Are You at Risk for Diseases of Aging?

Husband, on returning home from a Super Bowl party, groans, “I have the worst indigestion.”

Wife:  “Well, what did you eat?”

Husband: “Two plates of nachos, 3 slices of pizza, a chili dog, 4 steak kabobs, spinach artichoke dip with chips, chicken tenders with mustard sauce and about a dozen beers.”

Wife, sardonically, “Yeah, it’s hard to know what caused the indigestion when you ate so many different foods.”

This reductionist attitude makes for a good joke, but it’s no joke when applied to staying healthy throughout a long life.  Are so-called “Diseases of Aging” diseases at all, or are they largely the result of a stressful Western lifestyle that ignores centuries of human evolution and place demands on the body that wear it down over time, thus creating “Diseases of Aging”?

Research has shown that poor health does not have to be an inevitable consequence of aging. Older adults who practice healthy behaviors, take advantage of clinical preventive services, and continue to engage with family and friends are more likely to remain healthy, live independently, and incur fewer health-related costs. ~ Centers for Disease Control.

I’d like to make a distinction between an infectious disease and a chronic condition.

An infectious disease has a definable and specific cause, such as a mosquito bite causing malaria or stepping on a rusty nail causing tetanus or a virus causing polio.  The start of the disease is traceable to a singular event.  While lifestyle and health habits may influence how the body reacts to the invasion, there is no correlation between, for example, taking Vitamin E supplements and preventing that nail from coming up through the carpet and scratching your naked foot.

A condition is a complex combination of symptoms caused by a multitude of factors. Chronic conditions include heart disease, cancer, Alzheimer’s, stroke, diabetes, and obesity.  Years of physical self-abuse and neglect commingle to create these chronic conditions. There is no one “magic bullet” that reduces complex conditions to singular causes and thus cures them.  Lifestyle factors are major contributors to these conditions, and making lifestyle changes can prevent and reverse many of them. According to the CDC,

Four modifiable health risk behaviors—lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption—are responsible for much of the illness, suffering, and early death related to chronic diseases.

Although “genetic disposition” is frequently cited as a factor in the development of chronic conditions, it is rarely the only, or even the deciding factor.  Thus, with chronic conditions, there are no victims.  Though millions of dollars are spent each year on research for new drugs and cures, the truth is that we are at cause for much of the decline we fear.

Despite the abundance of knowledge about the causes of Diseases of Aging, there is almost universal denial that we are complicit in our own downfall.  Here are just three examples from CDC:

• More than one-third of all adults do not meet recommendations for aerobic physical activity based on the 2008 Physical Activity Guidelines for Americans, and 23% report no leisure-time physical activity at all in the preceding month.
• In 2007, less than 22% of high school students and only 24% of adults reported eating 5 or more servings of fruits and vegetables per day.
• More than 43 million American adults (approximately 1 in 5) smoke.

The resulting waste in lives and resources fuels a debate about “the cost of elders to society” as if elders are not part of and therefore not contributors to society.  Let’s be contributors by taking control of our own health and modeling healthy habits for future generations.

What are you doing to stay well?  Post your comment below.

The New Epidemic

There is an epidemic brewing. It is not caused by a germ or virus. You cannot stop it by washing your hands or covering your nose when you sneeze.  Neither can you catch it by being near someone who is afflicted.  However, it will likely change the life of you or someone you love, directly or indirectly.

Age is a factor.  If you are 65 years old, you have a 10% chance of being affected. The number of people doubles every five years beyond age 65. If you live to age 85 you have a 50% chance of expressing some form of this disease.  As our population ages, more people are developing this illness.  If nothing changes, by 2050, 80 million people will be afflicted worldwide.  That’s one in every 117 people!

At present this 6^th leading cause of death in America fells more people than either diabetes or influenza. As more people become ill, it could overtake stroke, cancer and HIV, for which death rates are going down.

The resources expended to care for this population is enormous and will continue to rise. Total payments for health and long-term care services for people with this condition will amount to $172 billion from all sources in 2010.

In 2010, Medicare and Medicaid spending for this disease was estimated at $123 billion. This group accounted for 34% of Medicare spending, although they make up less than 13% of the total Medicare population.

