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Objective articles about life in an assisted living facility and aging in general.

Age Well, Stay Active

Here, from your fellow assisted-living residents, are some tips on how they keep going as they age. The suggestions are all from workshop members of Brush Point Manor, an independent living community in Detroit. Here, with attribution, are their ideas:

  1. Joyce Alfaro enjoys traveling to many countries now that she has time.
  2. Nathan Anderson stopped using drugs and counsels other addicts.
  3. Bessie Ardis keeps in touch with her family at reunions.
  4. Dorothy Bell cherishes her freedom: she does what she wants to do when she wants to do it.
  5. To be creative, Barbara- Jean Carter plays music and crochets.
  6. Mildred Everett enjoys trips with the Grandparents Raising Grandchildren program.
  7. Charity Jackson teaches an exercise program to fellow residents while improving her own health.
  8. Thomas Jackson takes pride in photography and singing.
  9. Harriet Jenkins feels glad that her husband still thanks her for being his caregiver a few years ago.
  10. Edward Leonard shares with others life lessons he’s learned.
  11. Leila Marsheall looks forward to new experiences in her work as an evangelist.
  12. Harold Massengille’s post-retirement job as Brush Park Manor service coordinator brings him appreciation and smiles.
  13. Helen Presley finds comfort from reading her Bible. It makes her feel that life is worth living.
  14. Bettye Rosboro’s faith strengthens her through trials in life and makes aging wonderful.
  15. Dorothy Wise, a heart and kidney transplant and cancer survivor, declares she is a miracle!
  16. Barbara Young keeps busy with committee work and dating her male companion!

Assisted Living: Small But Special

An article in The Guardian of England of April 15, 2014 reports on an unusually good nursing home in England. Though small, Saint Leonard’s could well be a model for much larger facilities everywhere.

A survey of 21,000 residents of assisted-living facilities in Great Britain showed a surprising result. The best “care” home (as it is called in Great Britain) was a small rest home in Hampshire called Saint Leonard’s. The survey included residents of big private and not-for-profit care providers throughout the United Kingdom, but an unusual fact about Saint Leonard’s is that it has only fifteen beds! It was probably the smallest residence in the survey!

The caring owners are a husband and wife team, Frank and Mary Bartlett, who have run Saint Leonard’s for more than seventeen years. Once inside the front door, The Guardian notes, you have a good idea why the residents feel so at home. The decor is more homey than up-to-date, the residents seem to feel at ease, and their families and staff are all eager to pay tribute to the high quality care and family atmosphere it offers. “It’s an amazing place,” says Diane Searle whose 83-year-old mother, Joyce Sivers, has dementia and lives in the home.”It was the hardest thing I’ve ever had to do, putting my mum into care, but it was like coming home when she came here. Mum is always comfy, they fuss around the residents like they’re their own mums, and they’ve been good for me too, giving me support.”

Frank Bartlett sums up the philosophy of the place in a way that is undoubtedly relevant to assisted living facilities everywhere, even those ten times the size of Saint Leonard’s. He says, “This place doesn’t look like much from the outside, but inside we like to think there’s a heart of gold. We try to run a family friendly care home. The residents are your mums, dads, or aunties, and we treat them accordingly—like our family.”

Kate Murray, the reporter for The Guardian, agrees that the residence has hidden charms. She writes that from the outside, it is a pretty undistinguished-looking place. Two houses knocked into one on an ordinary street with walls that its owner says is about to get a much needed coat of paint. There is no  sign to tell you that this is an assisted-living facility, let alone one of the best ones of its kind in all of England.

Does Older Mean Wiser?

What does it mean to be wise?

We move closer to wisdom if we can promote well-being in ourselves and others  by carefully estimating the risks and balances of any situation and, having done so, we use that estimation to act for the greatest good.

It is a wise person who behaves this way. A wise person is able to make use of knowledge, experience, understanding, common sense and insight. He or she possesses knowledge that he can then  apply it to any given circumstance. To achieve this balance, it is important to be able to control one’s emotions. Those who have these qualities or can develop them are considered wise.

