Thoughts on Aging...

 

My perspective on aging has definitely changed since starting FW in a geriatric setting.  Thoughts about aging to me used to be a 50% scared of what changes aging would have in store for the future & the other 50% of my mind was I would just be really happy to have as many days on this planet as possible.  Like most people I would love to live a long, healthy, productive & fulfilling life.  After to being exposed to the different circumstances of age related changes & health related changes in a SNF things have changed.  Time obviously should never be taken for granted as it is apparent no one is immune from a life changing impairment. To see people who are impacted with health issues either rapidly of or slowly has really opened my eyes to the possibilities that come along with “getting older”.

This brings me to the second point of what has “the biggest impact on how one ages?”  In my opinion it would primarily have to be environment.  Ones environment has everything to do with cultural habits i.e. some people never go to the doctor for regular checkups, financial reasons, the resources available to them medically or otherwise are lacking.  To start with ones environment it would include diet & exercise.  Some people are raised to eat the food from the land that they work hard to raise like in rural communities others are raised with a Happy Meal & a Xbox game, while still others are raised with a diet passed done from generation to generation of very starchy & a lot of fried foods.  The habits that are ingrained in each of us from early on do last a lifetime, some good others not so good for the big picture of healthy living.  Also when it comes to generational habits some people never go to the doctor, never get immunizations, and never go to the dentist.  Alarming to most but to some people the doctor is a waste of hard earned money & if something isn’t obviously broke there is now apparent need to be fixed.

There are also some people that don’t have the financial ability to have regular checkups in their life that would go under preventative health measures.  In a story done by PBS it is reported that “44 MILLION Americans don’t have insurance & 38 MILLION have inadequate health insurance.”  That is almost 1/3 of Americans!  Holy cow that is alarming but it is the facts of life.  To find out more the link is posted here => http://www.pbs.org/healthcarecrisis/uninsured.html   No matter what the process or road each of us goes down the biggest picture of all is to hopefully, live well & BE HAPPY with the time we have.  It does no good to ponder today the possible ill happenings of tomorrow.  WE can do things different to attempt a healthy & long life its just a matter of changing up some not so great habits.

Age is just a number

I've always had my personal feelings on aging and getting older. At first I never thought I'd be 16 and able to drive. Then it was becoming 18 having "freedom." Then there was the time I never thought I'd live to see 21. And with each passing day and year, I realize my thoughts on aging were wrong. It's easy to judge age as a number when we are young because so much of what we can and can't do is based on a number. But now that I've become older and can look at my past and the future, I realize there is a lot more to aging than just a number.
Through watching my grandparents age I was able to learn a lot about them, life, and even myself. Since my parents are both only children, my siblings and I were spent a lot of time just ourselves with our grandparents. As I look back, I can realize how much I learned from each of them and how different their lives were growing up and how it shaped who they are. As I walk around Rose Manor I see these faces that vaguely remind me of the last years of my memory of my grandparents. I learned that my g'parents were a lot more than the wrinkles and gray hair on their heads. The walkers and wheelchairs didn't change what lives the lived being in the Navy or the Mayor or an English teacher for 40 years. I'm learning to look past these same wrinkles on the faces I see twice and week. I can't define these folks by their age, but by what the've accomplished. These folks have lived through a lot and can share their stories if only we listen. As an OTA, I'm with someone for 45 min. and in that time I've got goals to which I'm working towards. But in the cracks of a session I can really find out whom these people are and were.
One thing I do know is how much an environment can shape how someone is. On one hand, I had a grandmother who was frivolous with money and always seemed to have nice, new things. Growing up she was a beautiful lady who loved going to parties and dancing. Her husband was a Navy man who also became Mayor of a tiny town in Florida. She had a previous marriage to a genius  alcoholic in which my father was born. They were too busy with their parties and wild events that they let someone else raise him. Towards the very end, she always loved money, jewels, and hated dirt. I always remember having to tip-toe around her house to avoid even putting footprints on her white carpet. Then, their was the opposite. My mothers mother who managed to raise a girl, while being a teacher, all on her own. She sewed my mothers close and saved every dime she made. She used to wash tinfoil and plastic bags in her dishwasher (if she wasn't hand washing everything). Even to this day I get made fun of for still washing plastic ziploc bags in the dishwasher. This lady was raised on a farm during the depression and learned the value of money and 'stuff.' Her husband, a Navy man, passed while she was in the hospital giving birth to my mother. I still make sure to turn off every light behind me because I can see her shaking her finger at me if I leave it on.
When these two remarkable ladies passed, I learned a valuable lesson about the lives we lead. My dads mother passed away quietly without much noise. She had no friends come to the funeral, or letters and flowers being sent. She lived a sheltered life and never gave back to her community. Everything she did revolved around her. Her upbringing in Mass. was sheltered and not without. She always had food and 'things.' When my mothers mother passed, we received letter after letter. Friends who could make it showed up for the funeral. Letters from students from her 39 years of teaching filled our mailbox day after day. Every person saying how they loved her and how much she helped them. She was stricken in her final years with dementia and it was hard seeing this strong, independent lady become helpless. Even as she faded away, that person who saved all and gave all was there. She constantly was trying to clean the nursing home she was at and pick up the trash from inside and the weeds from outside.