In addition, family and friends provide over 12.5 billion hours of unpaid care, valued at $144 billion (based on $11.50/hour).   Fifteen percent of caregivers provide over 40 hours of care per week, and 32% have been providing care for five years or longer.

Most people with this disease also have other serious medical conditions. The combination complicates the management of these other conditions, resulting in more hospitalizations and longer hospital stays.

Yet, despite the tremendous drain on resources and the enormity of the problem, the National Institutes of Health–which spends over $6 billion a year on cancer research, over $4 billion on heart disease research and over $3 billion on HIV/AIDS research–spends less than $480 million to research this new epidemic.

I hope I have gotten your attention.  This picture is pretty bleak. But we have to face the facts in order to change them.  Don’t worry, be proactive. In future blogs I will show you how.

Now, have you guessed what I’m writing about?  Give me a ten-letter word for “A progressive neurodegenerative disease that slowly destroys an individual’s memory, judgment, cognition and eventually ability to function.”

Answer: “Alzheimer’s.”

Sources:

• Centers for Disease Control and Prevention
• http://www.alz.org/alzheimers_disease_facts_and_figures.asp
• Psychology Today

Invigorate Your Boomer Idealism — Go Back to School

I did not write the following paragraphs, but I wish I had.

Imagine the future: fifty- and sixty-somethings gathering on a college campus for a year or two of advanced study to prepare for the rest of their lives. They want to eradicate diseases, end poverty, reverse global warming, raise literacy rates, create ventures to produce peace in the Middle East—there’s no cause too big. They have drive and energy; they have a treasure trove of wisdom, experience, and connections. Now, they want the knowledge and credentials to take their leadership to the next level.

The Civic Ventures survey shows that a majority of Americans between the ages of 50 and 70 want to benefit their communities by helping the poor, the elderly, and children, or by improving quality of life through the arts or the environment.

College campuses—once the source of boomers’ zeal for change—could be the launching pad to leadership, and to improving the state of the world. Advanced Leadership Schools should be oriented toward creating a life business plan with high social impact. For their “dissertations,” participants could, for example:

• Design a foundation.
• Create a new social enterprise or a business venture with a social purpose.
• Prepare a plan to take a nonprofit to the next level of effectiveness.
• Plan a run for public office, with positions on major social issues.
• Write a book that can initiate a national awareness campaign.
• Create plans to reshape a city by working on health, education, and jobs.

This kind of educational experience would reignite the passion of youth and marry it to the wisdom of experience.

Source: Rosabeth Moss Kanter, Ernest L. Arbuckle Professor at Harvard Business School.

Dr. Kanter’s vision resonates with me.  I am one of those 50-70 year olds wanting to make a difference, and going back to college to get the skills, make the connections and build the vision.  In two weeks I will be starting graduate school, earning an MA in the Management of Aging Services.  This program at the recently endowed Erickson School of Aging, UMBC, is designed to appeal to mature learners, and provides just the kind of Leadership Training Dr. Kanter advocates.

As stated on the website, the Erickson School seeks “individuals of great vision [who] recognize an opportunity that will help society… and maybe even advance it to the next level.” The MA program lasts 1 ½ years and is taught mainly on alternate weekends, so professional students can continue in their jobs while earning a degree.

The faculty includes Dr. Bill Thomas, founder of the Green House movement (see Blog #4 – “The Green House Model of Elder Care Makes an Institution a Home“). The program integrates the study of aging, business management and public policy and challenges students to think creatively and positively about aging with dignity and purpose.

Institutions of higher learning across the nation recognize the value of attracting vibrant adults eager to grow professionally.  Innovative programs exist in most states.

One of these is Maryland’s Golden ID Tuition Waiver Program. You are eligible if you are

• 60 years of age or older
• a legal resident of the State of Maryland
• retired (not engaged in gainful employment for more than 20 hours a week)

Along with tuition waiver, state schools offer use of the library and recreational facilities, discount parking and other benefits.  You may take courses toward a degree or for the joy of learning.  Each school in the system adds its own requirements. Classes are offered on a space available basis.  Check with the Office of Admissions at the school of your choice for details.