Ronald tells Dan, his father, that he’s decided to quit his job in order to go into business with Eric, a good friend of his. The idea: bringing lobsters from Maine to Iowa, where they will open a string of roadside lobster huts of the type seen along the coast of Maine. “It’s a sure-fire idea, and the beauty part is that Eric’s putting up all of the money. All I have to invest is sweat-equity.” Dan points out: “If the business fails, you’ll have to start all over at another job. If it succeeds, Eric might decide that, since you didn’t invest money, you’re not really a partner, and you could wind up losing not only your “sweat equity”, but your good friend.”

There is a time-honored belief that wisdom comes with age and an acceptance of death. But there are  many foolish old people around, and their lack of development  dispels the notion that age always leads to wisdom. Happily there are also many judicious and thoughtful people in public and private life whom we can gladly call wise. They are perceptive and effective. They show good judgment and act after carefully reviewing the consequences of various courses of action. Wisdom is a large word. A solemn concept, but it is often shown in small, everyday ways.

If we are able to maintain a sense of well-being in the face of physical decline and death, we are on the path to successful aging and wisdom.

Vivian Clayton, a geriatric neurophysiologist, developed a definition of the components of wisdom in the 1970s, and these three seem to be paramount to achieving it:

Cognition (access to one’s acquired knowledge)
Reflection
Compassion.

Bill and Donna want to build a house at the top of a mountain in Estes Park, Colorado because of the fabulous view. Eddie, a pensioner who has lived there all his life, points out that his father told  him about a catastrophic mudslide  that occurred there when he was a young man. Bill: “But that was ages ago.” Eddie: “Not to the mountain.”

Unfortunately, cognition slows as people age, but speed in cognition may not be essential to the elderly anyway. Older people have much more information in their brains than younger ones, so retrieving it inevitably takes longer. On the other hand, the quality of the information in the older brain is more varied and nuanced, owing to the length and variety of experience in a long life.

Younger people are indeed faster in tests of cognitive performance,  but older people demonstrate a “greater sensitivity to fine-grained differences,” as shown by a study in Topics in Cognitive Science.

According to Dr. Clayton, to be wise, one must take time to gain insights and perspectives from one’s cognitive knowledge (the reflective dimension). Then one can use those insights to understand and help others (the compassionate dimension).

Tamara’s children are not doing well at a public school in the city. She blames it on the school. The other students are unruly and a bad influence. She tells Rose, her mother, that she and her husband have decided to move to an affluent suburb that has a top-rated school. Rose, who has had a lot of experience with how children influence one another, points out that the new classmates might be so advanced that they may discourage rather than encourage her children. Better to find a middle ground.        

Working from Dr. Clayton’s framework, Monika Ardelt, an associate professor of sociology at the University of Florida, expanded on studies of old age because research shows that satisfaction in old age that Dr. Clayton emphasizes of major qualities like retaining mental and physical health, volunteering and socializing with others.

But mental and physical health in the aged is often not optimum because the body may break down. Social roles for the elderly are diminished owing to death, loss, and deterioration in oneself, family and friends. These people are handicapped by their losses, Professor Ardelt noted, but questioned whether that meant that they have to give up all hope of successful aging.

Not if they are wise. Wisdom, she noted, is”the ace in the hole” that can help even severely impaired people find meaning, contentment and acceptance  in later life.

Do Brain Games Work ? (Part Two)

Brain Games won’t go away because there is such a strong impetus to improve memory in older adults now that we know that brain neurons do regenerate. The first results were equivocal (see Part One); later results are more encouraging. Last fall (September 2013) the scientific journal Nature published a study by researchers at the University of California at San Francisco showing that a computer driving game did improve short-term memory and long-term focus in older adults. These findings are significant because the research found that improvements weren’t limited to the game but also appeared to be linked to a strengthening of older brains overall, helping them to perform better at other memory and attention tasks.

Of greater importance, perhaps, is that in addition, brain monitoring during the study showed that in older adults, game training led to bursts in brain waves associated with attention:  the patterns were similar to those seen in much younger brains.

