Fraying Fabric: Dementia, Depression and Loneliness

There have been some recent articles about studies relating to loneliness and dementia.  Here is a link to “Loneliness Increases Dementia Risk Among the Elderly,”  which discusses the link between loneliness (NOT living alone or other social isolation) based on a three-year long Dutch study of elders. The jury is still out about the causality of the relationship (does loneliness lead to dementia – or the other way round?), but there is a strong correlation. The authors of the study are quoted as concluding “further research is needed to investigate whether cognitive deterioration and dementia are a consequence of feelings of loneliness or whether feelings of loneliness are a behaviourial reaction to diminished cognition.”

This report doesn’t necessarily tell us anything particularly new, but several studies have used different techniques over the years to demonstrate the correlation.  Here’s a link to an article published in 2007 entitled “Link Explored Between Loneliness and Dementia.”  Is loneliness one of the risks associated with aging, or is it something that some people have all their lives (coping behaviors, approaches to life and relationships) that is exacerbated by the many trials of old age?  If you are lonely at this time in your life, could “forgetting” be a coping behavior or affect along the lines of being more trusting and more optimistic?  These latter two phenomenon have been noted by psychologists and neuroscientists.  To reiterate, we have never had this many old people on the face of the earth before, so there are more “test subjects” in this regard. . . .

This brings me back to “elderhood” and the need to forge new connections and maintain old ones in later years. In the UK there is even a campaign to end loneliness and this past year the organization aiming to reduce chronic loneliness for people over 65 launched a “Dementia Awareness Week.”

Dementia and loneliness seem to be one of the combinations that may be difficult for clinicians to study because it involves a wide range of factors, not the least of which is self-reporting by people of loneliness.  Are social activity and engagement enough for persons to stave off dementia?  Will there be an effective “prescription” in the near future for preventing the development of or  slowing the advance of dementia that involves more social engagement?  what will this look like?

The roots of elderhood begin in a person’s forties and fifties – at that sometimes imperceptible and for some of us dramatic divide between the first half of life and the second.  I just bought a new Kindle and look forward to reading Richard Rohr’s book “Falling Upward: A Spirituality for the Two Halves of Life” (Jossey-Bass 2011)  on my new toy.  In the meantime, there are the library books – my most recent find relating to this topic is “Born for Love: Why Empathy is Essential and Endangered,” by Maia Szalavitz and Bruce Perry (2010: Morrow).  The link between empathy and loneliness is profound: can we as individuals allow ourselves to see and feel another person’s loneliness and isolation?  How might that change our own lives and those of others if we were freer and more capable of reaching out to and being with another?  It might change our world.

This reminds me of a favorite Anais Nin quote:   We see the world not as it is but as we are.

If we have lived with much pain and fear in our lives and our reaction is the slow tightening of our heart, it can become difficult to open to people who come into our lives to share the world with us, in whatever way they do.   Fear of change is essentially fear of life – this makes me think of the ancient Greek Heraclitus and his observation that we can never step into the same river twice.  How do we look at our own life – do you tend to view life as a process of becoming – or perhaps more as a series of “doings” or a “bucket list” or some other forms of accomplishments?  I would submit that our youth-glorifying culture tends to focus exclusively on the doing, and when there is no more “doing” left for us, life becomes pointless.   This is not to minimize the importance of doing, rather it is to put doing in its proper context . . . .  Loneliness may simply be that fear of rejection, that sentiment of “why bother – they won’t like me anyway.”  Perhaps the forgetting, which is the dementia – is a coping mechanism for this in an aged brain.  Contrast this reaction with letting go of the fear and anxiety of pain and pain avoidance and embracing the change.

Here is another Anais Nin quote:

Each friend represents a world in us, a world not born until they arrive, and it is only by this meeting that a new world is born.

Empathy can allow our hearts to open to new people and experiences and new worlds for us if we become friends with another.  In short, it can keep us alive.

This reminds me of a favorite and very simple prayer: that I may live until I die.

Perhaps too many of us are dying prematurely, by our own hands, hearts or minds  – slowly and almost imperceptibly.

©Barbara Cashman     www.DenverElderLaw.org

Human Rights and the Elderly

 

December is universal human rights month! Why December?  The Universal Declaration of Human Rights (UDHR) was adopted by the UN General Assembly on December 10, 1948.  After the end of the Second World War, the international community came together and vowed that such atrocities would not be allowed to happen again.  That’s right, there is such a thing as universal human rights under international law.  That’s the reason I went to law school – to study the international protection of human rights.  The UDHR formed the basis of important political and legal developments internationally and in many regions and individual countries, and spawning two International Covenants – on Civil and Political Rights and Economic, Social and Cultural Rights.

Now that I’ve been practicing elder law for many years, referring to the National Academy of Elder Law Attorneys’ Aspirational Standards (coincidentally, many internationally recognized human rights are “aspirational” in nature – meaning they are emerging or not fully recognized as rights as such in the legal system), I am seeing more of the broader connections between elder law and human rights.  So, based on that theme, I started looking around a bit more after I saw a reference in the latest query on the rights of elder people in international law.  Thomas Hammarberg, former Council of Europe human rights commissioner recently spoke in Gothenberg, Sweden   about the pressing situation faced by many elders in the European Community.  The number of elders worldwide is burgeoning and coupled with the Great Recession, many are faced with dire circumstances that are a breeding ground for exploitation and degradation.  The “rights of the elderly” is a concept that is both broad and particular at the same time, as it reflects the fact that the challenges and needs facing elders are quite diverse, reflecting a broad range of legal, social, financial, medical, emotional and social implications.