If you are not a resident of Maryland, research your state university system. They may have a program like the Golden ID.

Question: How do you plan to make a difference in the coming years?  What type of educational program would help you achieve that goal?  If it already exists, tell us about it. Click on the Comment link below.

Curing the High Cost of Medical Care

Sometimes I have to scratch my head in wonder at our current cultural bias.  I’m not talking about racism, or sexism or even ageism.  I’m referring to the prevailing cultural attitude that seeks cures for diseases, rather than prevent them in the first place.

Am I so outside the mainstream that I see things differently?  Well, yes.  So I’m going to give you my views from this other planet I inhabit, and maybe my distant perspective will inspire you to view things differently as well.

In an article on the website Money Smart Life entitled, “9 Ways to Lower Health Care Costs,” eight of the nine had to do with smart shopping for services.  Only one mentioned prevention.

Healthfinder.gov displays the tagline, “Take health care into your own hands.” The “Learn about Prevention” link looked promising, so I followed the instructions to “Just answer a few questions using the tool at the right. You’ll be taken to the healthfinder site, where you’ll find tips, tools and information matched to your situation.”

What did they consider health prevention for this 61-year-old female: 8 health tests, (for cancer, blood pressure, etc.), two vaccinations, one aspirin and three conversations to have with the doctor (for more medications).

With the first of the 7.2 million baby boomers turning 65 this year, the Center for Disease Control and Prevention putting average life expectancy at 77.9 years, and the rising tone of the debate about the future of Medicare and Medicaid and how our aging population will bankrupt our society, it’s time for a new pill.  The old ones just aren’t working.

The current debate is being waged within the long-standing paradigm of allowing disease to spread and then searching for cures.  This is a great policy for enriching a drug company, but it’s devastating for an individual and disastrous for a country.

If an ounce of prevention is worth a pound of cure, why isn’t our health care system oriented toward prevention? Prevention of disease is the solution to most of our health care problems, from high costs to side effects to declining quality of life.

As children we learn simple prevention behaviors, like,

• Cover your nose when you sneeze (with your elbow, not your hand).
• Wash your hands before you eat.
• Brush your teeth after.

And even though everyone knows you should “eat your vegetables,” how many of us get our five servings of fresh fruit and vegetables a day? (No, chocolate is NOT a vegetable.)

Prevention takes personal responsibility.  It takes forethought to give up a cheeseburger or cheesecake today for healthy arteries years from now.  It takes awareness to stop using drugs, pills, alcohol and tobacco and to deal instead with the emotions that cause the desire to self-medicate in the first place.  It takes discipline to get up off the couch and exercise instead of watching athletes on TV.  It takes self-love to say “no” to the needs of others and nurture ourselves before stress fells us.

In a culture inclined to live for today, from our national budget to our global environment, we may not be ready to embrace prevention. But a bankrupt country full of chronically ill adults is a bitter pill to swallow.

How do you plan to lower your medical costs? Leave your comments below.

Whither Social Security?

While researching for today’s blog I found this article.  It’s so good I decided to just reprint it.  ~ Joanna

By STEPHEN OHLEMACHER, Associated Press – Sun Dec 12, 2:43 pm ET

WASHINGTON – President Barack Obama’s plan to cut payroll taxes for a year would provide big savings for many workers, but makes Social Security advocates nervous that it could jeopardize the retirement program’s finances.

The plan is part of a package of tax cuts and extended unemployment benefits that Obama negotiated with Senate Republican leaders. It would cut workers’ share of Social Security taxes by nearly one-third for 2011. Workers making $50,000 in wages would get a $1,000 tax cut; those making $100,000 would get a $2,000 tax cut.

The government would borrow about $112 billion to make Social Security whole. Advocates and some lawmakers worry that relying on borrowed money to fund Social Security could eventually force it to compete with other federal programs for scarce dollars, leading to cuts.

[Related: Five things you need to know about Social Security]

Social Security taxes “ought to be held sacrosanct,” said Rep. Earl Pomeroy, D-N.D., chairman of the House Ways and Means subcommittee on Social Security.

“When you start to signal that the (Social Security) tax levels are negotiable, you end up in long-term trouble, I think, in terms of making absolutely certain that the entitlement funding streams are secure,” Pomeroy said.