And there’s more. In January, 2014,  a randomized trial of cognitive training in older healthy adults found that gains in reasoning and speed through brain training lasted as long as ten years. This study, financed by the National Institute of Health, recruited 2,832 volunteers with an average age of 74. The participants were divided into three training groups for memory, reasoning and speed of -processing. There was also one control group.

The groups took part in ten training sessions of 60 to 75 minutes over five to six weeks. Researchers measured the effect of the training five times over the next ten years.

Five years after training, all three groups still demonstrated improvements in the skills in which they had trained. However, the training did not carry over into other areas. But after ten years, the reasoning and speed-of-processing continued to show improvement.

There was also a curious, unexpected and gratifying finding: people in the reasoning and speed-of-mental-processing group had 50% fewer accidents than those in the control group!

Do Brain Games Work? (Part One)

I read a fascinating article by Tara Parker Pope in the March 11 edition of the New York Times. I thought I’d summarize and comment on it here.

As the aging population in the United States grows larger, brain game manufacturers have been working harder to help the aged keep mentally alert.

Luminosity, for example, the best known of these brain game developers, has users match tile patterns to challenge memory. The patterns are simple at first, then grow increasingly more difficult, demanding more memory from the user. This game, like most brain games, is designed to encourage active use of the brain.

Luminosity has fifty million subscribers who depend on it to keep mentally active until late old age. Other cognitive training centers, like Cogmed (British) and Neronix (Israeli) and many more,  are developing similar programs to prevent intellectual decline and promote intellectual vigor in old age.

Sources of encouragement for the development of methods of preventing senility through brain games now  includes Medicare and Medicaid, which are lending their support for what Neuronix calls “new hope for Alzheimer’s disease.” They are considering reimbursement to oldsters who enroll in “memory fitness” programs. This is a major shift in the brain fitness business, whose primary focus used to be   on helping children with attention-deficit problems and in improving academic performance. Now the emphasis in brain research is to find effective ways to stave off memory loss or prevent Alzheimer’s.

In recent years the search for a website or video game has became the “holy grail  of neuroscience”, said Dr. Murali Doraiswamy, Director of the Neurocognitive Disorders Program at Duke Institute for Brain Sciences. Unfortunately, as Dr. Doraiswamy discovered, the science of cognitive training has not kept up with the hype. We are simply not there yet. “Almost all the marketing claims made by all the companies devoted to brain games go beyond the data,” he said. “We need large national studies before you can conclude that it’s ready for prime time.”

Over the past twenty years, neuroscientists have  demonstrated that the brain regenerates neurons until late in life. This encouraging fact grew out of research with humans and animals and was the reason for so much hope and optimism about the brain’s never-ending vigor.; It has led to a burst of creative ways to tap into that vigor.

Those endeavors  resulted in a tsusami of brain games. Old people did well on them, and that was encouraging as well, but critical questions remain about whether an intervention that challenges  the brain—a puzzle, learning a new language or improving skill on a video game, can either raise intelligence or stave off normal memory loss.

In February 2013, an analysis of the newest studies at the University of Oslo concluded that while players do get better at their games, the increase in skill has not been shown to transfer to other tasks. In other words, playing Sudoku or an online matching game makes you better at the game,  but it doesn’t make you better at math or help you remember names.

And so, we can say that although there is a keen interest in and growing market for cognitive training tools, the results for improving memory across the board for aging adults have been mixed. However, the jury is still out as scientists continue to try figure out ways to help the regenerating neurons cross over to other areas of the brain and become more versatile.

On a personal note: I find reading about these studies fascinating because, as a retired psychologist, I have a continuing professional interest in them. However, I can also confidently say that, from observing elderly people (including myself) who keep their minds occupied by continuing to learn new skills or improving existing ones, the theories behind these brain games are credible.

Mindfulness

Mindfulness signifies presence of mind. It means to be thoughtful about what you are doing at the moment you are doing it. One should be attentive and aware of what is happening in the moment. To do this, one should maintain a calm awareness of one’s body, feelings, and mind. It is easy to keep such an inventory in mind when you realize that to be fully aware of life as you live it helps you to live it well.