The UDHR, at article 25, para. 1 states

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

The rights of the elderly often tend to be a right “to” something (such as security, health care, participation, dignity and nondiscrimination) as opposed to the United States’ historically preferred position to support freedoms “from” on the basis of governmental intrustions.  Of course, elders have well-recognized civil rights in this country to be free from exploitation, abuse, neglect and inhuman treatment.  How will the rights of elders evolve and develop?

Here’s a link to an interesting law review article entitled “International Human Rights and the Elderly,” published in the Marquette’s Elder Advisor and available here.     I also found an interesting abstract of a paper by a member of the law faculty at Montreal’s McGill University titled “The Human Rights of the Elderly: An Emerging Challenge.”     The most interesting aspect of this abstract is the connection made between “ageist” attitudes and discrimination in youth-glorifying and death-denying societies.  I find this connection especially apparent in our culture, which is obsessed with the “doing” aspects of life, and when we are no longer able to “do” as we previously did, we are diminished, worn down, used up and not entitled to the same level of respect as we previously enjoyed.  I think this attitude is not uncommon.  As long as our notions of dignity and respect are linked exclusively to “doing,” the ethics of how we treat people as rights bearing “beings” will be difficult to make coherent.   Included in this conundrum are the rights of the disabled along with those of many elders, whose capacities may be diminishing and are part of a large group of vulnerable persons in need of protection.  I found helpful an overview by the Human Rights Education Association about “The Rights of the Aged,” available here

I couldn’t write this post about the implications of youth-glorification and death-denial in our culture and legal systems without mentioning how our separation from our older, sicker and frailer selves also serves to distance us from the last part of our existence, our life journey  – dying.  Can the dying person and their dear ones reclaim grace and dignity in the process of dying?  Why yes, and thanks to The Soul of Bioethics newsletter I receive from The Healthcare Chaplaincy,    I learned about The Sacred Dying Foundation.    This follows on some familiar themes I have previously blogged about – how our treatment of death and dying informs our values about life. That’s all for now.

End of Year Lists: Don’t Forget the Digital Assets!

Okay, it’s December – and it might even snow soon here in Denver . . .

End of year planning means list-making, right? So here’s a follow up to a post I published on April 30th about passing on in a wired world.

        1. Make a list of all your digital “stuff”

        2. Tell someone you trust where to find it

        3. Don’t forget to update it regularly (new information and changes to existing)

These are the top three things I suggest doing – even if  my use of the term “stuff” is vague.  Why would I use such a vague term here?  Well, there are more than a few types of digital “property,” some of which may look like property but not be property (e.g., a license).   This area is relatively new, evolving and fraught with uncertainty.  This is why I think the better policy is to include all property on a list and have it “sorted out” later on if need be.

Relating to (2), you could consider someone taking care of your online identity/footprint/stuff as your “digital executor.”  I’m thinking  historically, back to the many writers who entrusted their unfinished works or compilations to their named “literary executors.”  In one case with which I’m familiar, a friend of a decedent was previously instructed to “wipe” the hard drive and all storage devices on the decedent’s computer and smartphone.  Not all of us want to live forever digitally or leave a trail for other’s to track.  It’s best to decide these things in advance.

You will want to regularly update the list, which could include ownership interests (like a domain name or a bank account for example), licenses or uses (subject to terms of use contracts), access information for accounts, communication and devices (including computers, external storage, cloud and smartphone).

Only a handful of states have enacted legislation relating to digital assets of a decedent and Colorado has not yet done so.  What is the state of the law applicable to these matters?  Evolving!  There is federal legislation regarding the internet, contract law pertaining to terms of use which govern access to most online accounts, and then there is the unsettled area relating to the application of agency law and decedent’s estates (powers of agents under durable powers of attorney and a personal representative of an estate).   Suffice it to say there are some very interesting legal scenarios about the nexus of these three sources of law . . .   Many estate planning attorneys now regularly ask their clients about digital assets, and some (myself included) have drafted powers of attorney regarding digital access and assets.

There are many nuanced issues relating to digital versions of the familiar world (at least to those of us like me, a “digital immigrant”)  – a good example is the book.  Let’s say Decedent leaves his library of Mark Twain works (published in 1903) to his son, and the impressive digital collection of the same complete works to his daughter.  Whoa! The first bequest is simple and straightforward, but in the bequest to daughter of the digitized versions of the works (which may include versions of audio, video, CD, eBook, etc.) each of the assets would need to be considered according to federal copyright law, any terms of use or terms of service the decedent agreed to when the purchase was made, and whether any kind of intellectual property protection may additionally apply (like under the federal Digital Millenium Copyright Act of 1988).

Okay, what about your Facebook account – maybe you’ve heard there are memorial pages available . . . .  This access depends on many factors as well.  For example, a coroner investigating a suspected suicide may not be able to access the deceased person’s Facebook account to help with the investigation.  Read Jim Lamm’s Oct. 11, 2012 blog post that discusses this very issue in the context of the Stored Wire and Communications Act (part of the Electronic Communications Privacy Act of 1986).

This area of law, like the rest of life – is uncertain.  If you want to ensure that everything is accounted for (or erased) – be sure to provide some instructions and make that list of your digital assets.

©Barbara Cashman     www.DenverElderLaw.org