Social Security is funded by a 6.2 percent payroll tax on the first $106,800 earned by a worker. The tax is matched by employers. The package negotiated by Obama would reduce the tax paid by workers to 4.2 percent for 2011. Employer rates would stay unchanged.

Obama administration officials say that a payroll tax cut is an efficient way to stimulate the economy by immediately increasing take home pay for about 155 million workers. The nonpartisan Congressional Budget Office agrees, and many business groups and Republicans support it.

“What came out of the compromise was the idea of the payroll tax holiday, which, frankly, a huge number of economists and other experts had been talking about over the last two years with a lot of support in both political parties,” said Larry Summers, Obama’s chief economic adviser.

The United Auto Workers endorsed the deal, saying, “Working families will likely spend this money in their local communities, creating jobs and stimulating overall growth.”

The payroll tax cut is part of a larger package negotiated by Obama and GOP lawmakers to extend a sweeping array of Bush era tax cuts that expire at the end of the month. Some Democratic lawmakers have balked at the plan, saying it is tilted too much in favor of the rich.

The payroll tax cut would provide relief to any worker earning a wage. It would replace Obama’s Making Work Pay tax credit, which has provided modest increases in most workers’ paychecks for the past two years.

The payroll tax credit would be more generous to individuals making more than $20,000 and married couples making more than $40,000. For those making less, the payroll tax cut would be less than the Making Work Pay credit.

Making Work Pay, which expires at the end of the year, gives workers a tax credit of 6.2 percent of their wages, but it is capped at $400 for individuals and $800 for couples. The credit is phased out for individuals making more than $75,000 and couples making more than $150,000.

A worker would have to make $20,000 in wages for the payroll tax cut to equal the $400 Making Work Pay tax credit; couples would have to make $40,000.

At the wealthy end of the pay scale, workers making $106,800 — the maximum amount of wages subject to Social Security taxes — would see their payroll taxes reduced by $2,136. That worker’s spouse could also get a payroll tax cut of up to $2,136, if he or she makes at least $106,800.

The proposal requires the Treasury Department to replenish Social Security with other government funds, which would have to be borrowed.

“The payroll tax cut has absolutely no effect on the solvency of Social Security,” said White House economic adviser Jason Furman.

Social Security has accumulated a $2.5 trillion trust fund since the 1980s. But the government has borrowed that money to pay for other programs. The Treasury Department has issued special bonds to Social Security, guaranteeing the money will be repaid, with interest.

As aging baby boomers start to retire and strain the system, advocates worry about future benefit cuts. This year, for the first time since the 1980s, Social Security will pay out more in benefits than it collects in payroll taxes. Without changes, Social Security’s trust funds will run out of money by 2037, according to the trustees who oversee the program.

To save money, the leaders of a bipartisan deficit commission recently proposed a gradual increase in the full retirement age, from 67 to 69, drawing opposition from groups representing older people.

“This 2 percent payroll tax cut is the beginning of the end of Social Security as we know it,” said the National Committee to Preserve Social Security and Medicare, which is led by former Rep. Barbara B. Kennelly, D-Conn. “Worker contributions have successfully funded the program for 75 years and that critical linkage between contributions and benefits is what keeps Social Security a self-funded program.”

Source: http://news.yahoo.com/s/ap/20101212/ap_on_bi_ge/us_payroll_tax_holiday

Join the discussion. Leave your comments on the future of Social Security.  Is a payroll tax holiday a good idea or are we starting down a slippery slope?

LOSS is inevitable, GRIEF is natural, HEALING is gradual

This is the first year I will celebrate important dates without Eddie. My birthday was a shock–no one to make it special for me.  Approaching Thanksgiving, my heart ached. With family and friends flung across the country, I had lost the community that shared special holidays together.

Thanksgiving turned out to be a wonderful event at my friend Jeanne Deignan-Kosmides, with three generations of Greek family, friends and neighbors delighting in traditional dishes as diverse as turkey with stuffing and baklava. I learned some great musician jokes, too.

Q: “What is the difference between a pizza and a drummer?”  A: “A pizza can feed a family of four.”

