June 15 is World Elder Abuse Awareness Day

The National Center on Elder Abuse of the Administration on Aging has declared June 15 World Elder Abuse Awareness Day.  Go to this link to find a local activity.   Yes, since this is a “World” day, there is also a United Nations declaration and such commemorations started in 2006 – in case you’re wondering.  The U.S. HHS Administration on Aging suggests three ways to be involved:

(1) Developing an educational program or press conference;

(2) Volunteering to call or visit an isolated senior; or

(3) Submitting an editorial or press release to your local newspaper to create awareness of elder abuse, neglect, and exploitation.

I hope this blog post meets the third criterion!

You can find excellent resources and stay posted on Colorado developments by going to the website of the Colorado Coalition for Elder Rights & Abuse Prevention  and you can sign up for their e-newsletter there.  In my recent visit to the site there was a link to a page entitled “culture change” which addresses person-centered care.  You can click here  for my blog post refresher on that topic and its originator, Tom Kitwood.  The culture change that the CCERAP site describes is about focusing on the needs of the individuals requiring care and those working closely with them.  This challenge is one we face on personal, community, national and global levels with the ever-growing number of elders in our communities.  It forces us to think about how we would want to be treated in similar circumstances.

So on the topic of elder abuse and the vulnerability of a particular group of elders – those experiencing cognitive decline associated with a dementia disease process, I will take a look at Alzheimer’s Disease and Recent Observations from Biophysics.

Okay, I don’t think I’ve ever typed the word “biophysics” but there it is. I subscribe to Scientific American’s email news and there was featured a guest blog post by Frank Ferrone entitled “Dangerous Braids that Tangle in Brains and Veins.”  You can read it here.   This article is about the importance of research, the accumulation of scientific knowledge and connections that can be made at a later date when more research is accomplished or perhaps investigatory techniques, often technological, allow more thorough information to be gathered.  Alzheimer’s Disease is a very particular type of dementia and it is only conclusively diagnosed post-mortem of those who had the disease.  Its calling card is the beta-amyloid protein molecule  which causes the plaques and tangles associated with the shrinkage of brain function. It turns out that these braided molecules share a lethal trait with the deadly molecules associated with sickle-cell disease, which allows both of these molecules to quickly build their housing (polymers) and spread their disease to a wider area.  What Ferrone concludes, hence the biophysics moniker – is that the two diseases [Alzheimer’s and sickle cell], disparate in manifestation, obey the same fundamental rules.  This is what Biophysics is all about, the discovery of fundamental physical laws that govern the behavior of diverse biological systems.   Ferrone’s discovery (made with others), published back in 1985,  was relied upon by Alzheimer’s researchers at Cambridge University for their new discovery.

Biophysics and biochemistry figure prominently in research in dementia – its proper diagnosis, treatment and of course prevention. Interested in the aging process in terms of entropy, mitochondrial decay? Read this excerpt.

All this overlap reminds me of a blog post I did for SoloinColo on The Hero’s Journey, in the Facebook for Lawyers context. . . .  where I described our networked society in the mythological term “special world.” That post (part of a twelve part series) can be read here  and referred to an article by a mathematical biologist.  Perhaps Alzheimer’s research will continue to be a cooperative proving ground in helpful ways.  If research on the disease can promote cooperation in substantial and significant ways and our ideas about identity and functioning are challenged with an ever-growing number of elder-boomers – then perhaps there is hope for us!

Yes, I could publish this post without a poem, but with no shortage of beautiful sources . . .  why would I?  This one (known as II,16) is by Rainer Maria Rilke (yes, he is one of my favorites):

How surely gravity’s law,

strong as an ocean current,

takes hold of even the strongest thing

and pulls it toward the heart of the world.

Each thing –

each stone, blossom, child –

is held in place.

Only we, in our arrogance,

push out beyond what we belong to

for some empty freedom.

If we surrendered

to earth’s intelligence

we could rise up rooted, like trees.

Instead we entangle ourselves

in knots of our own making

and struggle, lonely and confused.

So, like children, we begin again

to learn from the things,

because they are in God’s heart;

they have never left him.

This is what the things can teach us:

to fall,

patiently to trust our heaviness.

Even a bird has to do that

before he can fly.

     From Rilke’s Book of Hours: Love Poems to God, translated by Anita Barrows and Joanna Macy.

Life is uncertain and old age – even more so.  Perhaps old age and its inward pulling-ness is a kind of gravity, a force that we all share but one that isn’t easily recognized or understood.  Is this because we each live our own lives, separately and pulling away, or perhaps as a result of that long-term denial.  How difficult would it be to trust that gravity, that heaviness that we can look at things – our lives and our relationships – in new ways . . .  even in our oldness (or perhaps only as a result of it).

