Category / Stress

The Second Year After a Loved One’s Death

December 7, 2018

Moving forward while learning lessons about grief and living with the loss
By Jackson Rainer

For more than 25 years, I served as a psychology professor and researched grief and bereavement. I consulted and taught individuals, couples and families to meet the demands that chronic illness exacts, to build safety nets and resilience in the presence of stress, and to create space for the problems that the loss of a loved one brings. I was widely published, including a well-received book (Life After Loss:  Contemporary Grief Counseling and Therapy), and produced professional audio and video recordings on end-of-life and palliative care.

Throughout, I struggled with the truth that my wife lived with a genetic cancer syndrome causing chronic health concerns, including multiple presentations of vicious cancers over the course of 33 years. She was as well-educated as I; we met the challenges of her illness with state-of-the-art treatment and care, including two decades of participation with the National Institute of Health’s research projects related to Lynch Syndrome.

Then She Died

In the summer of 2016, she began to fail for no apparent reason. Her research teams and physicians had no explanation, nor could they offer any further course of treatment. As she lost energy and strength, I became more alarmed.

The principal investigator of her study told me, “Jack, she has outlived this disease longer than any of us ever expected. She is a medical marvel and there is nothing further that we have to give. It may be time to call in hospice.”

One of her gifted practitioners, a neurologist, suggested that her body “just had enough,” which he termed idiopathic metabolic myopathy, diagnosed when the body unexpectedly stops translating nutrients into chemical energy.

They were right. Her body was exhausted and said “No more!” She died over the course of five weeks as an in-patient in a local hospice, attended to by personal and loving friends with whom we had worked over the years.

The Process of Grief

I arrogantly thought I was ready for my wife’s death. But it took me no time to realize that the experiential nature of grief is very, very different from academic study or clinical facilitation of others through the process. My spouse, lover and favorite playmate was gone. For years, I had taught that the process of grief does not change a person as much as it reveals another part of the self. What I quickly learned is the understanding of myself as student, professor and scholar had little relevance to living as a 61-year-old man whose wife of 38 years had died.

There Are Benchmarks

Much has been written about the natural process of grief. Those in the presence of loss are taught to stay in motion, however that looks personally, and to talk about their feelings of the impact caused by the absence of the deceased. Much is made of the first year following the death of a loved one. There is such focus to understand and explain the loss and come to terms with voids created by the absence of the deceased.

Meeting the markers of the “firsts” such as holidays and birthdays are places for attention, coupled with the erroneous belief that getting over such hurdles will lead to an easier acceptance of the loss.

Little is discussed of the second year, when those who grieve begin to assume a new identity reflecting new circumstances of life. The second-year experiences surprise us in that our loved one will always be absent, yet somehow present. Personally, I became uncomfortably aware of the discrepancy between the world that is now and the world that was.

The Sadness of the Second Year

Sadness is more than an abstract feeling. It penetrates the source of a person’s being and emerges when there is nothing, nothing, nothing to do except live with the loss. It is about resignation and invites one to turn attention inward, to take stock and to adjust.

For me, sadness continues to fine tune my memory in order to tolerate the good, bad, and ugly of my marriage. Over time, sadness has become a bass note to the day-to-day music of my life.

Time has a different meaning. Like all of us, I rely on chronological and sequential time to stay in the rhythm of the day (I have a young friend who calls this “the default world”), but in this second year, I live in what I’ve learned is kairos time, when an hour can be forever, a year a moment. I don’t understand this very well, but trust that time as we typically know it is not real. It is neither an event nor a thing, but a human-mind interpretation of a sense.

For some strange reason, I believe that I can simultaneously grasp the past in memory, the present by attention and the future by expectation. This is the oddest experience and more than a little squirrely.  Life goes on in a linear way, so for many of us grieving the loss of a loved one, the second year forces us to face the harshness of loneliness because the social support of others fades.

What to Do?

In grief, it is never a good idea to curl up into a ball and wait for the will to live to pass away, as appealing as this thought may be. Better, acknowledge the loss and the truth that things do change.

Companionship counters loneliness. While I miss the companionship of my wife, I want the company of others. Such proximity allows an honoring of her spirit, rather than focusing on my intellect. The presence of others bears witness to the struggles of life.

Realize, with “real eyes,” as Rockland, Maine spiritual director Deirdre Felton says, “Doors are opening. Doors have closed. Take a breather and spend time with the new chrysalis that will hatch in its own time, with a new version of yourself, still who you are, but now somehow different.”

By Jackson Rainer

Jackson Rainer is a board certified clinical psychologist who practices psychotherapy with individuals and couples at the Care and Counseling Center, Atlanta.  He is a Professor Emeritus of Psychology with the University System of Georgia.




 

When You Are Shamed for Moving a Parent into a Care Center

November 30, 2018

How to cope when other relatives don't understand your decision

By Rachael Wonderlin

Beth came up to me, tears in her eyes.

“My cousins came into town,” she lamented. Normally this would not seem like a big deal, but Beth’s cousins were diametrically opposed to the idea of her moving her mother — their aunt — into a long-term dementia care community.

“They think I shouldn’t have moved Mom…they think I should have just kept taking care of her at home,” Beth sighed, dabbing at her eyes. “Maybe they’re right. Maybe I should just take Mom back home with me.”

More3 Surprising Things That Raise Your Dementia Risk

I would love to tell you that this was the first story of a family member getting shamed for moving their loved one into a care community, but it is not. I am the director of Memory Care at an assisted living community, and I’ve been working in dementia care for five years. I hear this kind of thing all the time.

Harsh Judgment

We’ve all heard of “shaming,” a phrase that seems to have picked up more popularity recently. We have seen everything from “body shaming” to “middle class shaming” in articles online. I’ve become very familiar with another type of shaming: shaming people for moving their loved ones into long-term care communities.

Although it would be very nice if everyone could take care of their aging loved ones at home forever, this is just not the case for many families. There are many factors involved: where the family lives, what jobs and responsibilities the family members have, what type of care the aging adult needs, financial concerns, nutrition and health concerns.

Most complicated are mental health concerns for the aging adult. Taking care of anyone at home is challenging. Taking care of an adult with dementia at home is particularly difficult. For example, if you are caring for someone with dementia in your three-story house, you cannot explain to that person that he or she should not attempt to use the stairs if they are home alone. People with dementia have trouble remembering facts, following directions, or understanding risks.

