The Human Odyssey

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The American Association of Retired People (AARP) has a free monthly e-newsletter called Human Values in Aging, that provides a rich source of information about humanistic gerotology, including brief articles, books and films of interest, weblinks, calendar of events, and quotations on humanism and spirituality in aging.  It is edited by Dr. Harry R. Moody, author of The Five Stages of the Soul: Charting the Spiritual Passages that Shape Our Lives, former Chairman of the Board of Elderhostel, and currently Director of Academic Affairs for AARP.  To read a sample issue, click here. To subscribe to the e-newsletter, click here.

New Group Called "The Elders" Brings Wisdom to World Problems

Yesterday I was watching Charlie Rose on TV and he had Richard Branson, the maverick billionaire, on the show talking about a new philanthropic effort that he is supporting called The Elders.  This consists of a group of twelve individuals who have attained world recognition for their work in supporting peace, justice, health, and other positive values around the globe, including Nelson Mandela, Kofi Annan, Desmond Tutu, and former president Jimmy Carter.  The idea is that they can use their "1,000 years of collective experience" to help solve existing problems around the world. Their first project was to travel to the Sudan last year to help with the Darfur crisis.  They have recently concluded a trip to Kenya to help mediate the violent partisan dispute over leadership there.  The group is sponsored by a number of individuals and organizations that have raised $18 million thus far to support their efforts.

This strikes me as an extremely worthy enterprise, because it values the elders of our society to generate solutions to age-old problems.  Historically, cultures have often turned to the elders for answers to life's deep problems.  Unfortunately, in our modern age, we have too often put the reigns of control and leadership in the hands of youngsters who have not yet gained the experience necessary to make good decisions.  This project is an acknowledgement that we need to turn once again to our elders to access the wisdom they have in solving the great problems of our world, including war, poverty, human rights abuses, and environmental pollution.  For more information, go to www.theelders.org.   

Large Investment Groups Buy Nursing Homes and Care Declines

The New York Times examined more than 1200 nursing homes purchased by private investment groups in the past eight years, and discovered that, compared to national averages, these homes declined in care given, and scored lower in 12 of 14 indicators used to track ailments of long-term residents.  Homes owned by such investment firms as Warburg Pincus and the Carlyle Group (owners of Dunkin' Donuts), had greater than average incidences in residents of bedsores, easily preventable infections, and unecessary restraints in freedom and mobility.  Investment firms move in and take over unprofitable nursing homes, fire nursing staff and cut back on other resources, begin making money, and then may sell the homes at a big profit.  While this particular strategy benefits investors, it leaves many aged nursing home residents more vulnerable to a range of age-related risks including depression, loss of mobility, and loss of the ability to dress and feed themselves.  A big problem with investor-owned nursing homes is that they often legallly structure their ownership in such a way that it becomes difficult to sue them when residents become ill or die due to neglect.  Because they are privately owned, they are also immune to many of the local, state, and national regulations that apply to publicly owned nursing homes.  They are, therefore, able to function below the radar screens, and above the law.  According to the New York Times, nursing homes received $75 billion in 2006 from Medicare and Medicaid, making them a veritable cash cow for those investment groups that prey on them, cutting expenses, making huge profits, and leaving residents with sub-par living conditions.  To read the entire New York Times article, click here. 

