vrijdag 29 mei 2015

Till Death Do Us Part

As a young nurse trainee I was assigned an 80year old woman, admitted to hospital because she was dying.  The lady had been admitted to hospital two weeks after the death of her husband of 50+ years.  Her medical file was light on details:  no sudden illnesses, chronic diseases or obvious causes resulting in her becoming bedridden and time-limited. 

Understanding what was happening with this lady was beyond me.  As way of explanation, the charge nurse told me that the woman wanted to die.  That after her husband, who had been sick with cancer for almost a year, died – she ran out of reasons to live and was now willing herself to die.

As I gave her a bed-bath and changed her sheets, I tried to persuade the woman that there were many good reasons to be alive.  Her eyes remained vacant and her lack of words told me that she was unconvinced by my arguments and determined in her own plan of action.  She died on her fifth day in the hospital.  Being young and inexperienced in most life matters rendered me incapable of understanding her lust for death.

“Till death do us part” is part of a marriage vow originating from the Book of Common Prayer (originally published in 1549), still repeated in many wedding ceremonies conducted in the English speaking world.  Rising divorce figures clearly indicate that an increasing number of couples are not taking this vow seriously, yet there remains a significant group of older adults able to legitimately celebrate 30, 40, 50 or even 60years of marriage. 

Getting old with someone you love is a popular romantic notion intrinsic is all societies.  Generally over time romance diminishes and is replaced by more practical considerations like jobs, mortgages, children, vacations, aging parents etc etc.  For better or worse, enduring partner projects are the things that glue many marriages together.

Increasing age comes with an escalating probability of illness and disability – often resulting in one partner taking on the role of care-giver for their ailing spouse.  With most chronic illnesses, like dementia, this role can extend for years becoming heavier as the disease progresses.  Spousal care-givers frequently conceal their exhaustion and difficulties, not wanting to admit defeat by asking for help to look after their partners.  This can cause stress that negatively impacts on the care-giver’s health and ultimately leads to “caregiver burnout”.   

Assessment of an in-home care situation with older couples is difficult for families and professionals alike.  Family members are often blind to what is happening in their parent’s home.  They may believe that everything is okay and that their ill parent is having a rare ‘bad day’ when they visit or are unable to speak to them on the phone.  Health professionals may be denied entry into the home and distracted from the truth by cancelled appointments and assertions that everything is fine.   The threat of separation by hospitalisation or admission to residential care is a source of great anxiety for many older couples – as is the fear of being left alone. 

The irony is that accepting the help that is available can often extend the time a chronically sick person can be managed within the home environment.    For a spouse, accepting help can mean taking a well needed respite break – whether for a few hours or a few weeks.  A good example is that of the many dementia sufferers exhibiting nocturnal sleeping disturbances, often waking to loudly rummage through drawers and wardrobes.  Caregivers quickly become exhausted when their own night sleep patterns are disrupted.  Giving a caregiver a few hours to sleep, relax, go to the movies, drink coffee with a friend, take a walk, whatever the person needs to do to replenish themselves is not a luxury – but a necessity.  It helps to maintain perspective and attachment to the world going on outside the home that holds them, albeit willingly, inside caring for their partner.  

Home care services, support groups, older adult respite care programs (day and longer term), informal help from family and friends – are all options available to support older adults caring or being cared for within their own home.  While little can be done to lighten or remove the feelings of loss and sadness at seeing a life partner suffering due to illness, we can help to ease the daily burden of care by encouraging older couples to accept the services available to them.  Most importantly, supporting the individuals, rather than seeing the couple as a single unit, will promote an individual acceptance of the situation from their own personal perspective - and relieve the unreasonable expectation - “till death do us part” .

(This piece was published on Huffington Post on 29 May 2015

dinsdag 26 mei 2015

The Little Boy and the Old Man

Something beautiful from author Shel Silverstein....

The Little Boy and the Old Man

Said the little boy, "Sometimes I drop my spoon."
Said the old man, "I do that too."
The little boy whispered, "I wet my pants."
I do that too," laughed the little old man.
Said the little boy, "I often cry."
The old man nodded, "So do I."
But worst of all," said the boy, "it seems
Grown-ups don't pay attention to me."
And he felt the warmth of a wrinkled old hand.
I know what you mean," said the little old man.”

vrijdag 22 mei 2015

donderdag 16 april 2015


Stereotypes of old people driving cars are numerous, albeit always unflattering towards drivers who often have 40+ years of driving experience under their (seat)belts.   While most of us wouldn’t argue that decreased vision, hearing, and mobility are common factors of aging – it is the question of when these deficits make a person unsafe to drive that opens the quagmire of discussions on individual rights; community safety; isolation; adequate provision of public transport; town planning; home help services; family responsibility – and independence.

In many countries, people over a certain age (country specific) must agree to being reassessed by the driver’s licensing authorities.  If family members have sufficient concerns about the person driving before scheduled retesting, they may contact the family doctor.  Based on this hearsay from family members and/or caregivers, the doctor can request an early reassessment or a revocation of their driving license.

This issue has recently arisen in my own family.  My father who has numerous health problems, now including a diagnosis of “mild cognitive impairment” (often a precursor to dementia) has bumped his car into two parked cars.  I have three separate sibling accounts.  My brother reports that my father is an unsafe driver and has contacted the doctor.  One sister stated that the car he drives is now too large for him to handle – and consequently he did not see the parked cars he knocked.  My remaining sister has not had any recent experience of driving with our father, but based on his other health problems, feels that he shouldn’t be driving.

Flipside:  my father needs a car to get around in the rural town he lives in.  He is unable to walk more than 100metres and public transport is not an option.  His daily routine involves a drive to his local McDonalds for a morning coffee and then on to my brother’s business – before driving home three hours later (total distance per day of 6km).   The remainder of the day he sleeps or watches television.  Remove his car and license will mean that he spends all day at home, dependent on my mother and siblings – who are busy with their own lives.  He will loose the routine that gets him out of bed and into the community each day.

My father’s story will sound familiar to many people.  Naturally should he be an obvious risk to other drivers – and to himself – removing his license would be essential.  But this is not the case.  As with many older people in the early stages of chronic illnesses, like dementia, the disease progress slowly destroys skills and abilities. 

Yet a diagnosis is only a label with a likely path of prognosis. People need to be considered as individuals.  Other health problems, especially with eyesight and hearing, need to be evaluated should driving safety be a concern.  Safer alternatives should be implemented – for example, driving only familiar routes, only during daytime hours and in good weather, driving with someone else,  and retesting.

Finally – considering how routines and social contacts outside the home can be maintained should the person no longer be able to drive is important in making the transition from being an independent driver to someone dependent on others to be where they want to be – a little easier to accept.