Friday, 30 December 2016

How Long we Tolerate  the  Parental Stubbornness ?
Soumya Nair

‘At this age we are a nuisance to others. They are doing their best.  Why can’t you behave nicely’, a gentle reminder from 82 year old Vasudevan to his fellow inmate in our care home.  76 year old Seethamma is wheel chair bound past 3 years and lives in our care facility. A retiree from the agricultural university as a professor made her think that others are all subservient to her whims and fancies. Her ‘arrogance’ has illuminated her personality into a person whom no one can no longer bear to be around. She has again managed to alienate everyone around her with her insults and insensitivity. She is nasty and uncooperative with the aids (who are wonderful) and complains, complains, complains about everyone, everything and blames everyone for even the air she breathes.

Many of our client’s grown up children who come for counseling complain about Parental stubbornness. Adult children are finding that father doesn’t always know best when it comes to his driving, diet, housing, caregiving, health, medication or other important issues. 

Meera Jagannathan, a 46-year-old program analyst currently living in Ocean, NJ, is thinking of writing a book on parental stubbornness. Her parents were living in an upscale area in Indiranagar with all the possible support systems. “What made them sell the house in Indiranagar is still a mystery. They never consulted with me or my sister before this crucial decision.  We  begged them to move near to another house which has ground floor rooms instead they moved into an apartment complex to the 2nd floor. They invested wrongly and now their finances also in a mess. My mother is wheel chair bound, due to arthritis past several years.  They refused to pay decent salaries to domestic helps so nobody stays with them more than one month’.

My parents’ life decisions have greatly impacted me and I am very resentful,” says Meera Jagannathan. “I love my mother, but I am at my wit’s end. My father somehow is a reasonable person but my mother’s decisions are supreme. I can’t even begin to tell you how many times my husband and I have suggested options to improve my parents’ quality of life and they have turned us down. I feel like we could open a senior care business like you or write a book, weighing the options because of all the programs, aid and other things we have looked into for them. My elderly mother is becoming mean, hateful and unreasonable. How can I deal with this?”

As a social gerontology consultant, past several years, Judith Parnes (NJ) concedes it as a knotty issue. But it is real and a growing concern, like Meera’s mother’s behavior and that of other older adults who insist on acting a certain way and, as a result, are labeled as stubborn personalities. Judy started learning how aging parents often respond to advice or help from their adult children by “insisting, resisting or persisting in their ways or opinions.”

"My mother is driving me crazy!" The oft-repeated phrase is uttered (or screamed) by caregivers everywhere who are caring for elderly parents.  As social gerontologists we come across many such harassed adult children detailing about their perils and struggles of dealing with the difficult behavior of their aged parents. Those of us who are caring for old parents are often bewildered by the crazy unrealistic attitude and decisions -- and by their seemingly stubborn refusal to follow any advice. We shake our heads over their obsession with the past, their caution, and the snail pace with which they make decisions and move through the world. As much as we love our parents, dealing with them can often be fraught with tension and frustrating, as we try to bridge a communications gap as yawning as any we've experienced with rebellious toddlers or teenagers. Most of us give-up after many attempts.

How to deal with them and their scripted predicament? Dodging is not a solution. We cannot allow the situations to snowball. Our Past experiences as practicing social gerontologists, taught us that there is no middle path, either we go with them or we enforce a new code of conduct in old age. Can we yield to their unrealistic demands, lest we allow them to harm themselves. 

Many old parents try doing things which they are not supposed to do. Ram Iyer is hyper active even in his 80’s and disregarding his infirmity he climbed up a small tree to prune it. It was his nemesis. Unfortunately his body did not comply with his mind. He felt giddy and suffered TBA. ‘Had he been listening to my mother, not to be adventurous in the later years, he could have avoided this fatality. This mishap has impacted our lives very badly’, a spasm of anger and pain contorted Lalitha’s face while explaining the struggle of coma care.     