Little Girl: “Daddy, when I grow up I want to be a drummer.”  Father: “You can’t have it both ways.”

On Sunday after Thanksgiving I held my first ever linear party.  Beginning with a “Crafternoon,” friends gathered for an afternoon of sewing, jewelry making, knitting, etc. Guests from yoga class, On Purpose Networking, Bolton Street Synagogue and the Kindness Project engaged in lively chatter.  Minds moved as nimbly as fingers as we explored profound topics of deep interest to each of us.

The participants shifted for the next event, a group meditation, attended by friends from the Spiritual Empowerment Center.

They stayed for the next segment, a peasant potluck dinner of homemade vegetable soup, cornbread, salad and yam pie.  I invited neighbors at Courthouse Square to join us for dinner. Two more yoga friends bearing cheesy cauliflower also attended.

With two long tables spanning the distance from the dining room windows to the sofa, the room filled with warmth and good cheer. A satisfying, light dinner (after all that holiday stuffing), more stimulating conversation, friends from all my circles represented during the day, me at the head of the table taking it all in… I gloried in the scene.

I expect holidays to be challenging, but not depressing. I am making it a priority to honor old friendships and memories even as I create new traditions for the future.

Age brings with it the accelerated experience of loss, grief and healing.  Fortunately, I published a book on that topic in 2008.  It has been a great comfort to read the wisdom of others who have trod the path I am just beginning.

You can order “Loss is inevitable, Grief is natural, Healing is gradual”
by sending your name, address and a check for $16.00
(includes tax, postage and handling) to
Joanna Brandt, 806 Mockingbird Lane #202, Towson, MD 21286.
Expect one week for delivery, in plenty of time for holiday giving.

Note: Go back to the top to see the beautiful cover and read the comment for the Table of Contents.

How Safe Is DWO?

When time came for 80 year old Mrs. D. to renew her driver’s license, she asked her son Bob to drive her to the MVA.  How common is this?

“I only drive locally, to three places I know.  And I don’t drive at night anymore,” the regal woman with coiffed orange locks admits with a laugh. “But I still drive. It keeps me independent.”

Mrs. D. speaks for the 30 million drivers over 65, 15 percent of the total driving population.  Having a car in America means independence, freedom and mobility.

But are elderly drivers less safe than others? Recent studies show that while highway deaths are declining overall (a good thing), deaths among over-70 drivers have declined even more (even better).  The risk of elders driving is not to others, but to themselves, as older drivers are less likely to survive a crash.

“Older adults may make up the highest fatality rate, but that rate actually accounts for less than one percent of deaths for those ages 65 or older. Compare that to a whopping 33 percent of deaths for teenagers,” points out Dr. Bill Thomas in his blog.

December 6–10, 2010 is the American Occupational Therapy Association’s (AOTA) Older Driver Safety Awareness Week. Throughout the week, AOTA will bring attention to a different aspect of older driver safety:

• Monday, December 6: Family Conversations
• Tuesday, December 7: Screening/Evaluations
• Wednesday, December 8: Driving Equipment/Adaptations
• Thursday, December 9: Taking Changes in Stride
• Friday, December 10: Life After Driving

You can get details at their website, www.aota.org/Older-Driver/Awareness.aspx

If you are concerned about the wisdom of your driving, take this nifty self-test at www.aaafoundation.org/quizzes/index.cfm?button=driver55.  It’s fast and fun.

AARP sponsors a Driver Safety Program. Locate one near you at http://www.aarp.org/findacourse.  This program is also offered online. It covers

• How to minimize the effects of dangerous blind spots
• How to maintain the proper following distance behind another car
• The safest ways to change lanes and make turns at busy intersections
• Proper use of safety belts, air bags, anti-lock brakes, and new technologies used in cars
• Ways to monitor your own and others’ driving skills and capabilities
• The effects of medications on driving
• The importance of eliminating distractions, such as eating, smoking, and cell-phone use

I’m not going to list suggestions for safer driving here.  To me they seem like so much common sense. What struck me as I read website after website on how older drivers can remain safe is this: Older drivers are no different from any other drivers.  The same rules keep drivers safe at any age.

