Wednesday, May 22, 2013

Posts Tagged ‘quality of life’

The Pedigree Road Map™

“A person often meets his destiny on the road he took to avoid it.”

Jean de La Fontaine

The inclusion of genetics into a life management strategy may appear at first to be mistake. Life management implies choices and genetics is seen by most people as more luck of the draw rather than something that can be changed or upgraded. “Why bother” is typical response. Genetics, however, proves to be an ideal reframing tool for middle age adults. It provides an essential global view of a person’s family history that is beneficial in two areas:

1. It provides information for schematic overview of a person’s family medical history that we have entitled The Pedigree Road Map™.

2. It offers and emotional connection to specific risk factors and their outcomes, an essential step in the reframing process.

The Pedigree Road Map™ is unique portrayal of an individual’s family health history. While genetic history is one of the most valuable tools in preventative medicine, it is also the most underused. Part of the reason for its obscurity lies in its limited emphasis in clinical medicine.

While physicians will enquire about the family members and close relatives, alive and dead, the information is rarely developed or transferred into a usable form that allows patients to benefit from a global view of their risks, possible outcomes, and options. In the baby boomer world of increased volatility, stability begins with accurately knowing and managing risk.

The Pedigree Road Map™ plots out the magnitude and nature of the dangers that lie ahead. What was a curiosity in the first half of life, now becomes an essential piece of information for preserving quality of life. The effectiveness of The Pedigree Road Map™ to provide this level of risk management lies in the emotional context it creates for health issues.

Middle age adults are encouraged to exercise, watch their weight, eat a balanced diet, quit smoking, and reduce the stress in their lives. While this is all good advice to reduce the risk of heart disease, diabetes, and cancer, they are essentially perceived as facts. Facts, as previously discussed, are usually not enough to change concepts and behavior. Good advice needs to be presented from a different vantage point, repackaged with an emotional context in order to be effective in reframing. The emotionally charged world of families is an ideal platform to accomplish this.

Families are charged with emotions, both positive and negative. One thing they are not is neutral. Setting out to build The Pedigree Road Map™ may appear at first to be a clinical endeavor. It is not. The contextual diagramming of parents, siblings, grandparents, etc. initiates an emotional experience between real people and the person who stands on the base of the genetic tree. Each life, for better or worse, has dimensions, a story, and lessons. These insights are not lost on middle age adults who are wondering who they are, what the future will bring, and where their vulnerabilities lie.

The simple building of The Pedigree Road Map™ seems to ask as many questions as it answers. It sends the builder back to the family drawing board to find out more about the people who are directly linked to their lives. The obvious disease patterns are one thing, hyperlipidemia, hypertension, diabetes, heart disease, and cancer. But it is the unplanned discoveries within the family system that make The Pedigree Road Map™ such a potent sector in The Quality of Life Portfolio™.

Not surprisingly, so much of what individuals know about their family is comprised of second hand information and in many cases myth. Facts have a way of changing over time with details being lost or changed from one telling to another. The Pedigree Road Map™ offers a forum to reexamine what really happened to family members. It becomes a vehicle to fill in the blanks on subjects or people that had been vague or misunderstood for years.

Unknown or unappreciated patterns begin to emerge, themes that have a significant bearing on the quality of life for middle age adults. The search for heart disease not only turns up heart disease but also a strong and undeniable pattern of depression in each successive generation. This discovery raises a red flag regarding mental health issues for all close family members. Like untreated hypertension, untreated depression can be devastating to quality of life. But a warning regarding depression in itself is simply a health alert.

The Pedigree Road Map™ gives it an emotional context inside of the family. Its expression and consequences become personal, linked to real people and real lives. It resonates as both a warning and forecast unless further action is taken. Because of this, it is ideally packaged for the reframing process, able to make a cognitive impression that can potentially alter behavior. In a world of long standing lifestyle habits, this turns out to be no small feat.

Finally, The Pedigree Road Map™ brings into focus an overlooked element in discussions regarding quality of life. All lives, upon close inspection, are deeply unique and require customized management plans. Clinical medicine does a good job of offering general guidelines for health screening, but the final and most important choices reside with the individual.

This has become more apparent as the financial burden of health care is being steadily shifted to consumer. In a similar fashion, the outcome burden is also being transferred as physicians readily admit they cannot know or implement every diagnostic or treatment option. Individuals must take a bigger role in their health care including wellness management. Middle age adults have enough mileage to realize that illness is not an abstract concept that only happens to others. They know risk factors pose a real danger to both personal stability and the ability to pursue their goals. What good are new dreams if your body can’t make the journey or you spend all of your time and resources on being sick?