As people age and their health diminish, their attitudes about life and their care often change drastically. This can cause your elderly loved ones to start exhibiting pretty bad behavior that may or may not be directed at you. Age and illness can intensify longstanding personality traits in some unpleasant ways: An irritable person may become enraged, an impatient person demanding and impossible to please. Unfortunately, the person taking care of the elderly parent is often the target.

If you are a caregiver for an elderly loved one, then you probably have faced the brunt of a few bad behavior days, but how far?  Universally accepted norm is to face it and to accommodate.  We have a different confronting approach, which may be unconventional. As the primary care giver, you need to express your displeasure and tell them directly that it is causing pain and uneasiness.  Make the parents understand the unpleasant behavior is causing heartburn and embarrassment to others and need to have control over it. It is sure that all these days you listened to them but make them understand it is time to have a role reversal. We suggest the adult children to be more stern and tough in their dealings with older parents, on the contrary, a docile approach can only exacerbate.

You are not stony hearted or uncaring. Indeed you are parenting the parent, so a little bit disciplining is obligatory.

Sunday, 18 December 2016

As long as there's a heartbeat, don’t loose hope.
                                                                                  Roshan Jacob
Sandra cannot control her emotions when she explained the past three months in the hospital as a bystander to her father who is in coma. Her father and mother met with a road accident on the way back from a vacation trip. It was a fatal accident and father sustained head injury and mother had multiple fractures.  Sandra and her sister, Fiona are lost and don’t know the way forward. No one has any clue for this conundrum. It was the doctors in the Rehab who suggested my name for the long term care consultation.

Riddled with uncertainty, a coma is one of the most frightening injuries, at least in part because it deprive you of the ability to communicate with your loved one in the coma. Loosing hope is nothing but natural in the long wait. But the good news is that people can and do survive comas.  Over the last 15 years in long term care with a specialization in coma management, we felt a strong need to fortify and bolster the family and friends morale, thereby providing the best chances of a wake-up from deep sleep.

Most family members find the hospital experience a "roller coaster ride through hell” especially in a situation like this. Hospital ICU is where bad things happen--people get very sick, or die. Making this more frightening is that doctors and nurses often speak in strange languages. For example, people don't have a bruise, they have a "hematoma"--which is exactly the same thing as a bruise. Doctors and nurses are very busy and may be impatient with family members who are not sure of what questions to ask. Doctors tend to give quick, short news with lots of medical terms. No wonder dealing with the hospital can be a very frustrating experience. It doesn't have to be this way but the reality is that no one really cares.

Treating a coma patient is like running a long race. It is like this that you don't sprint a 26-mile marathon. One may start out intensely, but have to pace yourself for the long race. Remember, head-injured patients go through some phases. If you understand them, you will be better able to pace yourself. So, I think it's important for family members to get educated about coma rehabilitation. You need to read as much as you can about coma.

This is a very tough time for family members. Family burn-out is the norm. Do you start getting anxious when you get close to the hospital? Do you avoid going to the hospital or feel guilty about these feelings? Don't be ashamed if you feel this way--everybody does. It is important to talk to others about your feelings. This is when you meet a long-term care specialist. He/she can help you to understand what's going on, and to make plans for the next phase called long term care. The long-term care specialists can plan for the discharge and the next phase of rehabilitation.

Now lets talk about what to do when a comatose person gets discharged from the hospital. Often this is a very big event for family members. Definitely a great occasion but the concerns are very many. Remember, it's just the beginning of a very difficult phase. The physical injuries (basically the bruises and broken bones) can heal very quickly. But waking up from a coma can take years. When someone goes home, many family members think, it will just be just a couple more months. In truth, it's usually a lot longer. Family with its inherent limitations cannot provide such care. So we need to put him in a proper long-term care (rehab) facility.

I wanted to tell the world, as long as there's a heartbeat, don’t give up on hope.  With this perspective, I strongly feel the comatose person expects a need for communication, support, care and company. It is important that we empower the friends and relatives of the comatose person with a slew of information in dealing with the care of the comatose person. Families who are going or have been through the experience of having a family member or friend in coma have many needs. Do not despair.


