Category: Dementia

Growing Older, Not Bolder

There was an initial shock in providing psychological services to nursing homes.  It was less from the environment than the unexpected nature of the patient’s comments.  Bed-ridden patients warned staff to make travel arrangements as soon as possible; do not wait until they are too old and sick.  Most believed the whole notion of the “golden years” to be a cruel myth.  The very mention of “golden years” often forced an eye roll-even overt anger.  Story after story related a lifetime of work and sacrifice, with the view of saving money to effect a pleasant retirement.  The climax of so many stories was that a serious medical problem interrupted their plans.  Despite time and money, the retiree was not going beyond their front door.

Another unexpected facet of nursing home culture was the perception of children.  So many had come to believe that their offspring were downright traitors.  The truth is that responsible children are often required to liquidate their parent’s assets to pay for medical care.  This rarely sits well with the parents.  It is especially bothersome to those with dementia, since they are unable to understand the rationale for the actions of their children.  Often such demented patients only retain the emotionally charged aspects of the message, which is typically that their home was sold beneath them.  The logical conclusion, based on the few facts they retain, is that the children want to grab their money before they die.  This is rarely the case.  It is heartbreaking for the children to perform so much work for their parent, only to be regarded as little better than a criminal.

The brooding disappointment of extreme old age is not just relegated to the depressed individuals.  The loss of independence rarely sits well with Americans.  Many cultures appear to accept this as unavoidable, but Americans do not like the word “unavoidable.”  To work and plan for decades, only to be thwarted at the last moment, strikes Americans as horribly unfair.  The experience of other cultures is that life is often unfair, and this fact does not improve with age.  The American perspective on fairness is less prevalent with the older generations.  Two world wars and a depression impacted them in a way that is foreign to baby-boomers and beyond.  It is likely that the reaction of subsequent generations to nursing home placement will be increasingly negative.  While the WWII generation is less apt to gripe about fairness, they remain extremely adverse to depending on others.

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A change in perspective would also alleviate rancor between the patient and responsible children.  In order to liquidate assets to pay for medical care, children are  often forced to seek the paid assistance of consultants.  It would simply the process to have disinterested third parties perform this action, as part of the government benefit.  Strangely, even demented nursing home patients rarely become agitated over this process if performed by an attorney.  While the author has listened to thousands of complaints regarding the motives of the children, even one such complaint directed at an attorney cannot be recalled.  This should not be taken as an endorsement of attorneys, rather it speaks to the reduced agitation inherent in having a third party manage the assets.  Since most people cannot afford attorneys, it is necessary to make the service part of the Medicare or Medicaid benefit.

Growing older is not a right, but the benefit of a life well-lived.  Even though fifty percent of nursing home patients return home, the typical belief is that nursing homes only function as a place to die.  Often, the staff and doctors do not know who will improve, such that the patient is held in a state of suspense.  Placement within a nursing home may be the final hurdle; a concrete message that one’s life is limited and will soon be over.  How well we accept this message says not only a lot about ourselves, but also the culture that has influenced our values and expectations.  Still, all in all…it’s probably better to take that world cruise now.

Lifestyle and Mental Health

The following is a condensation of a literature review by Dr. Roger Walsh.  It appeared recently in the American Psychologist, a journal of the American Psychological Association.  Please review the suggested Therapeutic Lifestyle Changes (TLC).  These scientifically derived principles for living may benefit those suffering from cognitive and emotional impairments.  Fortunately, most of the article is less abstract than practical, and has the additional appeal of common sense.  Let us not forget that common sense is anything but common-to paraphrase Mark Twain.

Exercise is one of the most reviled words in the English language.  When most people feel like exercising, they lay down until the feeling passes.  Another paraphrase of Twain.  Joking aside, the influence of exercise on mild to moderate depression has been studied extensively.  Its therapeutic benefits compare favorably with medication and psychotherapy.  Higher intensity workouts appear to be more effective than lower intensity, but the exact guidelines for each level of intensity is unclear.  The effect of exercise on cognition is very good news.  For the young, it enhances academic performance.  For the elderly, it is an important aide to stroke recovery.  Exercise reduces geriatric memory loss, reduces the risk of Alzheimer’s Disease by 45%, and reduces the risk of other dementing conditions as well.  Exercise programs of one to three months offer significant cognitive benefits, but those lasting more than six months are more beneficial.  The benefits are even more significant if the exercise lasts more than thirty minutes, and combines both aerobic and strength training components.

Diet may be the second most reviled word in the English language.  It is often used to denote controlled starvation in popular literature, but it is not the meaning discussed in Dr. Walsh’s article.  It simply means one’s choice of food items.  Not surprisingly, the chemicals ingested into our body from food have a significant impact on cognitive and emotional health.  The best diet is miserably close to what our parents forced us to eat!  The diet should be rich in fruits and vegetables, contains some fish, and an eye should be kept on reducing calories. This sort of dietary intake appears to enhance cognitive and academic performance in children, and reduce the severity of mood and psychotic disorders in adults.  There is also a reduction in age-related cognitive decline, Alzheimer’s Disease and Parkinson’s Disease.
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The influence of supplements on lifestyle has skyrocketed in the last twenty years.  The supplements that appear to have a real benefit on cognition and/or mood are Vitamin D, S-adenosyl-methionine, folic acid and fish oil.  The benefit appears to be the greatest with fish oil, in relatively high doses of nearly one gram per day, which entails the ingestion of multiple capsules.  The fish oil may slow the clotting of blood, such that mixing with other anticoagulants is not suggested.  In older adults, the use of fish oil reduces cognitive decline, but is not effective as a treatment for Alzheimer’s Disease.  Fish oil may also reduce aggression in children and adults, prevent the onset of psychosis in high risk youth, and have a modest benefit for those suffering with schizophrenia and Huntington’s Disease.  Lastly, given its action as an anticoagulant, consider reducing or discontinuing it usage if unusual bruising appears, as well as bleeding from the nose or in the throat.  Do not forget that supplements and medications are to enhance and prolong our life.  Be quick to reduce or discontinue usage if it is having an overall negative affect.  It is easy to focus on the intended benefits, to the exclusion of significant detriments.

The next post will delve further into Dr. Walsh’s literature review.  The role of relationships, spirituality, nature and giving to others will be examined in terms of their effect on mental health.