Concepts in Human Development: Lost Possible Selves

In Henrik Ibsen's play Romersholm, a middle-aged tutor named Ulrik Brendel brags to his friends about all the potential creative literary projects that he has inside of him just waiting to be let out.  But one day, he tells his friends that he has just come to a shocking conclusion:  "For five and twenty years I have been like a miser sitting on his locked money chest.  And then today, when I opened it to take out my treasure, there was nothing there.  The mills of time had ground it into dust. There was not a blessed thing left of the whole lot."  Brendel had waited too long to develop this possibility in himself.  Had he begun writing twenty-five years before, when the impulse to create had first impressed itself upon him, he would have over that period of time brought into realization his potential as a literary artist.  Now, however, he had to face what psychologists are calling these days a "lost possible self."  In the October 2007 issue of American Psychologist (a journal of the American Psychological Association), Laura A. King and Joshua A. Hicks write about how people deal with their lost possible selves in an article entitled: "Whatever Happened to 'What Might Have Been.'"  They note that many people have difficulty thinking about their lost possible selves because this often leads to regrets, distress, and a lowered sense of well-being.  These individuals pursue a strategy of not thinking about "what might have been" so that they are able to preserve a sense of happiness in life.  These individuals prefer to focus on the goals that they have chosen to develop in life, and to reap the satisfaction that comes from meeting these goals.  This represents one dimension of maturity in adult development.  However, there are other individuals who are able to handle more complexity in their lives, and these individuals can often reflect upon their lost possible selves and also experience a deep happiness in their lives, despite, or perhaps one might even say, because of, the difficulties and disappointments that they have had to face.  One mother in their study, for example, whose personal life goals were interrupted for a time by the experience of giving birth to a child diagnosed with Down Syndrome, said:  "I was on the road to self-discovery. . . . I was searching for a little more purpose. Being a mother, being a wife, being a nurse was not enough: I wanted to fulfill my destiny. I wanted to continue on the search for self actualization.  Well [my son] came along.  Everything was tested, values, beliefs, friendships, wedding vows, etc. Much growth, difficult growth, lots of confusion, but I am on the other side now . . . I am right back on track and could not be happier.  I'm stronger--I'm more experienced, and God knows, I'm much more compassionate and humble." (p. 630)   The authors of this study conclude that spending too much time focusing on what has been lost correlates to unhappiness, but for the individual who is willing to engage in an honest process of self-exploration, such disappointments concerning "lost selves" can serve as spring to a broader vision of oneself. 

If you are in your fifties, sixties, or beyond, take some time to reflect on one or more of your lost possible selves.  Perhaps you wanted to be a major league baseball player, a nuclear physicist, a surgeon, a best-selling author by the age of forty, a famous politician, a glamorous movie star, a world-class ballerina, or even less lofty but still significant goals:  reaching a twenty-fifth wedding anniversary, being the mother or father of happy and successful children, attaining the highest level at your place of work, maintaining perfect health into old age.  Perhaps you know now that it's too late, or simply not possible, to become that thing that you wanted to be so badly.  Are you willing to fully experience the regret of not having reached your goal, of not having fully developed this aspect of yourself?  And can you find a deeper meaning in this loss?  In a sense, losing a possible self is like losing a significant person in our lives.  We need to grieve this loss, but we also need to get on with our lives.  If we are fortunate, we can learn to view this loss as a deepening of our understanding of life's journey, and of how it has made us richer and more complex human beings.  The Germans have a word Torschlusspanik, meaning "the panic of closing doors," to refer to the process of freaking out when we realize it is too late to develop some aspect of ourselves.  Perhaps we need a new word that means something like "the wisdom that comes from closing doors."  The psychoanalyst and developmental psychologist Erik Erikson defined integrity in late adulthood as an acceptance of one's one and only life cycle as something that had to be (Erik Erikson, Identity and the Life Cycle, p. 104).  This encounter with our lost possible selves may help us toward this fundamental acceptance of life. And this, according to Erikson, makes it possible for us to face our death as well.

Support the Elder Justice Act in Congress

Everyday we read about elderly people who have been bilked out of their life savings, or stuck in sub-standard housing, or physically abused.  Elder abuse is a significant problem in our society.  In 2006, there were 565,747 cases of abuse reported and research suggests that only 1 in 14 cases ever see the light of day.  These figures are likely to increase dramatically with the aging of baby boomers.  However, as Senator Orrin Hatch R-Utah reports, "We don't have one federal employee working full time combatting elder abuse."  Versions of a legislative act that would begin protecting our senior population have been introduced in Congress since 2003, but, with one exception, they have failed even to make it out of committee, and in that one instance, failed in the Senate.  This year, the Elder Justice Act has been reintroduced in both the House and the Senate (S. 1070 and H.R. 1783).  It will, among other provisions, provide $400 million spread over four years to pay for strengthening state and local adult protective services agencies.  Please write your members of Congress and urge them to support this important measure.  For a state-by-state list of elder abuse resources (including information on reporting elder abuse), click here.  For information on the warning signs of elder abuse, click here. 

Medical Care Crisis Looming Up Ahead for Aging Population

I just finished this fascinating article that was in the April 30, 2007 issue of The New Yorker, on the looming crisis in care for the aged.  It was entitled (with a nod to Anthony Trollope) "The Way We Age Now."  Two things in particular struck my attention in the piece. 