I cannot tell you how many people have had to move their loved ones with dementia into an assisted living or skilled nursing facility because of a major fall.

A Limited View

I explained all of this to Beth. I also reminded her that, no matter what her cousins from out of town had to say, they were not the ones caring for her mother. They didn’t come visit her every single day. They hadn’t been taking care of her at home for the past two years, watching her dementia progress and her falls become more frequent.

These cousins hadn’t retired early, just so they could help care for this aging woman in her own home. They weren’t taking time away from friends, other family, and vacations to bathe, clothe and feed this woman.

More3 Ways to Work From Home and Be a Caregiver, Too

Beth’s cousins had absolutely no idea what it was like to take care of another human being at home without much in the way of other help.

It’s Different With Kids

When you are raising children at home, there’s a community that rallies around you. You host big birthday parties, invite other parents and their children over to your house, plan nights out, call up babysitters, and, although you are probably exhausted, you feel joy in watching your children learn and grow.

From what I have seen, caring for an aging parent is the complete opposite. There is no sense of community. There is no joy in watching them grow and learn. There is only guilt, sadness and panic as you watch them descend deeper into physical and mental disability. There aren’t birthday parties, family gatherings and babysitters to lend you a hand.

A Common Theme

I offer a phone call service for caregivers who have questions about dementia care. While I always help these caregivers troubleshoot their dementia-related issues and provide advice about care communities or care at home, we always end up talking about guilt. All of these caregivers feel guilty, even the ones who are taking care of their loved ones at home.

They don’t give themselves time off, they don’t get paid, and they certainly don’t let themselves off the hook about mistakes they feel that they have made.

“Mom fell the other day,” one told me. “I left the room for 20 minutes to do her laundry, and I should have put the phone next to her — she could have called me for help! This was all my fault.”

‘Clean, State-of-the-Art’

Choosing to move a loved one into a care community is a personal decision. Care communities are also not the awful places we read about decades ago. “Putting someone in a home” does not carry the painful weight it used to carry.

Many of the care communities I’ve visited are clean, state-of-the-art buildings that offer social activities and outings. Sure, care communities are not perfect, but caring for people is an imperfect science. Choosing to move a loved one into assisted living or skilled nursing should not be a worst-case scenario. Sometimes it’s the best-case scenario for aging adults and their families.

My hope is that, as our population continues to age, our society will begin to understand the need for all types of care. The U.S. prides itself on being made up of many types of people and families. Yet we lack the progress and understanding that comes with accommodating different types of caregiving. You can care for a loved one from across the country and still be a fantastic caregiver. There is no shame in choosing the best possible care situation for you and your loved ones.

When You Are Shamed for Moving a Parent into a Care Center

November 16, 2018

How to cope when other realtives don't understand your decision

By Rachael Wonderlin

Beth came up to me, tears in her eyes.

“My cousins came into town,” she lamented. Normally this would not seem like a big deal, but Beth’s cousins were diametrically opposed to the idea of her moving her mother — their aunt — into a long-term dementia care community.

“They think I shouldn’t have moved Mom…they think I should have just kept taking care of her at home,” Beth sighed, dabbing at her eyes. “Maybe they’re right. Maybe I should just take Mom back home with me.”

More3 Surprising Things That Raise Your Dementia Risk

I would love to tell you that this was the first story of a family member getting shamed for moving their loved one into a care community, but it is not. I am the director of Memory Care at an assisted living community, and I’ve been working in dementia care for five years. I hear this kind of thing all the time.

Harsh Judgment

We’ve all heard of “shaming,” a phrase that seems to have picked up more popularity recently. We have seen everything from “body shaming” to “middle class shaming” in articles online. I’ve become very familiar with another type of shaming: shaming people for moving their loved ones into long-term care communities.

Although it would be very nice if everyone could take care of their aging loved ones at home forever, this is just not the case for many families. There are many factors involved: where the family lives, what jobs and responsibilities the family members have, what type of care the aging adult needs, financial concerns, nutrition and health concerns.

Most complicated are mental health concerns for the aging adult. Taking care of anyone at home is challenging. Taking care of an adult with dementia at home is particularly difficult. For example, if you are caring for someone with dementia in your three-story house, you cannot explain to that person that he or she should not attempt to use the stairs if they are home alone. People with dementia have trouble remembering facts, following directions, or understanding risks.

I cannot tell you how many people have had to move their loved ones with dementia into an assisted living or skilled nursing facility because of a major fall.

A Limited View

I explained all of this to Beth. I also reminded her that, no matter what her cousins from out of town had to say, they were not the ones caring for her mother. They didn’t come visit her every single day. They hadn’t been taking care of her at home for the past two years, watching her dementia progress and her falls become more frequent.

These cousins hadn’t retired early, just so they could help care for this aging woman in her own home. They weren’t taking time away from friends, other family, and vacations to bathe, clothe and feed this woman.

More3 Ways to Work From Home and Be a Caregiver, Too

Beth’s cousins had absolutely no idea what it was like to take care of another human being at home without much in the way of other help.

It’s Different With Kids

When you are raising children at home, there’s a community that rallies around you. You host big birthday parties, invite other parents and their children over to your house, plan nights out, call up babysitters, and, although you are probably exhausted, you feel joy in watching your children learn and grow.

From what I have seen, caring for an aging parent is the complete opposite. There is no sense of community. There is no joy in watching them grow and learn. There is only guilt, sadness and panic as you watch them descend deeper into physical and mental disability. There aren’t birthday parties, family gatherings and babysitters to lend you a hand.

A Common Theme

I offer a phone call service for caregivers who have questions about dementia care. While I always help these caregivers troubleshoot their dementia-related issues and provide advice about care communities or care at home, we always end up talking about guilt. All of these caregivers feel guilty, even the ones who are taking care of their loved ones at home.

They don’t give themselves time off, they don’t get paid, and they certainly don’t let themselves off the hook about mistakes they feel that they have made.

“Mom fell the other day,” one told me. “I left the room for 20 minutes to do her laundry, and I should have put the phone next to her — she could have called me for help! This was all my fault.”