With these two women as examples, I think environment plays a huge role in who we become and how we age. My grandmother with her life all about her faded fast once the disease got ahold of her. She didn't have much to live for other than telling us what to do for her. While my mother's mother slowly walked away from this world. She was always surrounded by people that loved her and always had something to do and look forward to.


There are many reasons a person ages the way they do. Stress, health, environment etc., all play a role. And while we can change our environment to an extent, it will always help define who we are. I imagine I'll be saying "yes ma'am and no sir" until the end of days. With a new generation beginning to fill the nursing homes, it is important that we get to know these individuals. They have lived fascinating lives that we can learn a lot from. We cannot judge these folks as a general age but we need to look at each as an individual. These baby boomers have been changing the way America functioned since they were born. First, we ran out of school rooms, and now, we are running out of social security and nursing home rooms. http://www.huffingtonpost.com/2012/04/02/aging-in-america-baby-boomers-arianna-huffington_n_1397686.html Each of these individuals will have a different past and different story to which they aged by. I look forward to working with this 'new' generation and the many things I will learn that will eventually help me age as well.

Aging

Aging still scares me a little but it is GOING to happen so I might as well get over it! I did get to tour the Senior Center in Durham which made me a little bit more excited to get older. It was so nice, with all kinds of art classes, exercise classes, social gatherings and a really nice gym!

I think that there are a lot of factors that contribute to how one ages.
For example:

My grandma at our flamingo party!

      
*Environment- My dad is a golf instructor who has worked outside most of his life. He never wore sunscreen or a hat. He LOOKS much older than he is, but since he stays so active, he feels younger than he is. (happy father’s day!)

*Health problems- My patient at Rose Manor has Lupus- Systemic lupus erythematosus (SLE) is a long-term autoimmune disorder that may affect the skin, joints, kidneys, brain, and other organs (PubMed Health). She is 80 years old and fatigues SO quickly. I think about my grandparents who are older than this and can still do a lot of activites! Her medical condition definitely seems to have worsened the aging process. More info about Lupus

*Psychology- My grandma has agoraphobia- Panic disorder with agoraphobia is an anxiety disorder in which a person has attacks of intense fear and anxiety. There is also a fear of being in places where it is hard to escape, or where help might not be available. Agoraphobia usually involves fear of crowds, bridges, or of being outside alone (PubMed Health). For years and years my grandma did not go out of the house. I think that the reason she was not diagnosed with anything until later in life was because 1) she rarely went to the doctor 2) the symptoms started many years ago before people were openly talking about these kinds of problems 3) it was a small town with few doctors and EVERYONE knew your business. This was so severe that she did not go to my parents wedding, her husband’s funeral, my brother’s graduation… This disorder led her to spending most of the day sitting around not staying active. More recently she was diagnosed and is doing great now, she goes out wherever and whenever! I think that if this would have gone undiagnosed, she would have “withered away” from inactivity. She is looks much stronger now and has a lot more energy. More info about agoraphobia


To sum up, I think that there are many different ways/rates people age…some are controllable (not wearing sunscreen, smoking) and some are not (diseases). For the people who GET to age normally: you should feel LUCKY!

