the energy of youth

A post on Reflections from Kathy prompted these thoughts. Thanks, Kathy.

Our grandson is just 19 months old and boy does he keep us going! It is wonderful to have him run towards us when we arrive, holding his hand out to grab one of my fingers so he can lead me toward the front door to go outside. He loves being outside. And he clearly associates our arrival with an opportunity to get out of the house.

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No matter how hard we try to keep him inside, where his energy isn’t quite so overpowering, to read books or play with his many motor vehicles, he insists on heading outdoors. And with his engaging smile, how can we resist?

My knees and hips may ache, and he doesn’t know his own strength as he holds on very tight to my finger and he swivels to change directions without warning, but I have decided he is my favorite exercise regime. He walks faster than I do, at least as he heads downhill pushing is toddler-sized cart filled with his favorite toys. So keeping up with him adds plenty of steps to my Fitbit record for the day.

He is approaching the terrible twos and seems ready to jump the gun. The other day, as we had urged him nearly home, trying to dissuade him from marching up the sidewalks to the neighbors’ porches, he began stalling, walking behind the fence that surrounds the house at the bottom of the cul de sac where his home is, watching us carefully to make sure we weren’t coming after him. When we called to him, he would come, but only as far as the driveway. He would stand on the lawn, dangling one foot in the air, as though he was about to step on the driveway to follow us, when he would swivel again and head back to the end of the lawn. Cajoling didn’t work to get him back on the path. And there is absolutely no way we would resort to a pat on his little behind to encourage good behavior – not these days.

But when he headed towards the neighbor’s back yard, we had to take matters – and him – into our own hands, picking him up and making our way swiftly back up to his home, our son’s home, our grandson’s mother’s home.

It is the most wonderful exercise program in the world.

institute of medicine report urges changes to end-of-life care

The Institute of Medicine has issued two previous reports on issues related to end-of-life care, the first in 1997, Approaching Death: Improving Care at the End of Life, followed in 2003 with When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families. Their latest report, issued this year and available in Prepublication form, is Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.

 

From the front matter of the report is this explanation.

The controversy on this topic [end-of-life options] and the political desire to avoid it do not alter the fact that every person will face the end of life one day, and many have had hard experience with the final days of a parent, a spouse, a child, a sibling, another relative, or a dear friend. At a time when public leaders hesitate to speak on a subject that is profoundly consequential for the health and well-being of all Americans, it is incumbent on others to examine the facts dispassionately, assess what can be done to make those final days better, and promote a reasoned and respectful public discourse on the subject.[1]

The report refers to the fact that while end-of-life is inevitable, and, for all but the few who die as a result of accidents or trauma, death comes as a result of one or more diseases that require careful management over weeks, months, and even years. Often the diseases bring on diminished cognitive functions, making it difficult or even impossible for family members and those caring for the individual to know the wishes of the person receiving care. When discussions haven’t taken place earlier, at a time when all individuals are able to express clearly what is desired during those final days, the decisions made are based on assumptions, unspoken fears, and even unrealistic hopes for recovery.

When I first went overseas to work for the U.S. Department of State as a Foreign Service Officer, I was advised to talk with my parents and other family members about what I wanted done if something should happen to me while I was overseas. One of my colleagues did and after that conversation she encouraged each of us even more strongly to hold those conversations. She told her parents that if she should die while overseas, she wanted to be cremated and her urn sent back to her family. When her father objected that he wouldn’t be able to accept her death without being able to see her face in a coffin, she changed her mind and agreed with her parents. Even that reason for holding a conversation with my parents wasn’t persuasive, so strong was the fear that talking about death was too close to inviting it.

The IOM report contains five recommendations, in the areas of care delivery, clinician-patient communication and advance care planning, professional education and development, policies and payment systems, and public education and engagement, which the report authors say collectively offer a roadmap for progress in the nation’s approach to end-of-life care and management. The recommendations boil down to: more resources to provide palliative and hospice care, encouragement for doctors and other health professionals to talk with patients about options for end-of-life care, providing incentives to pay care-givers to provide palliative care for patients with advanced serious illnesses outside of a hospital, and requirements for greater training in palliative care for all health professionals.

More than 25% of Americans, including those over 75 years of age, have not given thought to how they would like to spend their last days. Not even 25% of Americans have put their wishes in writing. Yet we all worry about being a burden on those around us, especially financially as we hear again and again that the difference between a comfortable life and bankruptcy is a lost job or a serious illness. Coupled with the fact that by the year 2050 the population of elderly in the United States will have doubled what it was in 2005, according to Pew Research [2], how can we not acknowledge the need for informing the elderly – and their family members – that there are options to costly surgeries and treatments intended to prolong life without considering what the quality of that life will?

My parents got the thinking started when they sent each of us children copies of their wills, powers of attorney, and advanced medical directives so that we would all know what their wishes were and why they had designated my brother as their power of attorney (he was the youngest, but he lived nearest them).