Wednesday, 7 December 2016

                                                               ROSHAN JACOB and SOUMYA NAIR

It was a chance meeting with Diwakar Kamat and he told me when I met him at a free medical camp recently:

‘… I lost both my parents 24 years ago and 6 years ago, at age 55, my wife left me for another man. It was more of a financial decision because I suffered losses in my business and my wife thought there is no point in sticking around with a man with liabilities. We had no children. I don’t have any siblings either; I’m an only child. Today, I’m a perfect orphan.’ Diwakar, sort of settled with the reality.

‘While I’ve always been pretty independent all these years, the complete lack of immediate family has left me at times scary in ways I never could have imagined. I cope by trying as hard as I can to rebuild a family-like structure with friends old and new, and to live in the moment whenever possible. But there’s no getting around the fact my life – and my perspective – is forever changed. The loneliness can be overwhelming and so difficult to express to well-meaning friends. My only hope is to work through it and hope the pain lessens over time. Today, I am old, alone and poor.’ Diwakar rues.   

Can’t we empathize or gloss over?

Being a social gerontologist, I sure can and felt bad.

The encounter with Diwakar made me privy to the growing trend of elder orphans.

Most of us hope that our family will step up and help out. But the reality is different. For an increasing number of seniors, that option isn’t there. Whether they’re estranged from family or have never married or had children, more and more people will find themselves alone as they age and their health declines.

By 2030, 2 million people are predicted to be over 65 without adult children, according to a 2014 study in UK. This represents a huge demographic trend across the world: approximately a quarter of people will get older without ever having had children. In our country, a large chunk of population goes through same anxiety and worry. It’s staggering that such a shift in society has been almost completely ignored in ageing debates. So why has this issue lacked debate?

As social gerontologists, we believe it is for a number of reasons. First, our society remains ageist and it holds good across nations. While sexism, racism and homophobia are deemed unacceptable, derogatory comments and assumptions about older adults pass by without remark. Infirm older adults are seen as a burden on society, lacking value or importance. There has been a stream of reports highlighting appalling treatment of particularly frail and vulnerable older people. Another crucial fact is that why blame others for your plight, when you yourself have no clue about your preparedness. So is it really a surprise that people fear ageing and worry about being ignored and badly treated? Lack of preparedness makes them more vulnerable.

A common answer we hear from people on the issue of ageing without children is: “Oh, I’ll just kill myself when I get to that stage” (that stage being old and frail). Is this practical?  How will you figure out the ‘that stage’? Though they disdain the prospect of being old and alone, at the back of their mind this question flashes. "How in the world will we take care of ourselves?". Obviously people are brushing aside the bigger aspect of planning, but it says a lot about how little faith people have of a good old age in this country that killing themselves seems like a better option.

We don’t believe that growing older without kids or a partner doesn't mean you're doomed. We're all at risk for becoming isolated and becoming elder orphans. Everybody has to prepare to live as independently as possible and adopt appropriate strategies. Few tips are listed below.

