January 19, 2020 Eldercare Discussion

The group discussed eldercare & aging issues—including assessment of older adult driving skillscoping with a loved one’s unexpected death or memory loss, care partner communicationmeditative visualization and mantra chanting. 

Aging & Elder Care

–  A participant described how a parent, who recently was thought to have been near death, has snapped out of her very poor condition and is currently doing very well.  It was noted that some straight talk about death from a medical professional appears to have been a key factor in her turnaround.  It was also a good reminder that the will to live was a powerful force and that the time of one’s death is uncertain.

–  The group discussed the difficulties of caring for a loved one with vascular dementia.  According to the National Library of Medicine’s MedlinePlus…

Vascular Dementia is the second most common cause of dementia after Alzheimer disease in people over age 65…[It] is caused by a series of small strokes.  [Like other forms of dementia], it can lead to a gradual and permanent loss of brain function….[affecting] memory, thinking, language, judgment, and behavior.  …Symptoms of Alzheimer disease can be similar to those of vascular dementia…and may occur together.

https://medlineplus.gov/ency/article/000746.htm

–  Another caregiver concern was that of a loved one who insists on driving, while their family and friends see this as risky or dangerous.  At our July 2019 meeting participants suggested the possibility of asking the loved one to take an elder driving evaluation, such as ones offered by the AARP and American Automobile Association (AAA).    

–  The AARP website has an Assessing Driving Ability page (https://www.aarp.org/auto/driver-safety/driving-assessment/) with links to some excellent training and assessment resources for impaired elders and their loved ones, including…

o  Fitness-to-Drive Screening Measure

o  We Need to Talk  – How do you know when it’s time for your loved one to limit or stop driving? 

o  Driving With Hearing Loss

o  AARP Smart Driver Course

–   The American Automobile Association (AAA)’s Website pages have lots of information and links to resources for assessing the driver skills of older adults and guiding those who wish to help loved ones be safer. 

See Senior Driving  https://seniordriving.aaa.com/

    Its Professional Assessment page describes two stages of driver evaluation…

1.  A driving skill evaluation includes an in-car evaluation of your driving abilities and a recommendation regarding any further specialized drivers’ training.

2.  Clinical driving assessments are used to identify underlying medical causes of any driving performance deficits and offer ways to address them, so driving remains a safe option… getting a clinical driving assessment can help you to decide if you should continue to drive and if so, under which conditions.

 [the cost is] typically $200 to $400+ for a full assessment. … To get a clinical driving assessment the American Occupational Therapy Association (AOTA) provides a nationwide database of driving programs and specialists. http://myaota.aota.org/driver_search/index.aspx/index.aspx  If you cannot find a resource there, contact your local rehabilitation hospital’s occupational therapy department for assistance.

See also: https://seniordriving.aaa.com/evaluate-your-driving-ability/professional-assessment/ 

–  For grieving care partners of a loved one who died unexpectedly or who is alive but seems lost to a severe dementia, a participant recommended a bookAmbiguous Loss: Learning to Live with Unresolved Grief by Pauline Boss; Cambridge, Mass: Harvard University Press, 2000.  Per Worldcat.org 

What happens when there is mourning with no closure, when a family member or a friend who may be still alive is lost to us nonetheless? How, for example, does the mother whose soldier son is missing in action, or the family of an Alzheimer’s patient who is suffering from severe dementia, deal with the uncertainty surrounding this kind of loss?    http://www.worldcat.org/oclc/611038604

Per the Family Caregiver Alliance

Adding to the stress, disorders such as Alzheimer’s disease or traumatic brain injury cause unpredictable memory loss that comes and goes—one moment here, the next moment gone. This roller coaster of absence and presence is a very stressful kind of loss—what author Pauline Boss calls ambiguous loss.

https://www.caregiver.org/caregiving-and-ambiguous-loss

–  The nonprofit Family Caregiver Alliance was formed more than 40 years ago to support… those struggling to provide long term care for a loved one who did not “fit” into traditional health systems: adults suffering from Alzheimer’s disease, stroke, Parkinson’s, traumatic brain injury and other debilitating disorders.  The diagnoses were different, but the families shared common challenges: isolation, lack of information, few community resources, and drastic changes in family roles.  https://www.caregiver.org

–  Pauline Boss, PhD (biography) – https://www.ambiguousloss.com/

    Since 1973, Dr. Boss has studied ambiguous loss, taught university students, practiced as a clinician, and trained family therapists, psychologists, counselors, and humanitarians around the world to help individuals and families suffering from the trauma of ambiguous loss and its grief that has no end.  Drawing on research and clinical experience, Dr. Boss worked across cultures to develop six useful and inclusive guidelines for building the resilience needed to both bear the ambiguity and move forward to live productive lives.