‘Clean, State-of-the-Art’

Choosing to move a loved one into a care community is a personal decision. Care communities are also not the awful places we read about decades ago. “Putting someone in a home” does not carry the painful weight it used to carry.

Many of the care communities I’ve visited are clean, state-of-the-art buildings that offer social activities and outings. Sure, care communities are not perfect, but caring for people is an imperfect science. Choosing to move a loved one into assisted living or skilled nursing should not be a worst-case scenario. Sometimes it’s the best-case scenario for aging adults and their families.

My hope is that, as our population continues to age, our society will begin to understand the need for all types of care. The U.S. prides itself on being made up of many types of people and families. Yet we lack the progress and understanding that comes with accommodating different types of caregiving. You can care for a loved one from across the country and still be a fantastic caregiver. There is no shame in choosing the best possible care situation for you and your loved ones.

Anxiety Is Another Stage of Grief

November 13, 2018

A new book explains why so many grieving people also experience anxiety

By Claire Bidwell Smith

(This article is excerpted from Anxiety: The Missing Stage of Grief by Claire Bidwell Smith.)

What is anxiety? Where does it come from, and how can you gain control over it? And why is it so frequently spurred by the loss of a loved one? These are often the first questions I address when meeting with a new client, because understanding anxiety is the first step in learning how to overcome it. But understanding how it is tied to the loss of a loved one is even more important.

I have been a grief counselor for more than a decade. I’ve worked in both hospice and private practice. I’ve held the hands of many people in their final moments of life, including my own father. And I’ve worked with countless people who have struggled to cope in the wake of grief after losing someone they love.

Yet while I’ve written and spoken and worked with death in so many capacities, it is this one issue that I have encountered more than any other: anxiety following a loss.

It is understandable that death makes us anxious. We experience anxiety after a loss because losing someone we love thrusts us into a vulnerable place. Loss changes our day-to-day lives. It forces us to confront our mortality. And facing these fundamental human truths about life’s unpredictability can cause fear and anxiety to surface in profound and unexpected ways.

The first thing to know is that anxiety is more common than you may even realize. Recent studies show that 18 percent of the population of the United States, roughly 40 million people, have suffered from anxiety in the past year. Not only that, but it also seems to be on the uptick. Anxiety is leading far ahead of depression as the most common health issue on college campuses. And even higher than the national average, data from the National Institute of Mental Health shows that 38 percent of teenage girls and 26 percent of teenage boys have an anxiety disorder.

The good news is that anxiety is also highly treatable.

The Basics of Anxiety

So what exactly is anxiety? At its core, anxiety is fear of something, real or imagined. Specifically, anxiety comes from fear-based thoughts about things that are not necessarily occurring in the present moment or that may never occur. Anxiety is intrinsically linked to our physiology. You may have a physical pain or sensation that then generates a fear-based thought or memory. Or you may have a fear-based thought that generates a physical sensation.

Anxiety is a feeling of dread or foreboding. Anxiety can be as simple as a general sense of uneasiness, a feeling that all is not right, or it can be as specific as worrying that you have cancer or that the plane you are flying in will crash. Anxiety comes from the Latin word anxius, which means a state of agitation and distress. This distress is often felt on a deep level, in both the mind and the body. It is the sense of danger but not always a specific one that you can identify.

Anxiety is also a practical and useful emotion. We actually need anxiety in certain situations. Anxiety helps us prepare for an exam or think about all the things we might need to pack for a trip. Anxiety helps us stay alert and present to our well-being.

But when anxiety goes beyond these practicalities and we begin to worry all the time, it can become problematic. Worry is the mind’s expression of anxiety. When we find ourselves worrying incessantly about things beyond our control, that is when we need to take steps to calm the mind.

After the death of a loved one, many of the fears that run through your mind can be perceived as more of a threat than before the loss. You have witnessed someone die, and now that inevitability is more real than ever before in your life. So when you have a fear-based thought about that person’s death, or about your own mortality, or a worry about losing someone else, your body and mind are reacting stronger than before you experienced loss.

The intense amount of emotions that come with grief can also heighten your sense of fear and danger. Most people have never felt such strong emotions as they do when they lose someone they love. It can be very frightening to find yourself overwhelmed with sadness or anger, and this can lead to even more anxiety, even years after the loss.

Anxiety can also perpetuate itself. I can’t tell you how many clients confess that what they are most anxious about is experiencing more anxiety. Once they have had one panic attack or one truly anxious spell, they often find themselves worrying that they will have another. They worry that they will be at an event, at work, or on a plane and that they will suddenly get hit with a bout of anxiety and be unable to cope with it. Thus, the fear-based thoughts become simply about having more of them. It’s a tricky cycle, one that can last far beyond the actual loss, but it is one that can be brought under control.

What Does Anxiety Look Like?

Anxiety comes in many shapes and sizes. While it can look different for different people, it also has a lot of common symptoms, many I’m sure you’ll recognize. Above all, the most complicated aspect of anxiety is that it can manifest in very real physical symptoms. These symptoms, ranging from heart palpitations to nausea, can deceive you into thinking there is something physically wrong with you, when really there is a deeper, underlying, psychological issue that must be addressed in order to alleviate the physical symptoms.

Symptoms of Anxiety and Panic Attacks

  • Irregular heartbeat
  • Dizziness and lightheadedness
  • Shortness of breath
  • Choking sensations and nausea
  • Shaking and sweating
  • Fatigue and weakness
  • Chest pain and heartburn
  • Muscle spasms
  • Hot flashes or sudden chills
  • Tingling sensations in your extremities
  • A fear that you’re going crazy
  • A fear that you might die or be seriously ill

At its most basic, anxiety is the sense of fear. These fears can be real or imagined. Your fears can be about something in the past, the present, or the future.

In grief we experience fear for many reasons. We can feel afraid of how the future has changed now that an important person in our lives is gone. We can feel afraid of more loss, worrying that we might lose more loved ones. We can worry about our health, concerned that we may get sick or die soon, too. Some people also have residual feelings of trauma as a result of witnessing or hearing details of the death itself.

While many people experience anxiety for a variety of reasons — divorce, moving, illness, a genetic predisposition — the kind of anxiety that is brought on as result of losing someone close to you is its own breed. While grief anxiety maintains many of the same characteristics as generalized anxiety, there is an underlying situational cause. So when we can allow ourselves to grieve and truly explore the impact of the loss, we are better able to ease and manage the anxiety that accompanies it.