                                                            

Mind vs Body: Round 1 (ding!)

 I have always been in a rush to grow up. To me, being 60 y/o, retired and a grandmother sounds better than being 30 y/o, working and having my own children. Whether that may be true or not the more time I spend around older adults the more I realize the importance of the mind vs the body.

I can only imagine how devastating it must be to THINK that you can be completely independent and someone is telling you "no you can't do that anymore." To be independent for so long and then slowly go back in reverse must be a very hard concept to grasp as you age. I remember when I used to work with cardiac rehab patients, we would give them exercise precautions when they first started in order to build their heart back up to it's normal strength. Some people wouldn't listen and they would try to do the same activity they have always done before their heart attack. They soon realized that their bodies just weren't the same and they would end up gasping for air or passing out because their heart was not strong enough to handle that much activity. It can be so difficult for someone to accept that their bodies are changing and they may not be able to do what they used to do.

I see the aging process as more psychological than anything else. The statement "you're only as old as you feel" is very true and can influence you either way. Some of my family members seem to "live up" their older age and they do as much activity as they have ever done. My family believes a lot in keeping their minds and their bodies active. If my 80 y/o grandmother had the mindset that she's 80 and she should take it easy and be careful with her body then she would probably be limited then ever because she's telling herself "no I can't." Instead she tells herself "whatever I can do I'm going to do it."

One day, I had a conversation about age to my pastors wife and she revealed to me that she is 57 y/o. I told her she looks great for her age (and she really does!) and she talked about staying active and taking vitamins but she also said it also has a lot to do with God. When you keep your mind on God, He gives people peace of mind and allows people not to stress or worry about anything but instead to live with joy in their hearts and mind. That made a lot of sense to me, whether someone believes in God or not the chemical reaction that stress creates in someones mind plays out into their lives and affects their outward appearance. Also those who stress a lot about things are probably continuously telling themselves "no" which will restrain anyone from moving forward and gaining progress in life.

I really believe that the mind is so powerful and it controls everything about a person. So it could either be played to your favor... or not. Each individual has a choice, the beauty about the mind is that it can be altered. When it comes to aging we can embrace the physical changes that come automatically and keep our minds focused on what we CAN still do. 

Don't Bring Me No Rocking Chair

 "When my bones are stiff and aching
 and my feet won't climb the stair,
 I will only ask one favor:
Don't bring me no rocking chair."    -On Aging, By Maya Angelou

     In talking to people I know who have surpassed the age of 80 the predominant theme to longevity has been staying active, both physically and mentally. Having the ability to continue on a forward path rather than living in the past has been a key in maintaining activity. According to a 96-yo woman I recently interviewed, aging is a natural process that will happen whether you want it to or not (if we are lucky.) She said by staying on the go "the years flowed into one another and I floated into old age." Four weeks ago she won 3rd prize in a talent contest for performing the Argentinian Tango with an instructor more than 30 years her junior. She did acknowledge it as a "modified tango" because her legs don't kick that high anymore.
     In a 2011 interview on AARP's "Inside E Street", Supreme Court Justice John Paul Stevens spoke about longevity and retirement. He tried to make his decision to leave the Supreme Court based on what he believed to be an ability to record decisions with clarity and  still make valuable contributions. He retired in 2010 at the age of 90, but thinks he may have "jumped the gun" with his departure.http://www.aarp.org/health/longevity/info-07-2011/video-john-paul-stevens-conversation-on-longevity.html
                         

     In the longest running study of its kind, the Harvard Study of Adult Development has followed the lives of more than 500 men since 1937; approximately half were students at the university, the other half men from the Boston area.  Dr. George Vaillant, a psychology professor at Harvard Medical School, has been its main custodian since the 1960s. In an article in The Atlantic Magazine he identified seven major factors that predict healthy aging. They are: coping mechanisms, education, stable marriage, not smoking, not abusing alcohol, exercise and weight management. According to his research, men who exhibited 5 or more of those traits at age 50 were likely to live to 80 as "happy-well" individuals, while those who had 3 or fewer were 3x more likely to perish before 80 and none of those who lived to 80 were deemed to be "happy-well". http://www.theatlantic.com/magazine/archive/2009/06/what-makes-us-happy/7439/

     As a result of the information above, I believe that looking forward in positive manner, challenging yourself mentally and physically and surrounding yourself with people you love are the main ingredients to aging well.