To be mindful of what you are doing is desirable at any age of course, but it’s especially desirable for old people.  We need to be sure  we’re taking the right bus to visit our sister or  our doctor because retracing  our steps takes time and energy (and can lead to confusion). We  want to avoid slippery walks because fractures take so long to heal.  We may need to read a passage in a book more slowly to be sure that  we have fully taken in its meaning.

These issues come up in assisted living. Dolly, a new resident of The Hallmark, raised her hand at a meeting and asked to speak on this topic, although she didn’t put it that way. She said,  “I did something very dumb and I want to tell you about it. I was talking on my cell while I was  going to get the mail and I tripped on the last step. Boom. Multiple fractures and two weeks in the hospital. My daughter said, ‘Ma, you’re a spring chicken in the heart, but not in the bones.’ She’s very good natured for all the trouble I caused her.”

Dolly went on to tell us that her recovery was slow and painful and it taught her to watch where she  is going. “Where’s the fire?” I ask myself now. She limped back to her seat.

She reminded me of my own headlong fall some years ago while I was running to answer the phone. The phone could have waited. The caller would have left a message. I’m embarrassed to say that I was in my late seventies at the time, a little late to learn common sense but thank Heaven I finally learned it. It taught me to be more deliberate—mindful, I guess.

When I had my hip operation, the doctor told me to get up and walk after the second day.  I hesitated to do it and my hospital roommate, Mrs. Jaffee, said, “I think the doctor is crazy. Who walks on a broken bone?”.  She just  laid back on her pillow and picked up the  phone to call a friend to bring a turkey sandwich.

I wanted to be mindful of doctor’s orders and my own vulnerability as well. What to do? I started out very slowly on my walker, silently agreeing with Mrs. Jaffee that the doctor was crazy.

I was inching down the corridor where I met Nate Glazier, whom I knew from my orthopedist’s waiting room. He was practicing on his walker and was very deliberate with each step. I told him that Mrs. Jaffee was sitting up in bed eating a turkey sandwich and that I thought I should go back and do the same. Nate said,  “If Dr. Sherman says we gotta do it, then we gotta do it. You just have to think about what you’re doing. You want to be mindful!”, he shouted back at me, because I was loitering in the hallway unsure of going further. I took slow steps at first and we crept down the corridor together.

“That’s the ticket,” Nate said. “Happy medium. Not too slow, not too fast.”

That sounded like mindfulness to me, so I moved a little faster.

Jiro Ono, 89: A World-Class Perfectionist

Jiro Ono from Japan is the world’s oldest chef. He is the owner and chef of the sushi restaurant, Sukiyabashi, in Tokyo. He was first awarded Three stars (its highest honor) in the coveted Michelin Guide to Tokyo in 2008. Now, near ninety, his star intact, he is still preparing sushi. His restaurant is right next to the Ginza metro entrance in the basement of a building in Tokyo. This is a modest entrance to great meal.

A meal at Sukiyabashi consists of  twenty pieces of sushi served one at a time and costs 30,000 Japanese yen (about three hundred and seventy dollars). The meal lasts about fifteen or twenty minutes. Those who have eaten there say that the meal may be fleeting in time but, owing to its perfection, it lasts forever in memory. The dining arrangements are unusual: there are only ten seats and no set menu, no appetizers, and no changes of menu allowed. Despite these restrictions, people from all over the world flock to Jiro Ono’s restaurant for the privilege of eating a sushi dinner designed by a master. Jiro Ono’s standards are high and have even been deemed  “impossible.”

All of these elements go into his preparation for the day: first, his son bicycles early in the morning to the markets to find the best catch of the day. After that, Chef Ono meets with specialists in shrimp, eel, or octopus to see the fish for himself and confirm its quality.

Jiro Ono, this connoisseur of sushi, was born in 1925, left home at the age of nine and has been making sushi ever since. It is remarkable that he knew exactly what he wanted to do at such a young age. He seems to have had a calling. In Japan there has always been a ritual to making and serving sushi.  Its best practitioners are considered artists.