By Claire Bidwell Smith

Claire Bidwell Smith is a licensed therapist specializing in grief and the author of Anxiety: The Missing Stage of Grief and two previous books: The Rules of Inheritance: A Memoir and After This: When Life Is Over, Where Do We Go? She received her Master’s Degree in clinical psychology from Antioch University. She has a therapy practice in Los Angeles and works with clients around the globe.

The Best Way to Improve Brain Health

November 8, 2018

The first in a series of interviews with Longevity Innovators
By The Milken Institute Center for the Future of Aging

(Advances in science and public health are increasing longevity and enhancing the quality of life for people around the world. In a series of interviews with the Milken Institute Center for the Future of Aging, 14 visionaries will be revealing exciting trends and insights regarding healthy longevity, sharing their vision for a better future. The Longevity Innovators interviews highlight new discoveries in biomedical and psychosocial science, as well as strategies to promote prevention and wellness for older adults. This is the first in the series.)

Renowned neurosurgeon Dr. Keith Black (chair of the department of neurosurgery and director of the Maxine Dunitz Neurosurgical Institute at Cedars-Sinai Medical Center in Los Angeles) has pioneered advances in our understanding and treatment of brain cancers and complex neurological conditions. Black is also a research scientist studying targeted drug delivery, cancer stem cells and Alzheimer’s detection through retinal imaging, among many other areas. In an interview with the Milken Institute Center for the Future of Aging, Black talks about the importance of developing a test for early onset Alzheimer’s and his goal to inspire the next generation.

Dr. Keith Black

What is the most important thing that people should know about improving brain health?

People need to know how important lifestyle is to sustain health. Lifestyle, diet, exercise, moderating stress, making sure you get a good eight hours of sleep when you can, making sure you keep your brain engaged particularly in novel activities — all of these matter. You have to remember the brain is a living organism very much like a muscle — the more you use it, the stronger it becomes.

We need to treat our brains better. For example, try to avoid excessive alcohol and make sure that you screen yourself for diseases like diabetes and hypertension that can be devastating to the brain.

What will be the benefits of having a reliable test for early onset Alzheimer’s?

I think there’s a huge misconception that if you get Alzheimer’s or if you’re going to get Alzheimer’s, there’s nothing that you can do about it. And I think the science shows that that perception is incorrect.

We know two things now that address your question. The first is that Alzheimer’s starts about two decades before a person develops symptoms. During that period of 20 years, you’re losing brain cells, and you’re losing brain connectivity. If you can detect the disease at the very start, particularly before you lose enough brain cells to become symptomatic, we may have the ability to stop the process or at least slow it down and prevent an individual from becoming symptomatic.

If people are developing Alzheimer’s in their 50s and 60s, they are going to become symptomatic in their 70s and 80s. If you can slow the overall process and have people become symptomatic in their late 90s or 100s, you have the ability to essentially prevent the disease from being symptomatic in most of our lifetimes. That’s really the major reason to move towards early detection, because preventing brain loss is a lot easier than restoring brain cells once they’ve died.

The other reason people should be interested is that even though we don’t have a pill that can stop the progression, we know that Alzheimer’s also has a lifestyle component. The scientific evidence shows that lifestyle habits such as a Mediterranean diet, exercise, sleep, meditation and other types of mindfulness modify stress levels. We’re seeing that potentially even micronutrients like the omega-3 fish oils may be very important in slowing the progression of Alzheimer’s disease.

What’s your take on Pfizer ending research to find new drugs aimed at treating Alzheimer’s and Parkinson’s diseases? How do you think it will impact ongoing research?

I think a lot of the trials that have failed for Alzheimer’s disease, including the Pfizer trial, could’ve been better designed and better developed. I think we have a lot to learn from the failure of those trials.

For example, how do we get the drugs into the brain more effectively? How can we better select the right population of patients to treat? I think addressing those potential reasons for the failures of those drugs will lead to successful therapies and hopefully successful approvals.

By The Milken Institute Center for the Future of Aging

The Milken Institute Center for the Future of Aging aims to improve lives and strengthen societies by promoting healthy, productive and purposeful aging.

5 Retirement Pitfalls You’ll Want to Avoid

November 5, 2018

Advice from the author of 'The Retirement Dreammaker'
By Matthew Jackson

(The following article is adapted from The Retirement Dreammaker: Master the Art of Retirement Abundance by Matthew Jackson.)

I’ve interviewed more than 1,000 retirees over the years and have observed retirees defaulting to a retirement lifestyle lacking excitement, positive challenges, contribution in significant ways, personal growth, and, ultimately, fulfillment. Below are five retirement pitfalls I’ve witnessed. I believe that those who understand the circumstances, situations and events they may encounter in retirement have a better chance of avoiding the snags and of feeling fulfilled in the third chapter of their life.

Let’s unpack each, so you can identify whether you are experiencing any of these thought patterns, and start on a path to self-correction.

1. Lack Of Money

There are few things that frustrate me more professionally than watching good people get paralyzed by the feeling of not having enough. It’s easy to get caught up in the idea that we don’t have enough when other people’s abundance is constantly shoved in our face. 
Rather than looking inward for personal satisfaction and happiness, we are constantly and subconsciously told we must measure our happiness in terms of our possessions or the events that take place in our lives.

No matter how much money you believe you have or will make, if you are spending more than you are earning, you may very well find yourself with this retirement pitfall. Being content with where you are and living within your means is both empowering and freeing. Don’t be locked in a cage because of a lack of money.


2. Lack Of Permission

Feeling like you lack financial resources leads to the belief that you lack permission to follow your passions and live your life with confidence.

A couple recently came to my office feeling frustrated. They told me they had found their dream retirement home, a few miles from their current home. When they were done explaining the details of the property and all they could do with it, I told them I couldn’t wait to see it. That’s when the tone of the meeting changed. With a little embarrassment, humility and wonder in their voices, they told me they didn’t know if they could afford the extra cost of purchasing the property.

I watched their bodies and faces physically tighten as they explained their concerns. No one had given them the financial permission and the confidence they needed to believe they could live this retirement dream. We all experience these insecurities.

