Sex in the nursing home

Had some trouble pasting this to the blog, so my apologies if this has been confusing.  I have deleted the earlier posts made in error.  I think.

So, SEX.  This article from MSNBC indicates that in Australia, at least, sex may not be allowed in the nursing home.  So, part of our planning must be to:

1.  Make sure that the nursing home we are likely to end up in (remember, we childless must make this decision ourselves at a time when we can still make decisions) will allow us to either a) stay together, or b) sneak into eachother's rooms when, you know, its time to, well, you know.

2.  Retain possession of a car with a wheel-chair accessible back seat.

3.  Give up on SEX.  Yeh, right, like THAT is gonna happen.

#2 could be problematic, #3 just ain't gonna happen, so lets concentrate on the first option.

By Arthur Caplan, Ph.D.

When it comes to the elderly, almost no one wants to talk about sex. This is especially true when nursing home and residential care are involved.

According to new report by a group in Australia in the Journal of Medical Ethics, the idea that adults should be able to engage in sexual relationships whenever, and with whomever, they choose becomes very complicated for residents in most nursing homes. For residents with dementia, romantic intimacy is especially discouraged.

Many older people, including those with early stage dementia, enjoy sex while living at home with their spouses. But this ends once they move into a nursing home, even for long-term couples, note the researchers from the Australian Centre for Evidence-Based Aged Care. Married or not, sex ends at the nursing home door.

Nursing homes are simply not set up to permit romance. Privacy is at a premium and few room doors lock. Most rooms are double-occupancy with single beds. And nursing home staff don’t typically encourage romance and sex. It's one less thing for nursing home owners and administrators to worry about.

We're so prudish about the elderly and intimate relationships that we don’t even broach the topic when a loved one is heading to a home. We consider freedom and autonomy when debating who will have the right to pull the feeding tube or turn off the dialysis machine if Mom or Dad can't communicate, but we do nothing to ensure their right to enjoy themselves in an area of life that matters a great deal to them.

Sex may not be for every nursing home resident, but it is surely for some. That's autonomy worth talking about.

A nursing home ought be at least as tolerant as a prison. Some prisons permit conjugal visits. Shouldn’t we expect the same of nursing homes? If you care about your parents' and grandparents' dignity, sex ought to be a topic of conversation regarding the nursing home if that's where they're headed or where they now live.

Bioethicist Art Caplan is the head of the Division of Medical Ethics, NYU Langone Medical Center.

Rainy Day Money

Many elders, especially from the depression and WWII era, have saved rainy day money for years. Having that money available has provided reassurance and peace of mind for a long time. It is impossible to even think of it not being there. There is just one problem after all these years. They now can't recognize when that rainy day has arrived. And how could they even think about tapping into these savings that have become almost a part of them? Many excuses about why no changes are needed are offered, but often just to cover up the real reason, not wanting to spend the money. How can we help an elder accept the idea that it is not only rainy, but there is hurricane howling with lightening, thunder, and that the rain is causing "the creek to rise". Ask your elder what reason they would consider worthy of spending the money. If it is an emergency fund, tell me what would be an emergency? To get started I suggest using the Jeff Foxworthy approach. "You know it is time to use your rainy day funds when - - -" Your diet is finally working as there is nothing to eat in the house because you can't get to the store. Your expenses have dropped because the utilities were shut off for non-payment. Your neighbor's child got lost in your yard because it is so overgrown. You can't watch TV because your glasses have been lost in the clutter in the living room. You take a sponge bath as the edge of the tub has grown too high to get in and out. You stay in your underwear as the house is 90 degrees since the air conditioner stopped working. You get the idea. If you help them to find one thing that is bad enough to actually spend some of that money you will have made a crack in the dam. The money is spendable if the reason is sufficient. Now you only need to agree on whether the present situation meets the level needed to loosen the purse strings. P.S. If you are an heir do not get confused about whose money it is. NOT YOURS!

Two Things You Need to Know

It seems likely that we will [experience][endure][incur][enjoy] much of our elding in and around Newport.  It is where we live, and where we intend to live for some time.  However, there is a chance that eventually we will seek [warmer][safer][cheaper] climes in which to complete the journey.

Should you be inclined to do your elding elsewhere than your current where, there are two very important things to learn about the new where before you move there:  A good general practitioner/gerontologist physician THAT IS ACCEPTING NEW PATIENTS, and the menu of available social and elder services of which you may need to avail.

The first may be the most difficult, as there is an acute shortage of GP's and Gerontologists.  Many are already overwhelmed, and with cuts in Medicare and Medicaid payments they can neither afford nor handle more work.  Lots of people are getting old.  Lots of med students are going into specialties that pay better.  The Affordable Care Act will not likely solve this dilema any time soon.  So, carefully survey the market and find a doc BEFORE you move.  Don't forget a dentist as well. 

Once you find the doc, s/he may be able to help with the other item.  There are lots of social services organizations around that help with elder issues.  For example, here is a description of our local Child and Family Services:


Our experienced elder care specialists will talk to you honestly and confidentially about your loved one’s situation. Whatever your need


home care services
respite care
adult day services
dealing with depression or neglect
home delivered meals
crime victim support
housing advice
We can provide or arrange for respectful, reliable care. You can count on our support.