Although Japan has declared him a national treasure, he recently replied, “All I want to do is make better sushi.” Before cooking his octopus, for example, he used to massage it up to thirty minutes to soften it. He increased the time as he grew older,  believing that it was not as soft as he could get it. Now he will message it for up to forty minutes to give it an even softer texture and better taste. He always tastes his food as he makes it, and he dislikes holidays because he prefers to be working. As he is such a perfectionist, it comes as no surprise that Jiro also has his own rice supplier. Jiro is described as a shokunin, a person who embodies the artisan spirit, a person who embodies the relentless pursuit of perfection through his craft. This unflagging effort towards improvement is also an important Japanese ideal called kaizen

Because the restaurant does not have a menu, the food that will be served at any meal is recited to the patron by his server. They do not accept credit cards. Tables are booked for the next three months, but anyone contemplating a visit and a meal at Jiro Ono’s Sukiyadoshi retaurant should make a reservation at least six months in advance.

Age is no obstacle. Jiro Ono plans to be there in the kitchen as chef and owner when you arrive.

Ageless Gymnasts, Unusual Leader

As reported in The New York Times of March 2, 2014, Thomas Mickens, a former prisoner, is now an aerobics instructor to a large group of seniors in the Rochedale Village Senior Center in Queens, New York.

The class begins at 8:30 am, and these enthusiastic oldsters, sixty to ninety-years-old, under his direction, give their all, pushing, reaching. and stretching for an hour. The exercises include lifting one, two, or three-pound weights and stretching their muscles in standing and sitting positions. At one point they do The Wave in their chairs, and Mickens urges them on. “Looking good! Work with me! A little higher!” He uses a rhythm-and-blues records to keep the class up and moving.

Is this all too much for his ageing clientele? Not a bit of it said Audrey Williams, who is still lean and trim at 84. She drives about ten blocks to get to class. “I go to four of his classes a week”, she said. The workout make her feel so good that she goes to another one of the classes he teaches in Rockaway as well.

Mr. Mickens is fulfilling his mission to bring fitness to older adults, and he hopes to expand his exercise empire, called The Tommy Experience, to reach seniors throughout the country. His own personal experience is a far cry from the healthy world of aerobics. While transforming others, he is also transforming himself. When he was a young man of twenty-five in 1989, he was a drug dealer and notorious.

At that time he was described by one of the arresting officers as one of the five top drug dealers in southeastern Queens. He had a widespread operation, with more than fifty people working for him. Young as he was, he made so much money that he owned a five-bedroom house in an affluent neighborhood,  twenty-one luxury cars, including a Rolls  Royce, and a 38-foot yacht that he kept near a condominium he owned in California. All this luxury and high-living was acquired through a well-organized drug network. At the time of his trial in 1989, prosecutors estimated that he made more than 2.5 million dollars from the sale o f cocaine alone. This estimate did not even include down payments on properties and cars.

Mr. Mickens spent twenty years in prison, some of it in solitary confinement. While he was in solitary, his mother died, and the combination of his mother’s death and his time alone in prison may have been life-changing for him. He told this story to one of his classes recently.

“My mother was in a nursing home. She was half-paralyzed from a stroke, and no one would help or motivate her. I want to help you because I couldn’t help my mother. Every one of you, I see as my mother.”

During his long confinement, Mr. Mickens had plenty of time to consider how he wanted to live his life once he was free. As soon as he was released, he set about doing it. He worked for a fitness group, eventually leading two senior aerobic classes a week in fitness instruction, and got his certification as a physical fitness trainer.

It is ironic that Mr, Mickens demonstrated his intelligence, energy and organization ability in his early life and used it to destroy other human lives through drugs. Now, twenty years later, after prison with a lot of time to think about the course his life had taken, he has been able to turn his life around to enhance old people’s lives through exercise. These days he plans to use his new-found freedom in the service of exercise. As president and CEO of The Tommy Experience, he wants to turn his company focus on older adults into an international brand . He sees exercise and everything related d to it as the new, good gospel.

Shirley Temple

It’s hard to believe it, but Shirley Temple, the darling of our youth, the blonde curly-topped child star who sang and danced for us in our own childhoods, died on February 10, 2014 at the age of 85.