First, was the observation that although the population of aging America is going to skyrocket in the next two decades, the practice of geriatric medicine is actually decreasing.  The number of certified geriatricians fell by a third between 1998 and 2004.  The reasons for this are very similar to the reasons for the decline in the practice of adolescent medicine in the U.S., an issue that I explored in a previous post:  income for geriatric medicine is among the lowest of any of the medical specialties and aging people are difficult to deal with (they complain a lot, their memories are bad, you have to be extra patient with them etc.).  A lot of work for little money.  But what's going to happen when there are millions of us needing medical care that recognizes our special needs as older people, and there are no doctors specialized in geriatric medicine around to fill the bill?

The second thing in the article that fascinated me was the observation that a geriatric doctor often pays more attention to small details than to big medical issues.  A case that was cited in The New Yorker piece was of an eighty-five year old woman who had glaucoma, arthritis, lower back pain, both knees replaced, high blood pressure, surgery for colon cancer, and a lung nodule that needed a biopsy.  What was important to the geriatric physician who examined her that day, however, was not these major medical problems, but instead what she'd been eating, what her feet looked like, how she got up out of her chair, and other relatively insignificant issues.  As the writer, a Harvard Medical School professor named Atul Gawande, pointed out, "The single most serious threat she faced was not the lung nodule or the back pain.  It was falling"  (p. 55).  The geriatric specialist was concerned with the quality of her daily life.  Without good feet, or the ability to get out of a chair easily, she could be only a short step away from a nursing home.  Without proper daily nutrition, social support, or nightly rest, she might lack the energy, interaction, or repose necessary to a functional life.

There was much else in the article that was fascinating (including a run-down of how the body breaks down as we age).  However, these two ideas - the fact that a shortage of geriatric physicians is in our future, and the idea that our lives as older people often hinge on small details - are worth pondering at some length.   

Worm Gene May Hold Promise for Human Longevity

Scientists at the Salk Institute in La Jolla, California reported in the journal Nature today that they have discovered the existence of a genetic pathway in roundworms (Caenorhabditis elegans) that appears to extend their lives when their caloric intake has been reduced.  This finding may have implications for human longevity.  It's been known for some time that reducing the intake of calories extends the lives of human beings and other living creatures.  However, this is the first time that a specific genetic mechanism has been discovered that appears to be set off by a reduced-calorie diet.  Now that this link has been revealed, it may be possible to regulate this genetic pathway through drugs rather than a reduced calorie diet (a regimen that is difficult for many humans to follow).  Such a discovery may result in a significant extension of life for human beings.  While the specific gene was discovered in roundworms, scientists have discovered exact counterparts for this gene in mammals: three genes that have been labeled FoxA 1, 2, and 3.  These genes belong to a large family of master regulator genes that control other genes. While today's finding is significant for the possibility of extending lifespan in human beings, much research remains to be done to further define these genetic pathways and to develop drugs that do not have harmful side effects for human beings.   To read a report on these findings in The New York Times, click here.

What's Wrong With Aging?

There's been so much in the news lately about anti-aging remedies from anti-wrinkle cream to human growth hormone that I just wanted to speak for the pro-aging side.  What's wrong with aging?   I see the faces of elderly people who have decided to deny their aging with chin lifts, botox injections, and facial implants, and I get this creepy feeling inside.  Why are they avoiding the natural wrinkles, creases, bumps, and sags that come with growing old?  I've always felt that there's something beautiful about the faces of aging people.  When I was a child, I'd see these photos of older Native American leaders in the National Geographic, and even at that young age I felt a deep beauty in their faces.  I'd look at the faces of my grandmother and great-grandmother (who I was privileged to live with for a year), and be in awe.  In some ways, I get the same kind of feeling when I look at ancient trees.  It seems that people in our youth-oriented culture have lost touch with the deep meanings that collect around being old.  It's as if they wanted to eliminate autumn and winter from the four seasons.  It's as if they were saying "let's get rid of the hideous autumn foliage, and withered leaves, so everything can be green all the time."  There's a life-denying quality to those artificially stretched cheeks and foreheads; a kind of tension there that wants to pretend time doesn't exist.  But it does.  What a great honor it is to be a part of this mysterious life process that unfolds, that has been unfolding for as long as there have been living things!