Free in-home mental health care
Don’t let lack of transportation or inability to pay prevent your loved one from getting proper care for depression, anxiety, substance abuse, and other issues. Call (401) 848-4185 to see if you or your loved one qualifies.


Question about your health insurance?
Our trained volunteer State Health Insurance Program (SHIP) counselors can meet with Medicare beneficiaries and caregivers to answer any questions or concerns you have about health insurance or bills.


Living independently longer
We can help make staying home possible for your loved one. Our certified nursing assistants and homemakers, overseen by an experienced Nurse Supervisor, can assist with:


light housekeeping
shopping
personal care
meal preparation
errands
Friendly Visitors
Our volunteers visit the homebound elderly or those who are handicapped, to provide companionship and caring support. Volunteers will write a letter, play cards, chat or even drive you to a medical appointment.

Notice that they provide or help locate help with insurance questions, independent living, even snow removal.  It may be good to find these kinds of resources well before you need them.  One excellent way to get to know the providers is to volunteer.  Child & Family is a 501(c)(3), so they are dependent on grants, donations and volunteers.

Michael

Yummy!

So, at whatever elder hostel you may end up, ask to see the menu.  Lets don't settle for geezer food.

Thriving Gut Bacteria Linked To Good
Health
by ALLISON AUBREY
08:52 pm
July 15, 2012
There's no magic elixir for healthy
aging, but here's one more thing to add
to the list: good gut health.
A study published in the latest issue of
Nature finds diet may be key to
promoting diverse communities of
beneficial bacteria in the guts of older
people.
To evaluate this, researchers analyzed
the microbiota, or gut bacteria, of 178
older folks, mostly in their 70s and
80s.
Some of the people were living in their
own homes, and their diets were rich in fiber, fruits, vegetables, grains, poultry and
fish.
Others were living in long­term care facilities or nursing homes where the typical
diet was much less varied. "Mashed potato and porridge were the only staples in
this diet type that were consumed daily," explains Paul O'Toole of the Alimentary
Pharmabiotic Centre at University College Cork in Ireland. Meals were
supplemented with puddings, cookies and sugar­sweetened beverages such as tea.
O'Toole's team found that people living independently, who had the most diverse
diets, also had more varied gut bacteria. And they also scored better on clinical
tests measuring frailty and cognitive function. In other words, "they were healthier
older people," says O'Toole.
There may be many factors at play here, but O'Toole thinks diet is key. "We were
surprised that the correlations between microbiota and health came out so
strongly," O'Toole says.
There's an explosion of research into the gut microbiome as scientists fine­tune
methods to analyze bacteria in the gut, and with that comes an emerging body of
evidence that diversity of gut bacteria is important.
"What we're only now beginning to realize is that there's very close interaction
between the bacteria within GI tract and human health and disease," says Ilseung
Cho, a gastroenterologist at NYU School of Medicine.
Beneficial bacteria do a lot for us, says Cho. They help with digestion, help our
bodies make vitamins, and also likely help support a strong immune system.
But they also have to compete with the harmful bacteria. That's why we want a
variety of the good kind in our guts.
"If you have a lot of diversity and one bacteria that's doing something good is
iStockphoto.com
Eating plenty of fruits and vegetables is important for gut
health, especially in aging adults.7/23/12 Thriving Gut Bacteria Linked To Good Health : Shots ‑ Health Blog : NPR
www.npr.org/blogs/health/2012/07/16/156745291/thriving‑gut‑bacteria‑linked‑to‑good‑health?ft=3&f=11… 2/2
food and nutrition immune system bacteria aging
knocked out," explains Cho, "then you may have other bacteria that can compensate
for that loss."
These new findings are not proof that diverse microbiota lead to better health. But
experts say this paper is important because it establishes a link.
"Is it really that diet is altering the health of individuals through altering the gut
microbiota?" asks Gary Wu of the University of Pennsylvania. "Or is it that people
who are not as well tend to be housed in long­term care facilities?" It's possible that
the lack of bacterial diversity isn't the cause of illness, but a sign of sickness.
Wu says it will take additional studies to unravel cause and effect. Nonetheless, he
says, this new Nature paper is intriguing.
"I think there's growing evidence that diet is very important in regulating the
composition of the gut microbes," says Wu.

Attitudes (Gratitude in Particular)

Here is a quote from "True Secret to Success" in Inc. Magazine by Geoffrey James.  The context of the article is on how success in both business and life is related to fostering positive attitudes.

"I'm utterly convinced that the key to lifelong success is the regular exercise of a single emotional muscle: gratitude.  People who approach life with a sense of gratitude are constantly aware of what's wonderful in their life. Because they enjoy the fruits of their successes, they seek out more success. And when things don't go as planned, people who are grateful can put failure into perspective. "


He goes on to pose a way to reinforce a sense of gratitude by practicing, every night, to record in writing the day's events that fostered good feelings, either for you or for someone around you.  By making this practice habit (there it is again!), we become trained to have a positive outlook on life, an important aspect of both physical and mental health as we eld.  "The more regularly you practice this exercise, the stronger its effects."  In other words, make a positive outlook a habit.  