This couple had come to get my permission that their retirement plan could handle the extra expense of buying their dream property. As we ran the hypothetical stress test models, I could see that they would be able to handle it. I’ll never forget the day they came into my office to review the results. They walked in looking serious and sat very straight in the chairs. It was if a weight had been lifted from their shoulders. The tightness in their lips and chests disappeared instantly. My permission was met with a simultaneous sigh of relief and smiles on their faces.

I often wonder how many people don’t fully live a life true to their dreams because they haven’t heard a simple word of permission or encouragement to help them do so.

3. Isolation

I’m sure there have been times in your life, sitting at your work desk, that all you can think about is getting away from it all. It’s healthy to have a little isolation. Being isolated helps us to decompress, rejuvenate our physical and mental energy and to gain the mental clarity we need to solve problems we are experiencing. However, extended isolation with little social interaction has been well documented to increase the risk of cardiovascular problems, rheumatoid arthritis, osteoporosis, some forms of cancer, depression and memory loss.

Isolated individuals are up to 50 percent more likely to develop cognitive decline. They are less likely to exercise, eat right, and develop hobbies. Compared to people who have regular social interactions, isolated individuals are more likely to need long-term health care and to be victims of elder abuse.

Many retirees fall into isolation by no fault of their own. Here’s a list of circumstances to be aware of that can cause isolation.

  • Financial changes in retirement
  • Friends moving away
  • Getting stuck in old daily habits
  • Loss of optimism about the future
  • Hearing loss
  • Loss of mobility caused by health complications
  • Grief resulting from loss of a spouse or close friend
  • Physical and emotional pain
  • Decreased sense of personal safety
  • Problems with memory recall

I highly doubt that people ever anticipate how deeply isolation can affect their life in retirement. It’s my hope that your new awareness of the negative effects of isolation helps you to avoid it in any shape or form.

4. Waiting For Milestones

Milestones are the measuring stick we use to analyze our progress in life, compare ourselves to others and fit into the construct of the life we believe we should be living at the time we are living it.

From the time we are infants we hear statements like: 
When you’re old enough you can…
When you graduate high school you can… When you go to university you are a…. 
When you get married…
When you buy your first house… When you have your first child… When you have your second child… When you are xxx years old…

I can see how easy it is to measure life in terms of milestones, given the way we’ve been taught to get past them or to want to fulfill what others expect of us.

Milestones are an important part of human growth and development because they do give us feedback if we are on track, behind, or need help with our own growth and development.

A few examples of retirement milestones are:

  • Age 59 1⁄2: This is the first time you can take distributions from an Individual Retirement Account in your name without a 10 percent early withdraw penalty.
  • Age 62: This is the age we can take our first elected Social Security payment.
  • Age 65: This is the age you are eligible to enroll in Medicare health plans.
  • Age 66 to 67: This is the Full Retirement Age for Social Security, when you they may be able to receive your check with no reductions. If you were born between 1943 and 1954, your full Social Security retirement age is 66. If you were born in 1960 or later, it’s 67. For individuals born between 1955 and 1959, your full Social Security retirement age is somewhere between 66 and 67.
  • Age 70: This is the age you are eligible for your maximum Social Security benefit. If you’ve delayed collecting Social Security until this age, you have been enjoying the maximum 8 percent increase in your check since the time you elected to suspend payments (elected at ages 66 to 67).
  • Age 70 1⁄2: This is the age that you are required to take Minimum Distributions (RMDs) from your tax-deferred retirement accounts. The penalty for failure to take your RMD at the correct time is 50 percent of the RMD amount. You don’t want to miss this milestone!

So these milestones seem pretty positive in our lives. How can they hurt or prevent a person from having the most fulfillment in retirement? Quite simply, they can be the reason we put off doing important things.

Here are a few examples of negative milestones in retirement:

Children’s Milestones –Have you ever heard someone say, or thought to yourself, “When my child finally does “X,” we are all going to take a family trip. “X” can be a move, a job promotion, a wedding, a divorce, the birth of a grandchild, a work promotion or an advanced degree. But what if Johnny isn’t motivated to accomplish “X” or just can’t quite get it? You’ll never take that trip. What would be more important to you, making family memories on a vacation or waiting for Johnny to accomplish something you don’t have control of? Trust me…it’s the memories and connection that are much more important in the long run.

Personal Health Milestones – I believe it’s very important for all of us to have the courage to face the reality of our own good and poor health. Doing so can help us to make important decisions about delayed gratification of experiences, events and opportunities.

If you have heard a person you care about say he’s waiting for his or his spouse’s health to improve before they visit a place they’ve wanted to go, please encourage them not to wait. And if you’re waiting for your health to improve, don’t put off the trip.

Even though a health challenge may keep you from physically doing all you want, do whatever you can. It’s more important you do it now rather than wait for your health to be perfect. It may never be!

5. I Have Nothing Of Value To Contribute. I’m Not Relevant

Feelings of inadequacy and low self-esteem affect many retirees. In a time when twentysomethings have hundreds or thousands of followers and “friends” on Twitter, Snapchat, YouTube and Facebook, how can retirees not feel left behind in some ways? How can they find relevance in the modern age?

We all know that people don’t suddenly lose the talent and experience gained over a lifetime with passing of a birthday. But, somehow we are expected to believe that the world has outpaced our knowledge and experience. We’re told through media channels that the “new” is what is relevant. Experience is irrelevant.

The prospect of having to reinvent and learn new skills is frustrating for many people because even if they get more training and education, they believe there will still be a mark against them on their application… age.

This spills over into retirement. Imagine your psyche if you were downsized because of age, just prior to retirement. Would you feel as if the skill set you sharpened for 30+ working years meant anything? Would you have a great sense of relevance in the world?

The truth is that retirees have more value than they think. Just because it doesn’t fit into the traditional construct of how value is measured doesn’t mean it doesn’t matter.

Finding new value in your experience will require a shift in thinking.

By Matthew Jackson

Matthew Jackson is author of The Retirement Dreammaker: Mastering the Art of Retirement Abundance.  He is also an investment adviser representative of Royal Fund Management.

Ways to Talk With a Parent About Signs of Dementia

November 1, 2018

Tips from the Alzheimer's Association for Alzheimer’s & Brain Awareness month

By Emily Gurnon

Michele Foss refers to it as The Great Bacon Incident.