The good, the bad, and the ugly

Aging is a process that we can’t avoid.  The changes that take place are inevitable.  We can accept them optimistically or be discouraged by them.  Our attitudes about aging are often closely related to the physical and mental health that we experience.

I interviewed two women.  One was 87, and one was 92.  Their feelings about aging seemed to be significantly affected by the physical problems that they have.  Even though they’re no longer able to do all of the things that they used to do in terms of social activities and leisure activities, the most difficult aspect for them is not being as independent as they previously were.

One woman lives alone, and although she mostly lives independently, she no longer drives.  Someone takes her to the places where she needs to go, including to stores to do her shopping.  The other woman depends on someone to cook her meals and help her with ADLs such as toileting, bathing, and dressing.

These women still have a very good outlook, regardless of the challenges that they’ve had.  Both of them said that they lead very full lives and although, like most people, they do have some regrets, overall they’re satisfied with their lives.  Both of them have stayed as active as possible.  They’ve stayed connected to family and friends on a daily basis instead of isolating themselves, which could lead to depression.

When I first started to write this blog, I thought about a movie that I saw many years ago, “The Good, the Bad, and the Ugly,” starring Clint Eastwood.  I don’t remember much about the movie, but the title fits very well with this discussion question.  As we age, we have to take not only the good but also the bad and the ugly.

I thought about how Clint has aged since making that movie.  He’s 82 and continues to make movies.  I believe that his active lifestyle has helped him to age well.

There are good things about aging.  For example, most people don’t have to work as much, and they have more time to spend with family and friends.  Things about aging that could be considered bad include a variety of aches, pains, and health problems.  In terms of the ugly, many people aren’t happy about the wrinkles and the grey hair that they find when they look in the mirror.

In spite of the problems of aging, we can always hope that the good aspects will outweigh the bad and the ugly.

If you want to read more about Clint and the many activities in which he has participated, you can visit this link:

http://www.biography.com/people/clint-eastwood-9283502

Introductions...

                               

This last Thursday we met with our patients on the FW 1 site for Geriatrics.  It was a very interesting time to say the least.  First we go in and review the clients chart to be more aware of the conditions our client is ailed with.  My client suffered a R CVA not quite 90 days ago; is suffering from left neglect, confusion at times & can follow 2-3 step instructions to give a little idea of what was going on with them.  I go in to start a 45 minute session figuring a 15 minute warm up to get to introduce myself & get to know her a bit better.  It went well & I feel good about that.  I tried to use my best professional skills of therapeutic use of self to be confident, engaging & get to know the resident better as opposed to what I read in the charts.  Definitely I need to work on timing & the activities we are doing.  I gave her the choice of 3 activities to do & she wanted to do 2 of the 3.  We worked on designing a plate with 4 different brightly colored feathers & than she wanted to play rummy as her next activity.  (Left neglect was very apparent when decorating the round plate.  She pushed the plate in my direction after it was only half filled on primarily the right side.)  I’ve included below here a Youtube video demonstrating L neglect to get a better idea of how this actually appears in a person.  Once we got to playing rummy it was apparent also that it was going to take quite some time to finish the game & I didn’t want to leave the game unfinished.  The client was sometimes confused & acknowledged that some correction was needed.  The example is she tried to add a 9 to her set of 6’s.  It was interesting to see her figure through it & finally ask “is that right?”  She said a 9 can’t go upside down & that wouldn’t work.  The image I had of her from reading the chart looked similar from what I saw.  (I did see this client previously so I admit to an advantage there.  It did fill my heart to see all the progress she had made since the last time I saw her in person against the new information in the chart.)The favorite part of the session was when I asked if it would be ok if I came back next Tuesday and she smiled and said “yes.”  To me it was a sign that a semblance of rapport was built & we could go from there.  Onto next week!!! http://www.youtube.com/watch?v=ymKvS0XsM4w&feature=related