For some incredible photos of aged people, see the exhibition by Mark Story "Living in Three Centuries:  The Face of Age"

The River of Life

The River of Life

by Thomas Campbell (1777-1824)

The more we live, more brief appear
Our life's succeeding stages;
A day to childhood seems a year,
And years like passing ages.

The gladsome current of our youth,
Ere passion yet disorders,
Steals lingering like a river smooth
Along its grassy borders.

But as the careworn cheek grows wan,
And sorrow's shafts fly thicker,
Ye stars, that measure life to man,
Why seem your courses quicker?

When joys have lost their bloom and breath,
And life itself is vapid,
Why, as we reach the Falls of Death
Feel we its tide more rapid?

It may be strange—yet who would change
Time's course to slower speeding,
When one by one our friends have gone,
And left our bosoms bleeding?

Heaven gives our years of fading strength
Indemnifying fleetness;
And those of youth, a seeming length,
Proportion'd to their sweetness.

Tai Chi Protects Against Shingles

Researchers at UCLA have completed a study that suggests performing tai chi on a regular basis may help ward off shingles - a viral infection that causes a painful rash that can lead to complications.  Shingles is caused by the virus herpes zoster, which is the virus that causes chicken pox.  Adults who have had chicken pox in childhood are particularly at risk for shingles because the virus lies dormant in the nerves for decades only to appear as shingles when the immune system has become weakened in later adulthood (most often the disease occurs in people 50 and older).  An estimated 1 million people in the U.S. are afflicted with shingles every year.  Performing tai chi (something that millions of people in China do every day - see video), appears to boost the immune system, thus keeping the dormant virus from breaking out into shingles.  "These are exciting findings, because the positive results of this study also have implications for other infectious diseases, like influenza and pneumonia," said Michael Irwin, who is also director of the UCLA Cousins Center for Psychoneuroimmunology.  For information on other health benefits of tai chi, click here.   For information on performing tai chi moves, click here.

Lower Your Blood Pressure to Protect Your Brain

A new report in the journal Neuropsychology suggests that hypertension (high blood pressure) contributes to age-related declines in the brain and cognition.  They looked at two groups of adults:  one group remained healthy for 5 years; the other group either had hypertension at the start of the study, or developed it sometime during the 5 year period.  After 5 years, the hypertension group had twice the volume of brain abnormalities called white matter hyperintensities (WMH) compared to the control group (see accompanying photo which is not from the study but which illustrates the MRIs of a control brain and a brain with WMH). A larger volume of white matter hyperintensities is associated with cognitive decline, an increased risk of dementia, and accelerated brain aging, according to another study.  The authors of the Neuropsychology study write:  "Because vascular disease can be prevented, postponed, and ameliorated by established behavioral . . . and medical . . . means, recognizing its role as a modifier of brain-behavior relationships may be important in planning future interventions in cognitive aging (Neuropsychology, March 2007, p. 155).  So, folks, there's another reason to keep that blood pressure down through exercise, diet, stress-reduction, and/or prescribed medications!

 

Gray Market in Home Care for the Elderly: A Good Idea?

Because of soaring costs in home health care for the elderly, some relatives of individuals in late adulthood are tapping a "hidden" market:  the so-called "gray market" in elderly home health care.  This consists of a network of generally untrained, unscreened, unsupervised, women who are willing to work for less than the fees charged by for-profit licensed home health care agencies.  According to the New York Times, the exploding population of elderly in the United States (4.2 million people are currently over the age of 85, and this number is expected to increase to almost 6 million in the next 7 years), has driven the home-care industry underground.  While the financial advantages are clear, there are risks involved in informally hiring someone to take care of mom or dad at the end of their lives.  Without screening, a home care worker could turn out to have a criminal record or a history of abuse.  Without training, the worker may not be able to respond to an emergency (although untrained workers have more latitude in responding to certain emergencies since licensed agencies may require their workers to call 911 or get approval from a supervisor before helping a client who has fallen).  Still, there are attempts to bring some order into the gray market for home care.  In New York, 60,000 home care employees have been unionized and get benefits, receive support, and learn skills.   There is a training program for gray-market aides at the University of Arkansas.  As the number of elderly increase, and the costs of care along with it, this informal option may become of a more significant part of elderly care in the future.