She had gotten a call at her Baltimore home from her mother; both of Foss’s parents still lived in her hometown of Eagan, Minn., just outside of St. Paul.

Her father, Darrell Foss, was frying bacon for the two of them. When he was finished, he drained the grease. But instead of pouring it into an old glass jar as he typically would, he drained it onto the kitchen counter.

“Then when my mom asked him about it, he said, ‘That’s what we do,’” Foss said. “So that was really the trigger of [deciding] hey, we need to talk about this.”

That was in 2015. There had been other indications that her father, now 75, was having cognitive problems, Foss said. Some years earlier, the expert handyman and retired CPA began having trouble figuring his way through fix-it projects.

After the family talked about the need to get him tested, he was diagnosed with mild cognitive impairment, which increases his risk of developing Alzheimer’s disease or another type of dementia.

Having the Conversation About Dementia

It’s hard for adult children to watch parents decline in health as they age. It is even harder, for most of us, to talk with them about the changes we see. When the subject is something as frightening and sensitive as dementia, it can seem almost impossible.

“I think people are worried about hurting a family relationship or hurting someone’s feelings or upsetting people that they care about,” said Ruth Drew, director of family and information services at the Alzheimer’s Association.

But making the decision to broach the subject can help everyone — the parent and other loved ones — because it can lead to a diagnosis, Drew said.

“When you know what you’re dealing with upfront, then you can plan,” she said. “The person [with dementia] can have a voice in what happens next.”

For example, your parent might say: ‘If at some point down the road I am not able to take care of myself, here is what I would want,’ Drew said. “That planning is able to give some comfort and also reduce fear of the unknown,” she added. The alternative — waiting until there is a crisis — makes choices very limited, Drew noted.

More Reasons to Talk

An early diagnosis can lead to better medical treatment, the Alzheimer’s Association says. Even though there is no cure for Alzheimer’s and no drugs to slow the disease, some medications may help with symptoms. And lifestyle changes, like better diet and more exercise, can potentially help preserve brain function.

Your parent may also elect to participate in clinical trials for Alzheimer’s.

Another important reason to get your parent tested if you suspect dementia: You might be wrong.

Other illnesses and conditions can cause dementia-like symptoms that are potentially treatable. They include: Lyme disease; metabolic or endocrine problems; certain medications, including anticholinergics like Benadryl; autoimmune disorders such as Hashimoto’s thyroiditis and late-stage syphilis.

“You always want to find out what you’re dealing with… rather than just assume, well, this person is of a certain age and so they probably have Alzheimer’s,” Drew said.

New Survey Describes Reluctance

The Alzheimer’s Association released results of a new two-question survey May 31, in advance of Alzheimer’s & Brain Awareness Month in June, on difficulties family members have in talking about the disease. The responses are concerning.

Almost 30 percent of the approximately 1,000 adult respondents said they would not talk to a relative about troubling signs of dementia, despite their worries.

A majority said they would be concerned about “offending” a family member (76 percent) or “ruining [their] relationship” with that person (69 percent). And 38 percent said they would wait to talk to their loved one until symptoms worsened.

The online survey was taken last month.

Pam Montana, 63, said in a statement that getting diagnosed early was vital for her.

“It is important for me to face this disease and share my story while I’m able,” said Montana, of Danville, Calif., who speaks publicly as an Alzheimer’s Association early stage adviser.  “That leads to an enormous sense of accomplishment, even with this extremely difficult diagnosis. I want to tell these stories and let others know they are not alone.”

She also wants to demonstrate that having Alzheimer’s does not mean an immediate end to life.

How to Have the Conversation

If you are not sure whether your loved one may have dementia, check these 10 warning signs.

If you remain concerned, the Alzheimer’s Association offers six tips for talking with a loved one.

They include:

  • Have the talk as early in the disease stage as possible
  • Think about who is best to approach your loved one
  • Practice how you will start the conversation
  • Offer support and companionship
  • Anticipate that your loved one may deny the problem
  • Know that the conversation may not go the way you expect

“It’s a very, very hard conversation to have,” Michele Foss said. “You have to come in with a plan.  Because if you just say ‘you have cognitive issues’ and don’t have any plans forward, you don’t take action on it.

“To have a diagnosis means you can make an action plan and to move forward — and the earlier the better,” she said.

Emily Gurnon is Senior Content Editor covering health and caregiving for Next Avenue. She previously spent 20 years as a newspaper reporter in the San Francisco Bay Area and St. Paul. Write to her at egurnon@nextavenue.org.@EmilyGurnon

How to Have Difficult Conversations With Your Aging Parents

October 26, 2018

Follow tips from a new book on starting a conversation

By Catherine Hodder
September 21, 2018

(This article is an excerpt from Estate Planning for the Sandwich Generation: How to Help Your Parents and Protect Your Kids by Catherine Hodder.)

An important part of caring for your aging parents is understanding their situation and knowing what they want. If you don’t know, then it is up to you to figure it out.

Having open and frank discussions with your parents help avoid the stress and uncertainty about the future. It is a good idea to talk to parents about their wishes now instead of when they become much older or infirm. These talks will help them plan for future life events, resolve any conflicts within the family, and take the decision‐making burden off of you.

There are five essential conversations to have with your parents:

The Financial Talk – Find out about their financial situation. Do they have enough to live on and enough for the future? Do they have a durable power of attorney naming someone to handle their financial decisions if they are unable to? Do they have a will?

The Health Care Talk – What medical issues do they have? What medications do they take? Do they have a health care power of attorney appointing someone to make medical decisions if they are incapacitated?

The Aging Talk – What happens if they need significant care? Do they plan to age-in-place at home? What senior living options should they consider?

The EndofLife Talk – What are their wishes when they have a terminal or end-stage illness? Do they have advance medical directives or a living will?

The Family Legacy Talk – What do they want you to remember about them? What are the family stories, treasured recipes, and heirlooms to pass to future generations?

Before you start these talks, keep in mind the following to make the conversations easier and more productive.