1.    Speak up
We advise everyone to discuss their options openly with friends – married and single, men and women – before making a firm decision. We discuss our psychological issues with professionals. We discuss our money strategies with financial experts, so why not talk openly to a social gerontologist about family and care concerns and what it means to going solo in old age. 
2. Act early.
Life is more complex, especially when you get old. Don't get to a situation when you're 60 and now you're having to scramble to catch up. That’s absolutely ridiculous knowing you are alone and without plans.
Still not convinced? 
Everybody wants some control in their life. If you don't plan, what you're choosing to do is cede that control to somebody else – and most likely to end up in a disastrous situation, scripted by a stranger.
3. Make a surrogate family.
Your social connections can help with practical health care needs, like driving you to the doctor when you're unable. But they also do something powerful: keep you alive, research suggests. Connections can also help ward off  depression and create a semblance of well being. The more social activities you have, the more friends, the more things you can do to keep your body and mind active – that's the best protection you have against depression and mental illness.
4. Appoint a proxy.
Who is your most trusted friend or relative? Over these years, it won’t be difficult to identify such a person who is your well-wisher whom you have absolute faith. This person is supposed to help you if you're in a time of crisis, and revisit that periodically over your life. Make sure that person knows the whole list of things somebody needs to know if they're going to help you. Before it’s too late, consider designating that person as your durable power of attorney for health care, or the person who makes health care decisions for you when you're no longer able.
5. Consider institutionalisation.
It is a very hard decision. But, again it is necessary and be open about it. Running a fully functional home is near to impossible at advancing years. Many a time, ageing in place is hard when it comes to a person who is alone and old. The need for skilled care which cannot be afforded by most people within the home environment may also be a consideration for institutionalisation. Again, the old person has reached a point either physically, mentally or even financially where institutionalization needs to be considered. Reasons for institutionalization may vary greatly but revolves around a single factor – the elderly needs care within a facility.

Tuesday, 6 December 2016

Are you worried about ageing alone and forlorn, and then early preparation helps!
                                                                             ROSHAN JACOB and SOUMYA NAIR

Are you worried about ageing and living alone? Here’s how to build a life of peace and happiness – and how to cope with being alone in old age – whether you’re 65 or 85.

Irony, what else? He looked so forlorn that Anand’s heart lurched because this is not the same Rao who Anand knew few years back. People who knew Mr. Rao earlier, cannot comprehend his present plight. Few years back, Rao used to serve 10000 meals as a corporate caterer. He was a big timer in the catering industry commanding respect and a much sought after person by corporates. Those days he had the habit of drinking occasionally, but the chaos in personal life drive him to become an addict. His wife eloped with his own nephew, which is sort of unthinkable and unheard. But life sometimes turns illogical, may be stranger than fiction. He comforts himself on the fact that while his hey days he was able to educate his son and daughter from the premier institutions and help them settle abroad. Children, influenced by their mother, never paid him back.

Anand brought him to us to look after him.  Rao’s twilight is on a heart-rending, pitiable situation: shattered hopes, no money in the kitty, failing health, no family or companion.  Amongst us, we have several Rao’s and Ganesan’s whom the community discount as ‘mismanaged lives’. How many of us are growing older alone? How many of us are concerned over ageing solo, with family members — if we have them at all — living at too great a distance to be of use, emotionally or logistically? Whether by choice or chance, the number of older folks living alone is increasing.

These days a high proportion of older people live alone and the numbers are growing – though we gloss over, it means we have looming social problems of epic proportions. Living alone has been defined as “pathological” by many researchers, associating it with social isolation, psychiatric disorder and antisocial behavior. In majority of older adults, all these aspects are true and worrisome.

Why do older people live alone?
Living alone comes about through several different pathways. People may never have had a spouse or partner; they may have had one but now they are gone, through dissolution of marriage, separation or death. Some older people live with others, but have separate activities and identities. These situations may have come about by choice, but some are unanticipated.

When older people in my social gerontology practice were asked why they continued to live alone, the predominant responses were “freedom, choice and control and independence”. Kamala Sivadasan, a widow for 14 years summed it up – “(living alone) allows me to do what I want, when I want, and how I want”. This does not sound like a pathological state!

Disadvantages of living alone
Living alone is a bit challenging when especially failing health and increasing disabilities mean that infirm elders need help from others. Reduced mobility, may make it harder for them to get out, as will cognitive impairment. This makes older people more counting on the family and friends, formal and informal services, reducing the choice and control they enjoyed when living alone, as well as possibly leading to isolation and loneliness.

A less obvious disadvantage is having the sole responsibility and burden of decision-making. Our interaction with many elders in the past taught us the fact that they had no-one to talk to face-to-face, especially when they had to make critical decisions. They also commented on people taking advantage of older people living alone – financial abuse by their family, tradesmen, mail and phone scams, requests for donations.