She was born in 1928 and became famous in 1930 when her mother realized that she had a natural flair for singing and dancing.  At the age of three, she worked for an educational film company. Shortly thereafter she was put under contract by Fox, where she made movies like Bright Eyes and Captain January. She sang On The Good Ship Lollipop and she and the song became famous along with her.

She was the leading child star of the era, and in those days of intense segregation in the movies, she sang and danced with Bill “Bojangles” Robinson, a black actor, without censor. She was on our minds and in our hearts from the time she was three and a half until about the age of fourteen. She was an inspiration to all little girls, and to their parents as well. The girls wanted to sing and dance and be as adored as Shirley, and the Depression-era parents shelled out money they could ill-afford to send their children to singing and dancing school. A darling little girl became the role model for the way to fulfill the immigrant’s fantasy of the American dream.

I know that was true of my own parents. Even though they were already feeling the pinch of the Depression, they sent me to dancing school when I was six. I proved a dud, but I was only one of thousands of little girls my age sent to some hastily-created singing and dancing school with a secret dream of improving the family fortunes.

But it was not greed or ambition that prompted poor parents all over America to empty their pockets. Shirley Temple was the child you wanted your child to be: modest, sweet-tempered, sociable, talented, beautiful, well-behaved, intelligent and kind. And for a young child, she also seemed unusually sensible. Above all, as one of one of the commentators noted, she had “infectious optimism.” She won an Outstanding Personality Award in 1934 when she was only six!

There was no question that Shirley Temple made a poor, struggling, depression-sad nation feel better about itself, an amazing feat for a toddler aged three and one-half, for that is when the Shirley Temple reign began. Accounting for her universal popularity, President Roosevelt said that she raised the public’s morale during hard times. “As long as our country has Shirley Temple it will be all right,” he said.

Many child stars become disoriented by their early fame and cannot cope in adult life without it. This did not happen to Shirley Temple. From a sturdy child, she became a sturdy woman. Shirley Temple Black had a long happy marriage and became an ambassador for her country. One can truly say of her that she was an ambassador for her country from an early age.

Loss

I’m  still thinking about Roger Angell’s piece in The New Yorker (February 17, 2014), particularly his thoughts, at the age of 93, on how he has experienced and dealt with loss.

He begins with the hard but obvious fact that most of the people he knows are dead, almost beyond counting.  He brings them to mind by herding them together aboard a luxury ship. There’s his father, about to light up a Lucky Strike; a girl he knew  in the forth grade; V,S. Pritchett and Herbert Mitgang, writers he knew, and “my elder old maid  cousin.” Bart Giamatti, a former president of Yale, is on this ship, as is his daughter Callie. He hears Callie on the telephone fondly calling “Da-ad?”, with  her familiar rising inflection, just as she used to do. He remembers Slim Aarons (??), a baseball player he knew as sportswriter, and several colleagues and friends from The New Yorker, where he was an editor for over forty years.

Life speeds by so quickly, with hardly time for reflection, so when Roger Angell steps out from  the busy-ness of daily life into the quiet of old age to pause and reflect on the dead and to tell us about it, we are grateful to him for giving them their due. He remembers their gestures, tone of voice and relationships, even a bright scarf that one of his friends wore years ago. He remember them from different eras, from school age to old age.
These names are best kept in mind, he feels, rather than boxed and put away on a shelf or  remembered through  photographs. As Angell reports it, he seems to have the ability to live with his dead at any time, to call them forth at any time, and he seems to fund it comforting. He doesn’t visit them often, but once he starts, “the battalion” of the dead is alert and ready for him.

The concept of death itself is unsurprising because it is all around us. In hurricanes, floods, street crossings, murders, wars, drownings, disease and starvation. School  shootings, ethnic cleansings and many more catalogued and uncatalogued ways of dying. Death is  ubiquitous, and although all-important, is also universal and constant. It is the most feared aspect of life, yet the most commonplace. It is so reliably there that it can easily be ignored, though not by the old, who keep death in mind.

The best way to honor the dead is to bring them forth one by one as Roger Angell has done.  jAnd come to think of it, this is also a good way to pay full attention to the living.