, music helps us give meaning to our experiences and, as important, helps us cope.
Inspirational Walking integrates both of these strategies into one simple strategy. Here’s how it works:
1. Using iTunes, create a playlist that is thirty minutes long. Begin with a song that captures the reality, mood, or irony of being in a difficult caregiver situation. I personally like Van Morrison’s song “Stranded” with the lyrics “everyday is puzzle time again.” I can’t explain it, but hearing these kinds of songs makes me feel better. Then add songs that that offer courage, inspiration, and motivation. I personally like Jack Johnson’s “Upside Down,” Indigo Girls’ “Love of Our Lives, and Coldplay’s “Yellow.” The key is to find songs that speak to your heart, that pick up your mood and step, and that remind you that you are not alone with your life struggles. Don’t obsess about the order or the exact length of the first playlist. As they say at Nike, just create it.
2. Give your playlist a test run. Put on your most comfortable walking clothes and shoes and take an thirty minute Inspirational Walk. This is your thirty minutes off line. If you can, walk outside; it will have the deepest impact on your thoughts and mood. If not, use a treadmill or an indoor mall. Put the world on pause; it will have to make due without you for thirty minutes. Find your own starting pace and just go with the music.
Everyone is stiff and tight the first ten minutes and wonders if this is a good idea.
Everyone feels remarkably better at twenty minutes and are glad they took a walk.
Everyone feels better as they bring it home at end of thirty minutes and are sure it was good for their body, brain, and heart.
3. Modify your playlist and build new ones. Maybe you want to change the order of songs, or delete some songs and add new ones. Maybe you thought of a theme for another Inspirational Walk playlist. Create playlists for those days when nothing goes right. Create playlists for those days you are grateful for the lessons. Create playlists for those days you are on point and things are falling into place.
Our minds don’t do well sitting and stewing. We need movement and music to break us out of our mental quicksand. Try Inspirational Walking for thirty days, three to four times a week. See where the music takes you. See how your body feels with some new, consistent motion. See how your brain reacts to new input. Lastly, share your success and playlists with other caregivers who, like you, need a little time off line to regain their balance.
David Solie Updates
- Dancing with Negative Feedback: Redirection and Resolution
- The Car Front Mind Map
- Caregiver Mind Maps
- Communicating with Older Adults: An Update
- David Solie on Communicating with Senior Housing Clients
- Dancing with Life Review…
- From Pleading To Informing…
- Dangling Conversations…
- The Pedigree Road Map™
- Final Words…
David’s New Book
David Solie’s new book Caregiver Mind Maps is being acclaimed as “tangible breakthrough” in communicating with aging parents...
Learn more about this revolutionary approach in caregiving, download a sample, and order your copy here.
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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.
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