What’s DWO?  Driving While Old

Have a safe week.

Listen to Your Elders

You can go shopping next week on Black Friday and many people will.  But the day after Thanksgiving is also The National Day of Listening.

Telling their stories is especially important for elders.

“The need for an older [person] to tell and retell the stories of her life is no idle preoccupation with the past. It is a vital process of coming to terms with events and experiences in a way that can ultimately place them in an expanded frame of reference,” ~ Joan Borysenko, Ph.D. in A Woman’s Book of Life.

My mother surprised me when this need surfaced.  For my entire life Mom avoided revealing herself.  What made her tick remained largely a mystery. Then, a few years ago, she spontaneously asked, “What questions do you have for me?”  and announced, “I’ve been meaning to tell you about the time…”

Mom often doesn’t remember something I just told her, but scenes of her past live vividly and require expression.  If I cannot conjure a question, she is disappointed.  She expresses an urgency to bring the past forward and reveal it while she still can.

She tells the same stories over and over with great relish.  Her favorite is the time my dad tricked a Lothario into not going home with his mistress.  Mom laughs and laughs as she recounts that evening.  It’s fun for me to hear about her lighter side: gay, carefree and mischievous.

I’m looking for new questions to ask her.  I found help from StoryCorps, sponsors of The National Day of Listening, in their guide for conducting do-it-yourself interviews.  Here are some suggestions.

Create a List of Questions

Think about what you would like to learn from your partner, then make a list of 5-10 questions. Here are some questions that have led to great conversations:

• What are some of the most important lessons you have learned in life?
• What are you most proud of?
• What was the happiest moment of your life? The saddest?
• Who has been the biggest influence on your life? What lessons did they teach you?
• How would you like to be remembered?

Keep the Conversation Flowing

• Listen closely. Look your storyteller in the eyes. Smile. Stay engaged.
• Stick with the good stuff. Try to keep to the topics that move you. If the current topic isn’t what you want… gently steer the conversation in another direction.
• Ask emotional questions. Asking “How does this make you feel?” often elicits interesting responses. Don’t be afraid to ask.
• Respect your subject. If there is a topic that your interview partner doesn’t want to talk about, respect his or her wishes and move on.
• Take notes during the interview. Write down questions or stories you might want to return to later.
• Be curious and honest, and keep an open heart. Great things will happen.”

Great things have happened as Mom and I have swapped stories. I see the young vibrant woman who lived before I was born.  We have become closer and enjoy each other as peers.  I will miss her more now that I know her so much better.  I am grateful that there is so much more of her for me to miss.

This Thanksgiving I’m going to ask Mom some new questions about her life. Then I’m going to sit back and listen.

Resources:

www.storycorps.org

http://nationaldayoflistening.org

Five Wishes

The phone ringing at 2 a.m. warned me the end was near. “This is Dr. Singh from Good Samaritan Hospital,” said the message on my cell. “Please call as soon as possible.” I shook the sleep out of my head and called the number he gave me.

Dr. Singh answered, his voice filled with compassion. “Mr. Young is in critical condition. His white blood cell count and blood pressure are very low. We need to know if we should take heroic measures to keep him alive.  Are you his wife?”

“No,” I replied, truthfully.

“Does he have family?”

“He has a brother, a doctor in Kansas.  He hasn’t been actively involved.  I know the most about Eddie’s situation.  He does not want to be revived.”  For the next twenty minutes I begged Dr. Singh not to interfere, filling him with the details of my significant other’s year-long decline and oft-repeated wish that death would end his suffering.  I knew what Eddie wanted, but I did not have the legal authority to satisfy the hospital.

Dr. Singh patiently listened, said he would try to reach Dr. Young, and get back to me.

“Please, please, just let him die,” I prayed as I fell into a fitful sleep.

Every day families face difficult decisions concerning how their loved ones will be treated at the end of life.  Some families do not know the wishes of the dying person, layering guilt and confusion over an already traumatic situation.  Or, like me, they do know, but do not have the legal documents to act on the person’s behalf.

Hospitals, leery of lawsuits, will do everything they can to keep a patient alive, even though heroic measures such as feeding tubes, artificial respiration and CPR may do no more than prolong the dying process.