The Pedigree Road Map™ gives the abstract world of risk factors and poor outcomes substance by adding an emotional dimension to what works and what proves to be disastrous. It personalizes the why and how of spending health care dollars and in doing so, offers middle age adults a new level of confidence in their ability to read the danger signs and chose a better outcome.

Aging In The Wrong Place

As the boomers pass en masse through middle age, it is assumed that they will undergo “generativity,” a term coined by the psychoanalyst Erik Erikson in 1950 to denote “a concern for establishing and guiding the next generation.” Generativity represents a sociological moment of truth for adults entering the second half of life, an opportunity to move from “me” to “us” that reduces self-interest in favor of the interests of generations who follow. This was cultural ethos of the boomer’s parents. Their “group-centric” upbringing championed the common good above excessive magnification of self. Tom Brokaw’s book The Greatest Generation highlights their generational resistance to excessive adoration of WW II survivors, an insult to the “real heroes” who never made it off the battlefield. But will the boomers follow in the same sociological footsteps? All indications are they will not.

Blame it on the parents of boomers who wanted their post-war children to have a better future. Their good intentions ushered in the first child-centric society in US history. But what seemed magical on the parenting drawing board wound up replacing the group-centric ethos of the “greatest generation” with a new, self-centric ethos, a societal sea change that only intensified as it cascaded into succeeding generations.

This unprecedented magnification of self is proving difficult to shed in the passage through middle age fraught with financial setbacks, chronic health problems, and an overall generational distaste for being old. The boomer version of generativity is turning out to be a movement from “me” to “more me.” What does this mean?

Sadly, self-magnification rarely self-corrects. The societal narcissism introduced by boomers has become a full epidemic of self-magnification in succeeding generations, a perfect co-dependency between new technologies and child-devoted parenting. It is a shift in societal DNA that bodes poorly for boomers on a number of fronts:

1. Personal Health Over focus on self is a form of magical thinking. It assumes “just in time” interventions from the outside to save the day, which has been true for most of the boomer’s generational trek. Schools were built, jobs appeared, and opportunity flowed freely decade after decade. But health ultimately is the product of internal accountability, lifestyle, “health habits” that prove to be destiny. In this regard, boomers are self-centric consumers waiting for the illusive intervention of modern medicine to save them from unhealthy habits. Yet all the tests, procedures, and medications offered by the US healthcare system cannot override poor lifestyle choices, and they haven’t. The only rescue from poor health and its symbiotic twin bankruptcy is self-rescue. Ironically, medicine has known this for decades but has taken a different path. It seems doubtful that the boomers will recognize or accept this inner truth about accountability before time runs out.

2. Generational Mentoring Over focus on self sees old age as the worst of all possible outcomes. Not surprising, magical thinking is once again the boomer storyline as they bet the farm on anti-aging products and procedures to delay the dreaded “looking old,” a slight of hand trick that allows sixty-five to be declared the new forty-five. In this model that sees aging as disease, elders fade from society’s vernacular, and with it the loss of a historically stabilizing force in families and society. The traditional elder role of compassion, patience, and big picture wisdom is replaced by anxious sixty-something adults whose attempts to fend off being old only become more and more exaggerated.

3. Philanthropic Empathy Over focus on self trumps empathy for others leaving “someone else” to take care society’s problems. The sheer complexity of being middle age, up to your neck in debt, poorly positioned for an expensive longevity, and slipping into declining health leaves little emotional bandwidth for society’s “greater” needs that seem to be everywhere. Ironically, the largest generation of fifty year olds in the history of the world may wind up being the most costly in terms of social burden while being the least philanthropic.

Shakespeare noted that “past is prologue” but not all boomers are stuck in this self-magnified approach to the second half of life. They have taken the lifestyle path less traveled, high on accountability with careful attention to health habits. But the majority of boomers are at risk. Certainly late-onset course corrections are possible even against the stiff currents of self-magnification. But minus the support of a group-centric ethos, sustainable changes require a rare epiphany and determination to accept what needs to be done and then find a way to “just do it.”

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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 will take you to an article I authored on “communicating touch choices” that offers a practical strategy for how to do this:http://www.aging.org/i4a/pages/index.cfm?pageid=2103&textonly=1

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.