NOV. 17, 2019 ELDERCARE DISCUSSION

We discussed eldercare & aging issues—including traumatic brain injury, PTSDanger, dementia, and how to manage difficult eldercare situations.

Aging & Elder Care

–  We discussed how some older adults suffer from Traumatic Brain Injury (TBI) and Post-Traumatic Stress Disorder (PTSD) and how this might explain some troubling symptoms in older adults—including memory loss, depression and violent thoughts, threats and actions.  In some cases, these symptoms can emerge many decades after the traumatic events.  A better understanding of these conditions can help care partners to accept and manage troubling emotional symptoms that occur in some older adults. 

–  Per the U.S. National Library of Medicine’s MedlinePlus database…

Traumatic Brain Injury (TBI) happens when a bump, blow, jolt, or other head injury causes damage to the brain.  Every year, millions of people in the U.S. suffer brain injuries.  More than half are bad enough that people must go to the hospital.  The worst injuries can lead to permanent brain damage or death. Half of all TBIs are from motor vehicle accidents.  Military personnel in combat zones are also at risk.  Symptoms of a TBI may not appear until days or weeks following the injury.  A concussion is the mildest type.  It can cause a headache or neck pain, nausea, ringing in the ears, dizziness, and tiredness.  People with a moderate or severe TBI may have those, plus other symptoms:

–  A headache that gets worse or does not go away

–  Repeated vomiting or nausea

–  Convulsions or seizures

–  Inability to awaken from sleep

–  Slurred speech

–  Weakness or numbness in the arms and legs

–  Dilated eye pupils

Health care professionals use a neurological exam and imaging tests to assess TBI.  Serious traumatic brain injuries need emergency treatment.  Treatment and outcome depend on how severe the injury is.  TBI can cause a wide range of changes affecting thinking, sensation, language, or emotions.  TBI can be associated with post-traumatic stress disorder.  People with severe injuries usually need rehabilitation.   https://medlineplus.gov/traumaticbraininjury.html

–  Per the U.S. National Library of Medicine’s MedlinePlus database,

Post-Traumatic Stress Disorder (PTSD) is a real illness.  You can get PTSD after living through or seeing a traumatic event, such as war, a hurricane, sexual assault, physical abuse, or a bad accident.  PTSD makes you feel stressed and afraid after the danger is over.  It affects your life and the people around you.

PTSD can cause problems like…

–  Flashbacks, or feeling like the event is happening again

–  Trouble sleeping or nightmares

–  Feeling alone

–  Angry outbursts

–  Feeling worried, guilty, or sad

PTSD starts at different times for different people.  Signs of PTSD may start soon after a frightening event and then continue.  Other people develop new or more severe signs months or even years later.  PTSD can happen to anyone, even children.  Treatment may include talk therapy, medicines, or both. Treatment might take 6 to 12 weeks.  For some people, it takes longer.  https://medlineplus.gov/posttraumaticstressdisorder.html

–  Participants made several practical suggestions for care partners on managing such troubling conditions.  In addition to eldercare discussion groups like ours, other helpful resources were mental health family support groups, such as those offered nationwide and locally by the National Alliance for Mental Illness (NAMI) and the Cognitively-Based Compassion Training (CBCT) program developed by the Drepung Loseling Monastery and Emory University as part of their Science Initiative.  

–  NAMI DeKalb offers weekly support group sessions in Decatur on Mondays from 6:15-7:45pm for those who are concerned about someone who suffers from mental illness.  

The NAMI DeKalb Family Connections Support Group is for family members, caregivers, and loved ones of someone living with the everyday challenges of a mental illness.  These sessions take place in an intimate, confidential setting to allow families to share with each other their positives and negatives.  This type of group lets you know that you are not alone and it is not your fault.   Through the NAMI Family Support Groups, you will find: A network of friends who care and understand; ideas that help you take care of yourself and your family; a chance to share your experience and learn from others who have been there; and; information about brain disorders, treatment and services.  See https://www.namidekalb.org/family-support-group

–  Cognitively-Based Compassion Training (CBCT) isa secular training program based on Buddhist principles that was developed for health care workers, caregivers and interested persons who wish to improve their ability to relate to others with sensitivity and compassion.  It was developed by DLM’s Geshe Lobsang Tenzin Negi, PhD, and others at the Emory-Tibet Partnership (https://tibet.emory.edu/).