It’s convenient to avoid talking or thinking about a time when we cannot make our wishes known—death is so far off.  But do you have life insurance?  Having a living will is end-of-life insurance.  If you don’t have a living will, you want to know about Five Wishes, a product of Aging with Dignity. The following information is take from the website http://www.agingwithdignity.org.

“Aging with Dignity is a national non-profit organization with a mission to affirm and safeguard the human dignity of individuals as they age and to promote better care for those near the end of life. The life and work of Mother Teresa of Calcutta served as the inspirational foundation of Aging with Dignity… Her tender care and concern for all a person’s needs – medical, emotional and spiritual – served as the inspiration for Five Wishes, America’s most popular living will.

“Every adult has the right to make health care decisions in advance of a health crisis. They should be able to convey these decisions in legally valid documents that are easy to understand, allow people to put their wishes in their own words and include matters of the heart and soul.

“Five Wishes lets your family and doctors know:

• Who you want to make health care decisions for you when you can’t make them.
• The kind of medical treatment you want or don’t want.
• How comfortable you want to be.
• How you want people to treat you.
• What you want your loved ones to know.

“Five Wishes is changing the way America talks about and plans for care at the end of life. More than 14 million copies of Five Wishes are in circulation across the nation, distributed by more than 23,000 organizations. Five Wishes meets the legal requirements in 42 states and is useful in all 50.”

I heard from Dr. Singh again early the next morning.  He had not been able to contact Eddie’s brother.  I repeated my reasons for insisting that Eddie did not want intervention in his dying process. “We probably will not interfere,” Dr. Singh finally conceded.

“Does Eddie want me to be there?” I asked. “If he is near death, call me.”

I next heard from Dr. Singh at 11 that morning.  “I have some bad news,” he reported.  “Mr. Young died at 10:10 a.m.”

I breathed a sigh of relief.

###

You can order a copy of Five Wishes from www.agingwithdignity.org. Please do not put it off.

Have you had to make an end of life decision for a loved one?  What was your experience?

When Worlds Collide

Dorothy is an independent 91-year-old who plans to live to 100. She engages in life with gusto.  “I don’t have any aches and pains,” she laughs happily, “but I am starting to forget.  I still drive, though not at night,” she admits. “I might get lost.”

Dorothy is awesome.  She reared three children while moving around the country with her nuclear engineer husband.  He eventually retired and settled in Montana to manage a cattle ranch. She cared for her aging mother, taking her to the boardwalk in her wheelchair daily while working as a medical transcriptionist.

Husband and mother have passed on and Dorothy, single now, lives in a garden apartment surrounded by stuffed animals, bundles  of newspapers, stacks of storage containers and memories.

Dorothy and I met while walking our dogs. Recently, her dog died. I don’t think she felt sorry for herself for a minute, but I could see she was lonely.  I suggested she “baby sit” my dog Gabi.  “She’s such a good little dog,” Dorothy chuckled, stroking the Lhasa’s belly. “You’d let me take care of her?” she asked hopefully.

“Of course,” I smiled.

That’s how I entered Dorothy’s life and began to notice the fabric was fraying around the edges.

“My daughter is moving to Cleveland and wants me to move in with her,” she announced one day.  “I tried that before and it doesn’t work, so she suggested assisted living.” Here Dorothy wrinkled up her nose.  “When I was young I took a 4H group to entertain at a nursing home. Assisted living sounds like a nursing home to me. Besides I like it here. Moving to a state where I don’t know anybody…” she trailed off.

“What will happen when you are going to need more help?” I asked. “Your daughter doesn’t want to drive back and forth from Cleveland every weekend to take care of you.  That’s what I’ve seen daughters do.”

“Well, we’re going to Cleveland next week to look around,” she said with acceptance. “I’m starting to remind myself of my mother.”

####

Dorothy may be able to take care of herself for years, or she may not.  Her daughter wants her mother to move nearby while she is still independent and can make her own decisions. I have been in this situation.  Have you?  Where do the needs of the mother end and the daughter’s begin? What have you done, or would you do if you were in this situation?  Post a comment.

NOTE: Name and details have been changed to protect identity.