Left Arm Touch My Chin

This week I got to shadow an OT do a session on a patient who suffered from a right hemiplegia stroke several months ago. I noticed as I was observing how much patience it takes for the therapist during the session. I caught myself moving my body in the direction the patient needed to move in because the process was so slow and tedious. I realize you really have to keep a professional persona during everything because at times I'm sure it can feel like you're (the therapist) are not being heard when you tell the patient to do something and they don't do it right away.

 

Due to the fact that I was shadowing rather than actually doing the therapy session. I did not get to demonstrate any professional or clinical skills. One thing that I did do was try to ask questions and get clarification when the time was appropriate to make sure I was on track with the lingo of the session. I did observe the OT and another student who was shadowing try to scoot the patient back into her wheelchair. They were trying to grab underneath her legs and pick her up and scoot her back which was unsuccessful. The whole time I was thinking about how we do our transfers and how we learned how to scoot someone back in the chair. I asked if they have ever tried it the way we learned it and it seemed like she was unaware of what I was referring to, but they then approached her from the front and that worked. I am still curious if our method would have been successful or not or if the patient was too unstable to even try. There were a lot of things that the therapist did that I really liked; she had the patient say out loud what she wanted her to do to help reinforce movement from her arm that was spastic. For example, the patient had to touch her chin so the patient would say "left arm touch my chin."

One thing I need to work on is apply what I see to what I need to document in a SOAP note. I'm still having trouble processing the important parts of the information. I really tried during the session to keep a mental note about what I would record for my SOAP note by remembering that she did 2/5 trials of ROM flexion and extension. I'm not sure if I'm thinking accurately when it comes to trying to documenting what I see. I did learn that a lot of the things the OT observed I observed as well so I feel like I am doing better at analyzing therapy sessions like an OT.

My favorite part of the day was seeing the OT use different tactics to facilitate and decrease spasticity. She did a contract and relax method, each time she did that the patient was able to move her arm a little more in extension. Also having the patient use commands to move her arm was cool to learn too and seemed to work well.

Jumping In

                        "The time to hesitate is through." -The Doors
     Flexibility was the key to my week. The patient whose chart I reviewed was not mobile, so prior to seeing her it was determined I would work with someone else. I reviewed that patient's chart and located the room, but her bed was empty and her roommate didn't know where she was. After prompting from my instructor, I asked the people at the nursing station, who didn't know either. I looked throughout the facility and found a nurse who realized the patient was at a doctor's appointment. Strike one.
     Ms. G and I decided it would work to go back to my original patient for purposes of interview practice. When we arrived, she was already with another student and instructor. Strike two.
     I was assigned a third patient, quickly reviewed the therapy notes, and went to his room. The bed was empty. Strike three. I quickly began asking anyone who was possibly familiar with the patient, if they had an idea where he might be found. As I walked the halls an internal clock raced...tick, tick, tick: no patient, no therapy. No therapy, no paperwork. No paperwork...
     Luckily, as I rounded the corner to his room one last time, his family member wheeled him around the corner from the opposite direction.

I stopped him in the hall, introduced myself, appealed to his sense of altruism and asked if he would help me. He obliged by going to a triva game for residents. His hands were both in splints and he couldn't hold a pen, so we worked as a team with him answering the questions and me writing the answers. When he would question if one of his answers was right I would turn it around and say, "What do you think?" This seemed to make him more apt to answer with conviction and elaborate on some answers. He appears to have good cognitive abilities, with slight memory deficits for more recent trivia. I felt good about getting the opportunity to work with him in this way because we had a good rapport and I was able to make some general assessments even though I did not get to know him well.
     My time ran out quickly and I had to pass him off to one of the teachers for the remainder of the game so I could do my paperwork. Though my patient was not left unattended, I did not like the way I abruptly ended my session with him. I will definitely remember that for the future.
     This week I learned that I can roll with the punches, do not get too flustered by change, and I can jump right in an talk to a patient without hesitation.
      I didn't have many pre-formed opinions of my patient because I only reviewed his safety precautions and general goals. I wasn't affected by his physical appearance, however, which could have been shocking. He had fallen outside his home several days ago. No bones were broken, but because he was on blood thinners, the whole side of his face, both arms and both hands were completely purple. He didn't complain of much pain beyond his hands (which bore the brunt of the fall), so hopefully when I see him next week we can get him back on the road to full independence.