©Barbara Cashman     www.DenverElderLaw.org

Aging in Place and Person-Centered Care: It’s About Love: Part I

What is “aging in place?’  Take a look at the 2012 Senior Law Handbook published by the Colorado Bar Association for some further information about this.     Aging in place means aging, coping with all of life’s challenges and frailties that the aging process can bring, while living in a home and supported by family and friends and community.  This “new” approach is quite old-fashioned, hearkening back to the days when elders lived among the general population, before “retirement communities” and a medical model for institutionalizing the sick and frail elderly.  But wait, there’s a lot more eighty- and ninety-year-olds on the planet, and what about those baby boomers?  Well, I’m not proposing any earth shattering solutions in this post; I’m just suggesting looking at a few things a bit differently.

The Colorado Coalition for Elder Rights & Abuse Prevention published their April-June 2012 newsletter  with the headline “Transforming the Culture of Aging: Self Directed Living in All Settings.”   Person-centered care for people suffering dementia is especially important in trying to hold the person “in their identity” their essential personhood, and not just putting them away in a place where they will be safe.  Person-centered care was developed by the late Tom Kitwood, a British physician who had some revolutionary ideas about dementia and how to support people suffering from dementia.  Read more about him here.    Bottom line for Kitwood’s approach is that personhood, human dignity – is unique and sacred.  This is a far cry from what many in our youth-glorifying and death-denying American culture espouse.  We tend to focus on the losses that an elder suffers over the course of their inevitable physical decline, and pity their loss of autonomy – regardless of the fact that our individual “autonomy” is largely a fantasy anyway.  Here’s a link to information about person-centered care and gaining in place relevant to dementia sufferers.    So what are we missing here?

We can start with looking at elderhood as a stage of human development, ala psychologist Erik Erickson.  His wife Joan Erickson published an extended version of “The Life Cycle Completed,” (published by Norton  in 1998), including her own chapter entitled “The Ninth Stage.”  She notes at the beginning of the chapter:  “we must now see and understand the final life cycle stages through late eight- and ninety-year-old eyes.”  Erickson at 105.  She characterizes “old age” as a stage of life that is focused more on loss (“dystonic elements”) at the expense of self-growth and expansion (“syntonic qualities”).  Erickson asks the question of how it is possible to send elders out “into the world” they had previously inhabited and into a facility to have physical (medical) care and comforts met?  This is a good moral question that we must continue to ask ourselves.

This standard of care is the prevailing standard for care of protected persons, incapacitated individuals for whom it is necessary for another person to make decisions about daily care.  These types of decisions are known as “substituted judgment” and are recognized by the law in both probate proceedings (for a ward or protected person in guardianship proceedings) as well as by agents and proxy decision makers under state law.  The “best interests” standard applicable to substituted judgment is touted as an objective standard.

So then why resort to institutionalization?  Institutionalization is less prevalent than it used to be, but why is it necessary? For a number of reasons obviously – among which there may be no alternatives.  From my personal experience visiting residents in skilled nursing facilities over the last seven years (as a volunteer para-chaplain), I can tell you that the people I see are there because they want to continue to live and the facility is their only viable option to provide necessary life-sustaining care.  Are there steps we can be taking as a society to more fully re-integrate the old of the elder population (people over 80)?  Absolutely.  Erickson proposes more parks in which elders can meet.   The next question of course is whether there will be an opportunity for them to be heard, to be recognized as bearers of wisdom, still having something to contribute.  Will anyone ask them or want to hear their stories?   This is the biggest hurdle as far as I can tell.  Why?  We have no effective model of “elderhood” in our country!

Joan Erickson focuses on the “doing” part of elderhood – to rise above, exceed, outdo, go beyond , to continue to create so that elders can continue to “become” – which she identifies cleverly as gerotranscendance.  Erickson at 127.  Yes, the “dance” is intentional.  How beautiful!  I have difficulties with her exclusive focus on the “doing” and “making” part of becoming who we are – what about just the “being” part that is really the focus of person-centered care – what does that look like?

Well, I’ve nearly run out of space for this post, but I will mention that this will be continued.  I’ll be taking an in-depth look at a book I’m reading right now called “Elders on Love: Dialogues on the Consciousness, Cultivation and Expression of Love,” by Kenneth Lakrits and Thomas Knoblauch, Parabola Books 1999. I end with a quote from much-loved author Paulo Coelho:

The wise are wise only because they love.

More about love and wisdom, particularly the wisdom of elders – in a subsequent post.

©Barbara Cashman     www.DenverElderLaw.org