I know I am harping on this a lot, but the more I study the effects of aging, the more convinced I am that fostering good mental habits now will improve the quality of life later.  It won't solve every problem, but it will help deal with the unsolvable ones and perhaps protect us from the unexpected.  


So, while I look forward to being a curmudgeon, I am determined to remain a happy curmudgeon, surrounded by other happy old farts.  You know who you are.


Michael

Not more on HABITS???!!?!?!!?

I keep coming back to habit formation.  I think this may be important.  Good habits, formed now, might carry through into eldertime and perhaps prevent some of the issues that will not be addressed by the family that is not there.  I know they cannot take care of every issue.  A habit of not getting sick may not prevent you from getting sick.  A habit of not having accidents may not prevent you from being rear-ended by another senile old fart.  But a good habit can prevent some health-related issues from arising.

For Example:  Yesterday I spoke with a massage therapist who described an elderly patient who had developed bad posture habits.  She would slouch in her comfortable chair and look at TV.  Because of the slouching posture, her head was tilted forward for long periods in order to see the TV.  Now in her elder years, she has lost the ability to hold her head up, and has trouble swallowing which leads to drooling.  She is appalled that she drools, but can do nothing about it.  She cannot recover from this.

This is an extreme example of a self-induced medical issue.  A bad habit, formed in facile times, carried over into elder times and caused problems.  But there are smaller things that can have similar results.  Tilting your head back to read something through your reading glasses or bifocals changes your spine alignment and balance, creating lower back problems that make you less mobile, thus allowing your leg muscles to weaken from lack of use, thus making it more difficult to climb those stairs, making it more difficult to do laundry, resulting in unsanitary conditions resulting in bladder infections resulting in ......

You get the idea.

Another gem of advice from the same source - If you exercise now, the conditioning will carry forward as you age.  If you are in bad shape now, you will not get bretter as you age, no matter what.  Weight training is as important as, maybe more important than, cardio training.  Do both.

So, at the risk of sounding like your mother, STAND UP STRAIGHT!  TURN THAT TV OFF!  GO PLAY OUTSIDE!

Michael

Habits, Personality and Elder Abuse

A couple of things started me thinking about habits and personality this morning.  First, an article in our local (state) paper on elder abuse:  with a population of under 1 million, our little state had, in a twelve month period, 1,000 reports of elder abuse, and only 1 in 5 incidences are ever reported.  That is 5,000 instances of abuse.  Victims nationwide lose an estimated $2.6 billion from financial abuse and exploitation.

The second item was a discussion with Honey about the recent influx of scam emails we have been receiving purporting to be from a large prominent bank informing us that our account has been placed on hold and we must update our info in order to re-activate.  A thoughtful link to thebank.com is provided.  But if you put your cursor over the link, you are shown the actual url, which is to some obviously spurious location that is imitating thebank.com.  Upon checking our account, it was, of course, just fine.  I tried to forward one of these emails to the real bank site (they have an email address to which you can forward scams), but the email was somehow locked and unforwardable.  Slick.

So, here is the link to habits and personality.  I explained to Honey that when I receive a REAL email from thebank informing me that our bill is due, I never use the embeded link, even though I know this is the real deal.  It is my HABIT.  I go to the web site via what I know to be the real link to transact business.  Habitually.  Don't even have to think about it.  Just do it.  It is a feature of my personality to be skeptical, to never assume that what I see is what really is.

I believe that our personalities are, to a large extent, formed from a collection of habits (my psych friends may correct me on this).  Habits are difficult to un-learn.  And thus this aspect of my personality, these habits, will, I hope, carry over into my elderhoodedness and, perhaps, protect me from being susceptible to scams and elder abuse.

As I wrote earlier, I think that forming these kinds of habits now, while alert and facile, will enhance the experience of elding, and make for a more safe and secure eldertime.  While no guarantee, at the least it will improve my chances of same safeness and security.

By the way, elder (age 62 and above) abuse comes in the form of:  physical, emotional, financial, sexual, neglect, self-neglect, and the withholding of access to the good wine.  Now, Honey, where did you put the key to the celler?

Michael

Signs and Symptoms of Elder Abuse - look for these in your friends:

• Unexplained physical injury
• Agitation, trembling, confusion, disorientation (not to be confused with too much scotch)
• Emotional distress like crying, depression
• Withdrawn, shows no emotion
• Self-destructive behavior (not to be confused with too much scotch)
• Social and physical isolation
• Unexplained loss of financial independence and/or control
• Home is disarray, lacks basic necessities (no to be confused with too little scotch)
• Appears fearful of caregiver
• Appears reluctant to respond when questioned, or caregiver seeks to prevent elder from interacting privately with you
• Elder and caregiver give conflicting accounts of incidents
• Caregiver is indifferent or angry towards elder and refuses to provide necessary assistance
• Caregiver locks up the good wine and hides the key