Failure is not the end

Going into our first day with clients in a one-on-one session, I was very nervous and very excited. I could not wait for today to begin, as well as I had no idea what I was getting myself into. It began on a complicated note because I didn't even know if my patient was still a patient at the geriatric unit we are currently having our field work at. The last OT note I saw was dated for 5/6/12 and today was 5/31/12. Fortunately, my client was there for me to attempt to work with.
Right away I struggled with being to authoritative, as I went into the room to find my client, I found him asleep in bed. I know I love my sleep, so I definitely didn't know what to do about my gentleman. Thankfully, my professors help by sending me back into the room to wake him up and begin working with him. However, I immediately ran into my second brick wall. The man refused to want to work with me. I was able to, thanks to the aide of my professor, to finally be stubborn enough to force the gentleman to talk to me for about 15 minutes. I feel as I did well in talking with the fellow and finding out things about his life and things he enjoyed doing. Of course, all the while he was lying down because he wanted nothing more than to sleep. Through this interaction, I learned that I myself need to be more stubborn about working with patients. If there asleep, wake them, if they say "no" keep trying. Even though I was unable to get the fellow up and moving around, we were able to have a little conversation. So will I can talk and carry a meaningful conversation, one that attempts to get at the focus of therapy, I need to jump right in and not doubt myself.
My favorite part was that I did fail in my attempts to work with this patient. However, I didn't allow it to affect me personally. I have learned that yes, some things will work great, and some things will fall flat on it's face. My attempts to work with this gentleman and to coax him into working with me, failed. I was able to also "attempt" to follow the OT as she attempted to work with this man as well. Again, I was proven that failure is part of the job as the man refused to work with her as well, even getting angry and stating, "I'm getting tired of this damn s**t." This proves to me that just because I failed, doesn't mean it's my fault.
His papers, history and reports, were very confusing and mixed up. Between OT, SLT, and PT, this man was completely independent to completely dependent. Some had him working on balance while sitting while others showed him mobile. It did say he would refuse meds and OT which gave me some information on what to expect as far as personality. While working with the OT, we were able to get him to walk, but that's it. He would not use his UB for ANYTHING. He even walked with his hands clenched behind his back so as not to use them.
I was surprised at how accepting I was at failing. I thought I would take it more personally as if it was my fault. But thanks to pervious fieldworks and professors I have learned that it's just part of the job and to accept it. Thankfully, I was able to do just that and was still able to learn from it as well. I can't wait for Tuesday to come so that I may try again, this time with a different patient!

2nd day!

My session with the patient was mostly talking to get to know her although, she did have to use the bathroom so I got to assess how she gets up/sits down and moves around with her walker. When I first walked came she was waiting for someone to come clean up some water on the floor in the bathroom. I thought that was great use of safety awareness and her visual skills must be pretty good! I had to use time management skills  to make sure I could find out as much information as possible with my patient before PT came, observe a PT session and write my note. I did not feel as comfortable talking to the patient with her family in the room. They kept answering for her and I did not know how to get them to let her answer. I continue to learn that I get way too anxious going into new situations. They usually are way less stressful than I imagine them to be and afterwards I think “that wasn’t that bad…why was I freaking out so much?”

My favorite part of the session was just talking to my patient. She is very sweet and reminds me of my grandma. Also, my patient’s family kept implying that because she is 88 she doesn’t like games, crafts, or activities…we will prove them wrong!

My patient looked about the same as I saw her on paper. I had seen patients at wakemed that had hip replacements so I kind of had a picture of what she would look like.  I was only really surprised by her age! I was expecting her to look much older, be more frail and not move around as well as she did…she looked really good for 88!