Having children is no guarantee of NOT being alone when you’re old
Family dysfunction is nothing new and it is pronounced and hurting in old age.  No matter how many children you have, there’s no guarantee they’ll want to assist and care you when you need them most. Mangalabai’s both sons live in US. Her elder son got estranged when he married a Russian girl. Hostility continued even after 32 years passed and the elder son never spoken or contacted her. Second son hasn’t talked to this 84 year mother in over 10 years, and I don’t think that’ll change before his mom dies. This mother didn’t do anything wrong or bad – she was a stubborn character, but she certainly doesn’t deserve to be cut out of her son’s and grandchildren’s lives! As a former bureaucrat’s wife, she is fortunate to have her decent family pension and imagine the plight without such cushioning.  Magalabai, who is now a full-blown Alzheimer’s patient and staying in our dementia care home is mercifully oblivious of her destitution.

And, even if your kids like you, there’s no guarantee they’ll live in the same city, state, country, or continent as you. Many of our families are scattered across continents. Family visits are becoming rare, considering the long distances and the hectic schedules.  Biological kids or not, there is no guarantee you won’t be alone in your old age. Many seniors and baby boomers are alone even though they have adult children, because their kids are living their own busy lives. Adult children do not necessarily mean that older people aren’t alone – their kids may be physically or emotionally unable or unwilling to be family.  So having a family is no guarantee for an ideal setting in old age, 

Create your own “family” and connect with people before it is too late
At 84, Mr. Daniel lives in an apartment complex. He’s a widower with no children and his infirm elder brother lives in another city, which is far away. But thanks to a strong support system, he won’t be alone as he ages and his health inevitably declines.
Being alone “doesn’t scare me because I know that I have friends,” Daniel said with conviction and faith. He is part of an active church group and always  engaged in their activities.

Love, connection, solidarity, and togetherness is what helps alleviate sad feelings of being alone when you’re old. It doesn’t matter whether or not you’re alone in your old age as long as you hold on to hope, faith, and optimism.  It is not imperative that you need kin to feel loved, same way it doesn’t matter you need biological children to feel connected, and you don’t need family to feel united.

Ganesan, 76, a retiree from the army isn’t as fortunate. His wife is deceased, leaving him to live by his only son’s house for the first time in his life.
Ganesan said his daughter in law has made it clear that she will not be his caregiver in his old age. She made it clear that he is unwelcome in his son’s house.
“She thought that was too much responsibility for her,” Ganesan unwillingly accepted his fate. “It’s just devastating and I ended up in this sub standard old age home.” He regrets the stay in the old age home.
Daniel’s and Ganesan’s, illustrate the opposite ends of a quandary facing many seniors: Who will take care of us in our frail, declining years?
Most of us hope that our family will step up and help out. But for an increasing number of seniors, that option isn’t there. Whether they’re estranged from family or have never married or had children, more and more people will find themselves alone as they age and their health declines.

My experiences as a social gerontologists tells me that having biological kids is probably no guarantee to ensure you’re not alone as you age! But customarily we bank on our children for old age security. Mostly they fail us. There are too many unknowns. What if your child is physically or chronically ill from birth onwards? What if you outlive your child? What if you get divorced, and your child prefers your spouse to you? Even if your son/daughter are willing to support but their spouses disapprove.

If you don’t want get disappointed in your twilight years, don’t wait till the advanced years where the society feels you are unfit to be in the company of others, and that is why middle age is the best time to start making friendships and building ties that will last long till your end. Instead of counting on kin to keep you company or take care of you during your twilight years, start making connections with people you wish were your family. You can choose your ‘new family’ from a vast and varied background like hobbies, clubs, churches, interests, communities, etc.  Non-family relationships can be all embracing and easier than family relationships, because they come without the baggage of the past.

The challenges of living longer and living alone can be formidable, but there are lots of creative solutions already helping people across the world. The most important mantra for coping with the fear of ageing alone is to prepare well in advance.  In old age, many of us are orphans or estranged from our family members but you can create surrogate families and better support systems in place.