Yesterday, I had the chance to interview N and M, two psychologists based in NY, with a specialization in rehabilitation in all ages and ingeropsychology. They have a lot of experience in nursing home as well as have done a lot of research on quality of life issues. We had more than an hour-long conversation which triggered many thoughts and reflections.
I’m going to summarize the main points that emerged from this conversation as I think it'd be very useful as we move to the ideation phase.
On the role of senses in making life better for elder people
N and M observed in their work in nursing homes a lot of people who like Henry were completely lethargic and unresponsive. Yet, at some points, they or others working in these homes noticed that these people seem to react. They wondered how they could get in contact with these people and put a project together with music and massage therapists who trained family members and nursing assistants. The results of the researchshows that hand massages (with some acupressure points) were able to calm and relax people who were very agitated and usually had to take medicine. In contrast, music arouses people who have become lethargic.
N told me a story of this old lady with advanced dementia who was completely unresponsive and who suddenly after a handmassage, took the hands of the nursing assistant trying to give her a hand massage.
My thoughts: there have been several inspirations on the importance of senses as we are aging. How can we create environments, experiences to trigger senses?
Becoming aware of your whole lifespan and be prepared for it
In their work as psychotherapists, N and M work with people who after some major problem (heart attack, amputation,stroke) are physically debilitated and emotionally distressed. (Of course, as N and M mentioned they have a "biased" view as people who come to you are people who are distressed. Yet these are important people to think of as ideate for this challenge). What they both noticed that people are not only upset about the situation (which in itself is not surprising and normal) but also are in shock – in shock that they got sick or that they might be dying. M noted that for whatever reason, “they don’t have a perspective on the life span as a whole”. He added that statistically many people are going to go through adversity, as they grew older. Yet, most people seem to think (and society probably “supports” these beliefs) that they will live forever and never get sick. Therefore, when confronted to adversity, they are unprepared; they don’t comprehend and are in shock.
M stressed that it is important “to be prepared, to have a sense of what itis to have a normal life within a normal life span” and be ready thatadversity is probable. Of course, this does not mean being constantly depressed about time passing and stopping doing all the things that you might not dolater on, but finding the right balance: being aware and accepting it while enjoying your life now.
N highlighted that the point is to figure outa way to make your life meaningful despite the inevitable changes.
My thoughts: this is a life long practice and a mindset but an important one. How do we change our attitudes toward life, death and aging? How do we find ways to recognize the importance of meaning in our life?
You can’t get over it: you are aging
Both M and N insisted that telling to people that you don’t have to be old is a false and harmful ideal. To them, it is important to know that things might happen to you, to accept it. In a way this is part of normal life. So let metry to make the best of it as well as I can.
N referred to a book by Becker, The Denial of Death, write in the mid-70’s. In this book, Becker argued that denying death was detrimental to living a natural life.
My thoughts: this is a society and cultural issue. Challenges like this one are part of the process.
Different theoretical models of aging: from all loss to losses and gains
N explained me that when she was in grad school, the theoretical model of aging was a model of loss: as you aged, you will lose your health, your partner, etc.
In recent years, this model has been challenged, researchers arguing that while there a lot of losses associated with aging, there are also gains, more subtle, meaningful yet: wisdom, depth of relationship, being a role model for younger people, etc.
They made an interesting comment that people who are 75-80 today are often pioneers, in the sense that they are the first ones in their family who lived so old and they don’t know how to behave,nor how to feel about being old.
Life changes us and that’s part of the beauty of it
M, who is in his late 60’s, told me that hehad dinner recently with a friend of high school. This friend was just the sameas when he knew him when he was 20. He was just the same mentally; he had not changed. Great many would say; M found it disturbing. Indeed, he argued that after 50 years of life, life has had no impact on him. Yet, one should be different, should have learnt something.
Aging as a complex, multi-faceted phenomenon
Aging as a bio-psycho- socio phenomenon,yet people tend to focus on the biological, and tend to forget the psychosocialpart of it, which is key.
Nursing homes: what can we do about them?
I asked N and M about their work innursing homes and how “bad they were”. Their answer they are pretty bad although those they work with are quite good overall.
They made a couple of important points:
· Non-for-profit are better than for-profit as infor-profit, they just try to make money out of it and cut costs wherever they can
· Nursing homes (even non-for-profit) are run asan “institution” and money is still important. They have a budget; limited resources and they focus on efficiency. M noted that the reference to “the nursing homes industry” was a signal in itself of what these were.
· He also mentioned the importance of administrators in the quality of service offered in these homes. N stressed how in nursing home she is working in, the change from a caring administrator to a less caring administrator had ripple effects on the experience of the people living and working there.
· N noted that in many cases, even small things,could help make the life of people in nursing homes so much better.
Listening to them, it reminded me of debates about public schools in NY and how the "good "public schools are schools with a committed principal and a very active and involved body of parents.I wondered if there was not a way to be inspired by successful public schools.M and N found the analogy interesting but they noted that there would be a lotof resistance when it came to having volunteers for example complementing staff: the administration would be able of liability issues and the Unions of paid staff not getting jobs.
Both insisted that this was a bigger issue that involved a lot of policy thinking.
N said that while residents complained that personnel don’t care and don’t come and help them when they need, personnel complain that residents keep bugging them while they are overwhelmed. There is one “villain” forgotten here: the government that is not providing resources and support for providing better care to elder people in nursing homes.
My thoughts: how can we create small changes at the local level while being aware (and potentially influencing) changes at the institutional and policy level?
Usin the toilet in a nursing home
To illustrate problems in nursing homes, Nand M gave me the example of using the toilets in nursing home. Nursing homes are afraid that people are going to fall and hurt themselves. Hence there is a tension between preventing people from falling vs. allowing them to go to the toilets. Often time, the first concern wins and people are taking away thefreedom of using the toilets on the claim that we don’t have the staff to help you.People have diapers put on and they are explicitly told to go in their diapers,even if they are not incontinent. This is very demeaning…
My thoughts: I could not help thinking of the feeling … and remembering how you tell one year old to hold itand not do in in their diapers and go on the pot. How many parents have clappedin front of a kid on the potty and 70 + years later, you are asked to just “doit in the diaper”.
Sorry for this very long post but as you can see this was a rich conversation!
Thanks N and M for sharing your experience and thoughts.
Note on the image: I thought about the visual part and remembered this image of a Black and White photo of a Chinese farmer in 1932. He seemed engaged, maybe smiling, and in a balancing position... All of these are feelings that emerged from my conversation with N and M.Note on the image: I thought about the visual part and remembered this image of a Black and White photo of a Chinese farmer in 1932. He seemed engaged, maybe smiling, and in a balancing position... All of these are feelings that emerged from my conversation with N and M.