Be Patient

Talking with your parents about their future will not be a one‐time conversation but an on‐going process. You must be patient and willing to wait until your parents feel comfortable. They will need to be “ready” to talk with you or to make certain decisions about their future. The hardest part will be for them to admit they need help and that you will be taking on more responsibility for them. Understand they still see you as their child who they should be helping, not the other way around. Try to feel out the right times to talk about healthcare concerns and when to talk about finances. Depending on your parents’ personalities, one may be an easier conversation than the other.

Be Transparent With Other Family Members

While it is tempting to manage all information about your parents and keep it to yourself, you may be perceived by other siblings as too secretive, controlling, or influential. Try to include siblings in conversations or at least give them updates on what is transpiring so there are no unpleasant surprises.

Most siblings will be happy for you to handle things as long as you keep them in the loop. Difficult siblings who have contrary opinions can be extremely challenging. But if you give them consistent updates, you can take some of the drama away from them. They can’t accuse you of hiding something or going behind their back on some matter. Of course, if you have exceptionally difficult family members, realize that you can’t please everyone all of the time, and focus on what is in the best interests of your parents.

Keep Notes

Since this is an ongoing process, when your parent expresses what they would like to do in the future, be ready to record their thoughts. Recording thoughts and wishes makes it easier to follow up in future conversations. Based on what they say, you can figure out what needs to be done and what steps to take. It is also helpful to have notes when updating siblings and family members. Your notes can also prompt future discussions. For example, you could say, “Mom, we talked about who gets your jewelry and china, but you haven’t told us what you want to do with the house.”

Keep in mind, however, that any notes or recordings regarding beneficiaries or giving away assets are not enforceable unless they are made part of their wills.

Don’t Pressure

Talking to your parents gently and without reproach will have better results than being confrontational. This is not a time to make things fair among siblings or to right past transgressions (real or perceived) within the family. The goal is to have your parents set out plans for their financial and medical future. You may not agree with how they may handle distributions, but their plan is better than no plan at all.

Empathize

Put yourself in your parents’ shoes. How would that make you feel? Would you be scared of the future? How would you feel if you were losing control of your body and your mind? Would you want to talk about death? What if you could no longer work or enjoy social events and activities you once did?

Recognize that your aging parents may not want to focus on death. Discuss their thoughts and plans for the future without mentioning “death” or “dying.” Use terms like “passing” or “no longer with us.”

Listen

Sometimes the most important thing you can do to help someone is to just listen without judgment. A parent may need to express anger and anxiety over these preparations. There may be some bitterness at discovering their life did not turn out the way they wanted it. They may make accusations or blame themselves or their spouse for not taking responsibility sooner. Let your parents vent their frustrations and then help them work towards some resolutions.

Consult an Attorney

Making decisions to cover future life events is hard. Not only is an attorney skilled in making sure all the documents are correct and enforceable, but also a qualified estate attorney can raise questions you never contemplated. Everyone’s family and circumstances are unique. Boilerplate or online forms cannot account for the particular needs of your family.

By Catherine Hodder

Catherine Hodder, Esq. is an estate planning attorney turned author. She enjoys working with families who would rather be doing anything else than estate planning. Her new book, Estate Planning for the Sandwich Generation: How to Help Your Parents and Protect Your Kids, debuted at  #1 in new releases for Wills on Amazon.com. Her website is www.HodderInk.com.

 

Older Volunteers and Patients Win With Therapy Dog Visits

September 20, 2018

It's National Dog Week! Learn how trips to hospitals, nursing homes and assisted living centers benefit everyone.

By Tami Kamin Meyer

Part of the Transforming Life as We Age Special Report

Judy Turner, 62, of Powell, Ohio, has been taking her German shepherd to various health care facilities since January 2017.

“When I see the smiles Sunny puts on the faces of people she meets, I know we are helping someone who may be having a bad day, or just [providing] a distraction from what is going on in their life,” she says. Among the places they visit is the Chalmers P. Wylie VA Ambulatory Care Center in Columbus.

“As a dog lover, I know how much joy and stress relief my dogs provide to me,” says Turner.

Therapy Dog Visits Are Good for Volunteers and Patients

There are numerous benefits for older volunteers and for patients when taking a trained therapy dog to medical facilities, according to Russell Hartstein, a certified dog/cat behaviorist and trainer in Los Angeles and a former board member of the Disability Access Committee in Miami.

“It is intense, loving and caring to share your dog with others,” says Hartstein, owner of Fun Paw Care. Not only is it altruistic of the pet parent, guardian or handler to invest time with others at a facility; patients relish the interaction, too.

“Oxytocin is released when people pet dogs,” says Hartstein, noting that the body discharges other chemicals associated with happiness and joy, like serotonin, when loving interactions with dogs occur.

Helping others occupy their minds with present happiness is a fantastic tool for mindfulness. “One tends to be present and in the present moment” when petting and playing with a canine, says Hartstein.

Preparation for the Job

However, pet owners should be aware that not every pup is well suited to serve as a therapy dog, since it takes more than good behavior.

Mary Carlson, 65, is a veterinarian in Fort Collins, Colo., who accompanies Ivy, her 18-month-old goldendoodle, to a local health care center at least once a week. From the moment Carlson met Ivy as a young puppy, she knew she wanted to have her trained as a therapy dog. Ivy was about a year old when she earned various certifications proving she was up to the task.

While Carlson says there are no specific courses for a canine to become a registered therapy dog, there are several matters to consider when determining if a dog is suited for the responsibility. The dog should be at least 1 year old, have the right temperament and be well-behaved and healthy, says Carlson, author of the forthcoming memoir, Drinking from the Trough.

“Even though Cathie, Ivy’s breeder, had selected Ivy for me and it has been love ever since, I knew I had to start at the beginning to make this adorable, rambunctious creature into a gentle, loving dog of the world,” says Carlson.

For starters, Carlson is a strong proponent of puppy courses. The first class was puppy kindergarten, “a wonderful, rowdy course with playtime at the beginning to socialize puppies,” she says. After playtime, the puppies learned basic commands.

Next, Ivy participated in puppy obedience class, which focused on furthering the bond between owner and canine. Canine Good Citizen was the next class. If the dog successfully completes those courses, he or she becomes an official AKC Canine Good Citizen. The last course, which was complemented by many nights of drop-in obedience, was agility.

Other Requirements for Visiting With Your Dog

Turner did not enroll Sunny in classes, choosing to train her pooch as a therapy dog herself.  Sunny earned two certifications: the Canine Good Citizen and the Canine Community Good Citizen.