    …. Dr. Boss received her Ph.D. in Child Development and Family Studies from the University of Wisconsin-Madison in 1975.  From 1975 to 1981, Dr. Boss was an assistant and then associate professor with tenure at the University of Wisconsin-Madison.  In 1981, she joined the Department of Family Social Science at the University of Minnesota and continued there as full professor until 2005 when she became Emeritus Professor.  In 1995-96, Dr. Boss was appointed Visiting Professor at the Harvard Medical School, and in 2004-2005, she was awarded Moses Distinguished Professor at Hunter School of Social Work in New York City.

–  Dr. Boss has published several other books and articles on ambiguous loss and related topics.  See Books Available https://www.ambiguousloss.com/resources/ & https://en.wikipedia.org/wiki/Ambiguous_loss

–  There are links to Pauline Boss and ambiguous loss training as well as other audio, video and print resources at https://www.ambiguousloss.com/resources/interviews/ — including a 2016 National Public Radio interview of Dr. Boss by Krista Tippett (host of On Being) described below…

Pauline Boss is professor emeritus at the University of Minnesota. She is the author of “Loss, Trauma, and Resilience: Therapeutic Work with Ambiguous Loss,” “Loving Someone Who Has Dementia,” and “Ambiguous Loss.” She has also pioneered a global online course with the University of Minnesota called “Ambiguous Loss: Its Meaning and Application.”

https://onbeing.org/programs/pauline-boss-the-myth-of-closure-dec2018/

–  To reduce a care partner’s frustration with a frail loved one who refuses advice and help, one participant said that visualization of the Buddhist bodhisattva Tara helped her connect to the loved one with compassion.  

Tārā is a meditation deity worshiped by practitioners of the Tibetan branch of Vajrayana Buddhism to develop certain inner qualities and to understand outer, inner and secret teachings such as karuṇā (compassion), mettā (loving-kindness), and shunyata (emptiness). Tārā may more properly be understood as different aspects of the same quality, as bodhisattvas are often considered metaphors for Buddhist virtues.

https://en.wikipedia.org/wiki/Tara_(Buddhism)

–  On a practical note, another participant added that it was important to allow frail loved ones to make their own decisions—what experienced caregivers call “permission to fail”.   It is also important for a caregiver to realize the limits of your ability to get a loved one to do what you believe is best for them.

–  A June 30, 2015 article on the Working Caregiver blog discusses how caregivers should allow themselves the permission to fail. https://theworkingcaregiver.org/2015/06/30/permission-to-fail/

End-of-Life Care

–  Aparticipant recommended The Conversation Project for learning about ways to have difficult conversations with family members and reluctant listeners on the subject of death and dying.  At our May 2018 meeting this nonprofit organization (based in Boston Massachusetts) was described as a good resource for learning how to listen to care partners more intently and helping people talk about their wishes for end-of-life care.  https://theconversationproject.org/

–  A participant described how she uses mental visualization of thebodhisattva Avalokiteshvara to help deal with the sudden death of her child.  She also contemplates her lost child as a beloved person (in place of one’s often-used mother) when doing equanimity visualization meditation intended to see all persons as one’s own close family member.  When her loved one unexpectedly died, she invited everyone who came to the memorial service to wear bright colors, which helped keep the mood positive.

–  Avalokiteśvara (WikiPedia) is a bodhisattva who embodies the compassion of all Buddhas…. In Tibet, he is known as Chenrezig. https://en.wikipedia.org/wiki/Avalokiteśvara

–  Another participant recounted the recent death of her younger sibling who died peacefully.  It was a good death with lots of chanting in the hospital ICU during her last hours—including: Row, Row, Row Your Boat…Gently Down the Stream…Merrily, Merrily, Merrily, Merrily…Life is but a Dream (which she described as a very Buddhist little song).  The meeting ended on a high note, as she chanted the mantra of Avalokiteshvara for the group followed by another participant’s chant of a Sanskrit mantra—one she leads in her yoga classes.

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