Then my husband furthered my thinking when we sat down with a lawyer many years ago to draw up our wills. He insisted more strenuously than I thought necessary that he did not want extraordinary measures should he suffer a catastrophic illness or accident. It wasn’t so easy for me to agree that his wishes were mine. But by the time we had to go through that process yet again, now that we are live in a different state and we have a grandchild we wish to provide for as well, I had had time to think about it and to conclude what needed to be put into writing to ensure, if accident or trauma do not intervene, I will experience a good death. I will use my time to say I love you to those I love, to thank those around me for all they have done for me, to ask for forgiveness from anyone I know I have wronged, and to forgive anyone who has wronged me. I won’t need more time than that, especially if I don’t even know where I am or who those around me are.

In the words of the IOM report, “A palliative approach can offer patients near the end of life and their families the best chance of maintaining the highest possible quality of life for the longest possible time.”
[1] R9, Introduction to Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, National Academies Press, 2014, prepublication version.

why do the parents of college grads live longer?

I’m sure glad our son and daughter-in-law both have degrees!

All About Natural Wellness

Want to live longer? Send your kids to college came from a recent headline in the Washington Post’s Wonkblog. The Wall Street Journal also published a blog titled Send Your Kids To College To Live Longer, Paper Argues.

Could it be true? Could the simple secret to living longer be to have kids who are more educated? Granted, it’s not a cheap process, but while exciting, this may not necessarily be as true as we are led to believe. The research is advertised as having causality involved when in fact, especially with limited studies. If you were to run the same kind of study, you might conclude that oranges cure cancer, peanut butter prevents it, and anti-bullying programs in fact cause more bullying.

The reports come from the study The Schooling of Offspring and the Survival of Parents. This was published in the August issue of the journal Demography, and…

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the internet of things

I recently read about a study conducted by researchers from DARPA, the Defense Advanced Research Projects Agency, the folks who brought us the Internet, about in-vehicle technology such as OnStar on my favorite professional networking site, GovLoop.

Using a MacBook to hack into a car’s mobile connectivity system, the duo could control a car’s power steering, trip the GPS and falsify the speedometer and odometer readings. Even more worrisome than that, they could lock the vehicle’s brakes, disabling the driver’s ability to halt the car before crashing into another vehicle, person or structure.

Those results are exactly why I fear the consequences of the Internet of Things for seniors. My husband and I, for example, are considering the features we need in our next – and perhaps last – vehicle. Where we have always before settled for economical without comfort. This time we want luxury and convenience. As we age, we lose upper body strength so power steering, power brakes, and power windows are essential. Even our little Scion has those features. As turning our heads becomes more painful, rear view cameras with dashboard-mounted screens are now on our list of requirements. And as reaction times slow, automatic braking when approaching an obstacle ahead is also essential. Most vehicles with all those features include a number of in-vehicle technology, including OnStar or other communications systems. Studies such as the one referred to in GovLoop add other another factor to consider. Security and safety are central concerns for seniors.

While I don’t envision the risk of a hacker compromising any in-vehicle technology in our next car, perhaps the study will serve as inspiration for fiction. my own or someone else’s.

just what am i trying to do?

When I first decided to create a WordPress blog, I wanted a head start on learning about WordPress because my office planned to move the professional communities of practice we support from MovableType to WordPress. It was immediately clear, however, that I had to decide what my personal purpose would be since blogging on “how I learned to use WordPress” would be about as interesting as any elementary school child’s description of family summer vacations. I needed to learn, but I didn’t want to be boring.

At the time I began Better Than the Alternative, I was in the limbo years of being above the age at which I could retire with an immediate pension and the age at which I would be eligible to sign up for Social Security and Medicare. I had already retired as in stopped working as a career employee of the federal government, but I have continued to work as contingency staffing, through a contractor who gets a slice off the top of what is charged to my agency for my services. Since preparing for real retirement (as in no longer having to go to work for eight hours a day) was on my mind, I decided to focus on my thoughts and reflections on issues I was facing or would have to face that I had previously thought only pertained to my parents’ generation.

Thus arrived Better Than the Alternative. My youngest brother’s unexpected diagnosis of acute myeloid leukemia followed shortly after, making it very clear that it was not too early to begin focusing on end-of-life issues as well as end of work-life issues. My brother, after all, had just passed 50. His death less than two months later and my father’s deteriorating health provided food for thought.

More recently, I have been following how technology impacts the lives of seniors. This is a rich field of material I hope will keep me posting throughout the rest of 2014.

name and tagline

This month I started WordPress’ Blogging University course, Blogging 101. For the next 30 days, I hope to post my assignments.

The assignment for September 15 was to come up with a name (not necessarily the same as the blog’s url) and tag line. After much consideration of options that I just couldn’t make sound musical or sensible enough, I’ve settled on this pair:

Better Than the Alternative: Life in the Gray Lane