According to the American Kennel Club, the Canine Good Citizen award is required for many therapy dog groups. Both mixed-breed and pure-bred dogs are eligible.

Turner and Sunny were also rated by a Pet Partners evaluator to ensure they met the requirements of being a Pet Partner handler and dog therapy team. Pet Partners is a national organization that registers therapy animals for animal-assisted interactions, such as at hospitals, nursing homes, colleges and schools. Moreover, Sunny is required to undergo a physical exam by her veterinarian every two years and, as a team, the pair are retested bi-annually.

In addition, a nursing home, hospital or assisted living center may require you to have liability insurance for your dog.

“A liability policy protects the people” with whom the dog interacts, says Billie Smith, executive director of the Alliance of Therapy Dogs (ATD). Don’t rely on your homeowner’s policy to cover a mishap because it probably won’t, she cautions.

Preparation Takes Time

While Smith’s organization offers liability insurance to its 16,000 members nationwide, the criterion for a therapy dog to be accepted into the program is stringent. For example, the handler and the therapy dog must be evaluated on three occasions by an ATD volunteer charged with rating the dog’s temperament, among other considerations. At least two of the three interactions must occur in a medical facility.

You may also have to complete an educational requirement, such as an online test, before visiting a facility, as Turner did. The hospital and VA center where she takes Sunny also required her to get a flu shot and a tuberculosis test.

Through it all, Turner says she is thrilled to take Sunny to nursing facilities.

“Sunny and I absolutely love visiting, talking to people and putting smiles on people’s faces,” she says. “I remember when my mom was still alive, the joy she got from the attention my dogs paid to her truly brightened up her day.”

Tami Kamin Meyer is an attorney and freelance writer in Ohio. She is the chair of the marketing committee of the American Society of Journalists and Authors.@girlwithapen

6 Simple Tactics to Fight Loneliness

September 17, 2018

Taking small steps can make you happier and more connected

By Cyn Meyer

According to AARP’s Loneliness Study, which surveyed adults ages 45 and older, more than 35 percent of older adults are lonely, and loneliness is a significant predictor of poor health.

This report also found that lonely people are less likely to be involved in social events, which, too, can mean poorer health, since being social is so important for your mental, physical, and emotional well-being.

Additional consequences of loneliness include:

The good news is that being aware of your community involvement level (family, friends, neighbors or beyond) can help you focus on developing good daily habits so that you can better age in place by being healthy, happy and active.

Here are six simple steps for fighting loneliness:

  1. Acknowledgment

Just like depression or any other ailment that feels terrible, you’d be surprised at the number of people who remain in denial without admitting to their feelings of loneliness. Acknowledging bouts of loneliness and understanding that it’s a feeling, not a fact, can help you move past it.

Also, understanding the difference between isolation and loneliness can help you tackle the source of your feelings of loneliness.

Signs of isolation include living alone, having no close relatives, never leaving  the house, not participating in phone or digital chat or being  alone for nine or more hours per day.

Someone suffering from loneliness wishes for more friends, doesn’t see friends and family enough, doesn’t meet enough people, has no one to rely on and spends holidays alone.

Recognizing the difference between the two can also help you realize that many things are in your control and that you can change your behavior and experiences to help relieve some of your feelings from both loneliness and isolation.

  1. Make a Plan to Tackle Your Habits

After acknowledging your bouts of loneliness and understanding how susceptible you can be to isolation, you can more clearly plan and act toward improving your habits. Making an intentional plan is a huge step toward making progress. Start off simply and tackle one habit at a time until you’ve mastered it and it’s become a second-nature new habit. Then go back and take on another one.

  1. Focus on Others and Be Curious

Whether new or old, your relationships with people can travel so much further if the others feel supported and heard. Rather than focus on your own feelings or insecurities, focus your attention on the other person. This will relieve pressure from focusing on your own imperfections or negative self-talk and will make them feel appreciated and more likely to open up.

When you’re putting attention on those around you, try approaching your conversations with curiosity about their lives. Being inquisitive can have a large impact on the way your conversations go.

  1. Use Technology to Stay Connected

As you grow older, your social circle of family and friends are likely to spread or dwindle. One way to supplement your in-person contact is to maintain your long-distance relationships using technology.

There are plenty of options in this digital age: online chat, online video chat, video on your phone, email, etc. While learning a new digital platform can be challenging, once you get the hang of it, advantages include convenience and accessibility. Most tech-based communication channels are free or included with other bills you’re already paying such as phone and internet.

But be aware that technology can also be isolating, so use it to strengthen your relationships and not as a foundation. The AARP study found that although the internet makes it easier to share personal information, 13 percent of lonely respondents felt they have fewer deep connections when using the internet to keep in touch with people compared to 6 percent of the non-lonely.

  1. Volunteer

Finding the right volunteer opportunity that works well with your personal goals and core values can be beneficial on so many levels. Not only will you have the chance to meet new people, you can benefit by feeling healthier, less stressed and happier, inspiring others to give back.

Need a how-to for finding the perfect volunteer gig? Check out these seven tips. And if you’re already clear about the type of volunteer opportunity you desire, read this guide that reviews 20 top volunteer websites to help your search.

  1. Sign Up for a Class

What have you always been curious about learning? Now you have another reason to prioritize signing up for a class about it. There are so many benefits to lifelong learning, including expanding your growth experiences, building up your neuroplasticity, and of course, creating another opportunity to meet new people.

When you surround yourself with people who care about the same things you do, you’re that much more likely to align yourself with the right circle of influence — the people who will encourage you to make and reach your goals and live the lifestyle you want.

Taking Small Steps

So there you have six simple tactics you can consider implementing today. Of course, simple doesn’t mean easy… but by taking daily micro-steps, you can rewire your behavior and create healthy experiences for yourself.

By taking preventative action, you can help avoid the detrimental effects of loneliness and social isolation.

Which ideas resonate with you? Which tactics can you easily work into your life right now?

Cyn Meyer, founder of Second Wind Movement, offers education + coaching to help seniors transition into amazing next chapters and age successfully in place. By helping seniors live out active, healthy, happy "retirement" years, they can better fend off depression, loneliness, Alzheimer's and nursing home occupancy.

 
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