CBCT® (Cognitively-Based Compassion Training) is a system of contemplative exercises designed to strengthen and sustain compassion.  Practices include training in attentional stability and increased emotional awareness, as well as targeted analytical reflections to understand better one’s relationship with self and others.  The reflective exercises seek critical insights into the way one’s mindsets and attitudes can be shifted to support personal resiliency, to foster an inclusive and more accurate understanding of others, and ultimately to intensify altruistic motivation.  With practice, informed compassion can become a spontaneous response that permeates one’s life. https://compassion.emory.edu/cbct-compassion-training/index.html

–  CBCT® Courses https://compassion.emory.edu/cbct-compassion-training/cbct-courses/index.html

There are many opportunities to learn CBCT® at Emory and at many other locations.  Please see the links below to learn.  Please contact us if you don’t see a course that fits your needs, or if you would like to arrange a course for a specific group or location.  

Public Offerings at Emory

CBCT® for Emory Students

CBCT® at Emory School of Medicine

CBCT® for Nurses

Other CBCT® Courses

Those who are interested can observe how it is practiced by attending the Thursday 6:00-7:00pm CBCT Compassion Training and meditation sessions at the Dresden Road DLM Center, led by students and graduates of the training program.  These sessions are also broadcast live via the DLM LiveStream Channel.

DLM Calendar http://drepung.org/changing/calendar/Current.htm

DLM Livestream Channel http://new.livestream.com/accounts/7116288

–  The DLM’s free, open 7:30-9:00pm Tuesday Public Talks and 11:00am-noon Sunday Meditation sessions offer additional weekly in-person (and LiveStream) instructions on calming disturbing emotions.  For example, next Tuesday’s talk is on “How to Deal with Stress” by Geshe Ngawang Phende.  (See DLM Calendar and LiveStream links above)

–  We discussed the importance of having care partners and their affected loved ones adopt a positive view of Alzheimers or other dementias.  This view contrasts the well-intended, but misguided, tendency for some nonprofits to emphasize the negative or devastating aspects of dementia to raise money for their organizations.  There is an emerging consensus among dementia care professionals that it is better to identify and develop the positive qualities of persons with dementia to improve their quality of life as well as that of their care partners.

–  Some people have a much higher tolerance of pain than others.  This characteristic is believed to be genetically related.  This is why it’s important for caregivers to periodically check the fingers and toes of frail older adults for pressure sores or other pathology that the older person might not feel.

–  Participants agreed that it was not unusual for out-of-town children of frail parents to get better caregiving results and more appreciation than do their in-town siblings.  The reasons for this are many and varied.  For example, a parent might favor one child over others for some caregiving tasks, because the occasional visitor:

–  doesn’t shame or badger them to make unwanted (but arguably beneficial) lifestyle changes

–  has a particular medical, legal, financial or caregiver skill

–  is thought to be more attentive to their concerns and wishes

–  shares a strong common interest with them—such as sports, old movies, classical music or politics

–  To counter potential tension or resentment among siblings, participants suggested that an out-of-town care partner should express appreciation for siblings’ contributions and seek to empower them by asking them how you can support their sometimes rejected or unappreciated efforts to help your parent.  If it is difficult to do this in person or by phone, you might do this by sending them a letter or card. 

–  If you are a care partner, attendees said it could help to make a concerted effort to identify your parent’s unfulfilled ambitions or favorite memories, such as music, musicians, movies, TV and radio shows they enjoyed in their early years.  Many older persons also enjoy seeing old family photographs or being asked about their family history or life story.

–  Family counseling or mediation by an experienced impartial counselor was suggested as an option to consider for especially difficult care situations

–  We ended our session with a lively discussion about the purported harmful and beneficial aspects of anger—particularly as it arises in challenging care situations.  One participant described anger as an inherent human quality.  Some extolled the positive qualities of anger—that it is an honest reaction that shows the depth of one’s feelings; it can help to open substantive communication with some people; and, it allows the release of built-up tensions.  On the other hand, Buddhism views anger and attachment as the two most harmful negative emotions and—along with ignorance—are the root causes of our suffering.  One of our members noted that when DLM’s Geshe Phende discusses feelings of anger he often says “the problem is with me, not there.” 

–  The Buddha is reported by one source to have said. “Holding on to anger is like grasping a hot coal with the intent of throwing it at someone else; you are the one who gets burned.”  Anger and Aversion fromthe website A View on Buddhism (Accessed December 14, 2019). https://www.viewonbuddhism.org/anger.html

–  A 1997 book by the Dalai Lama discusses anger in depth.  

Healing Anger: The Power of Patience from a Buddhist Perspective Paperback – January 1, 1997

Dalai Lama (Author), Thupten Jinpa (Translator).  Snow Lion; 1997; 176pp.

    All the world’s major religions emphasize the importance of the practice of love, compassion, and tolerance.  This is particularly true in the Buddhist traditions, which unanimously state that compassion and love are the foundation of all paths of practice.  To cultivate the potential for compassion and love inherent within us, it is crucial to counteract their opposing forces of anger and hatred.
    In this book, the Dalai Lama shows how through the practice of patience and tolerance we can overcome the obstacles of anger and hatred. He bases his discussion on A Guide to the Bodhisattva Way of Life [by Shantideva], the classic work on the activities of Bodhisattvas—those who aspire to attain full enlightenment in order to benefit all beings.

    The techniques and methods presented are relevant not only for Buddhist practitioners but for all who seek to improve themselves.  Through these teachings and by his own example, the Dalai Lama shows the power that patience and tolerance have to heal anger and to generate peace in the world.

https://www.worldcat.org/title/healing-anger-the-power-of-patience-from-a-buddhist-perspective/

–  In a Lions Roar excerpt from his 2001 book on the same topic, Thich Nhat Hanh discusses anger.

Loosening the Knots of Anger by Thich Nhat Hanh – April 24, 2017

    Thich Nhat Hanh teaches you how to relax the bonds of anger, attachment, and delusion through mindfulness and kindness toward yourself.

In order to be free from anger, we have to practice, whether we are Christian, Muslim, Buddhist, Hindu or Jewish. We cannot ask the Buddha, Jesus, God or Mohammed to take anger out of our hearts for us. There are concrete instructions on how to transform the craving, anger and confusion within us. If we follow these instructions and learn to take good care of our suffering, we can help others do the same.

–  A participant added that care partners should honor their parent’s and siblings’ feelings with warmth vs. tension.  Others suggested that we emphasize kindness and the acceptance of our loved one’s decline as well as acceptance of our siblings’ challenges and suffering.  Another suggested doing the Hatha Yoga practice of letting go.

–  At our July 2018 meeting we discussed how, as care partners with a Buddhist outlook, we can often be more effective in helping others by first changing our own attitudes and behavior and helping ourselves.  When we see a person with dementia lash out, we should try to understand that they are suffering due to losses in their brain function and due to their limited ability to control their angerfear and other negative emotions.  Being mindful of the actual causes and conditions, we can then practice compassion by trying to see ourselves as a container for their suffering, transforming it into positive blessings and wishes for their wellbeing. 

Other Matters

–  The Emory Buddhist Club (http://buddhistclub.org/) is a student-led effort.  Their primary mission is to provide a free, weekly, on-campus opportunity for anyone with any interest in Buddhism to meet, practice, and learn with senior Buddhist teachers from the Atlanta area.  When the university is in session, they meet every Thursday at 6pm on Emory’s main campus, in Atlanta, Georgia, in Cannon Chapel, room 106.  They are free and open to the public—regardless of experience, point of view, or focus.  The club also coordinates periodic field trips to nearby Buddhist communities and centers.  For additional information, contact them at info@buddhistclub.org or (762) 218-2182.  To receive news about upcoming events by e-mail, subscribe to their events mailing list @ http://buddhistclub.org/mailman/listinfo/events_buddhistclub.org

    

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