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Life Goes On

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Gosh, it’s been seven months since last I posted. Where did the time go? I moved to a smaller apartment and bought a smaller car. My husband got COVID at the memory care facility, was hospitalized, and died in January. He was cremated and everything that needs to be done has been done.

Having him at home was painful, but so was having him in the facility. Because of the pandemic, I saw him only a few times, but each time he seemed to have deteriorated both physically and mentally. Phone conversations were harder to have and communication with the facility about him was less than adequate. I couldn’t be with him when he died and we have not yet had a memorial service yet – but soon.

After watching him change for four years, I thought that I was prepared for his death, but after five months of being on my own some days are just plain difficult. I have a great support system and keep busy, but the evenings are the hardest when we took a walk, watched television, or worked on a puzzle together. I can’t say I want the person he became back, but I sure do miss the person he was.

I Miss Him

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After struggling with his issues caused by Alzheimer’s disease for four years, I recently placed my husband of 62 years in a memory care facility.

On one hand, it was the hardest decision I ever made; on the other hand, I couldn’t manage his behaviors, and the responsibility to ensure he was safe any longer.

He wasn’t a wanderer but every evening around 4:30, the sundowning began and he became a very disagreeable, aggressive man no one could handle.

So, he has been in memory care community for about 3 ½ weeks. We talk almost every day, but I haven’t been able to visit him because of the COVID virus.

I don’t miss the constant questions and his saying the same thing over and over, the mood swings, the loss of memory – both short and term, and the constant worry, but I do miss the person he was. The person I shared my life with for so many years – the laughs, the special moments, and the struggles This was never in my game plan.

It Was Too Much To Handle

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I was the primary care-provider for my husband of 62 years who was recently diagnosed with Alzheimer’s disease.

He had been experiencing memory problems prior to a nine-day hospital stay which included abdominal surgery and a long list of medications. His memory declined after the hospital stay and never recovered – that was four years ago and declined markedly the last six months.

This once energetic, smart, funny man had been reduced to a forgetful, unconfident, sometimes ornery shadow of his former self.

Over the four years, I read online discussion boards, had strong family help and support, and did everything I could to keep him safe, to work with his limitations, and to not take his insults personally.

More than once, I thought, “I just can’t do this any longer,” but somewhere, somehow, I found the wherewithal to go on awhile longer. I tried to hire an in-home care provider, but he would not allow that to be successful. I visited memory care facilities, but I hated to do that and they were expensive. So, we struggled on.

Two months ago, I could no longer find that wherewithal any longer and made the hardest decision of my life – to find a new “home” for him.

We found a lovely care home with six residents one of whom had Alzheimer’s disease. He was there less than 24 hours and they asked him to leave – he tried to climb a fence, he walked off, and was totally disruptive. They couldn’t handle him. We were back to square one!

My daughter and son-in-law offered to let him stay with them. The plan was that I would spend part of the time there and part of the time at home to give me a break. It took the three of us watching him 24/7 to keep him safe and under control. He was rude, argumentative, and difficult. We quickly decided this would not be a workable option.

I then found a memory care facility and we took him there a few weeks ago. He was given stronger medication, he seems to be adjusting, and life has been relatively quiet. I certainly don’t miss the constant chaos he created, but I do miss hearing his voice and seeing him – he was my touch stone/ my rock.

All in all, it was the right decision. I can look myself in the mirror and know I did everything possible to keep him home and care for him as long as possible. But it is a loss that I may never get over.

Wife to Caregiver and Beyond

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I met my husband when I was 12, we were married when we were 19, and have been married 61 years. We raised two children, did well financially, and had a good life. He was my rock and my best friend. We exercised, ate nutritious, and worked full time long after the age of retirement even though he had some memory loss and I had eye surgery.

Three years ago our lives changed dramatically. He had emergency surgery. Whether it was the trauma of the surgery and hospital stay, the effects of the anesthesia and medication, or something else, I will never know but his memory not only didn’t recover but it has deteriorated dramatically since then.

At that time, I took on the dominant role in our relationship, I learned to manage the finances and fix computer problems, did the driving, and basically made all the decisions while letting him think he was still in charge. That was the easy part.

What was more difficult was losing the person I loved for so many years and finding a way to accept that I am no longer a wife and partner, but a care provider –a role I never wanted.

I wasn’t a wife working with her husband to accomplish shared goals any longer, but a parent managing a child- adult. This took a major shift in my habits, perceptions, and beliefs.

A habit can be defined as an acquired mode of behavior that has become nearly or completely involuntary. After being married for over fifty years, my husband had many habits in place. We made decisions together, shared the household duties, he did the driving, I made the meals, and we enjoyed being together. Those habits had to change. I had to make the decisions, tell him how to do certain household chores, and even plan the day.

Even though I changed some habits, other habits had to change, as well. When he asked the same questions 15 and 20 times, my habit was to say “I just told you” or ask “How many times do I have to tell you? I also asked him what he thought the answer might be. Those responses only frustrated him.

So, I adopted new habits such as changing the subject, not telling him something was happening until the last minute, and being less than truthful. I get his attention before telling him something by turning off the television, eliminating distractions, standing in front of him, taking his hand or touching him.

I set him up for success as much as possible. If he is going to do a task, I set out the tools and I gave him limited choices such as “do you want to take a shower now or later?” He cannot be rationalized with, so I no longer challenge his erroneous thinking, but agree with him and work around it.

A belief is something that is accepted, considered to be true, or held as an opinion. Because my husband’s capabilities have changed, I had to examine my beliefs about marriage, about my role as a wife and, and about who I am.

For example: I was brought up to tell the truth; yet, I can no longer tell him the truth regarding most matters. So, I had to change that belief to one that says sometimes I have to be less than honest, it is in his best interest.

He should not be driving, so I tell him I want to practice my driving. I always believed that our marriage was a partnership, but that can no longer be. He doesn’t realize he is not the man he was, so I live a double standard – agreeing with his pipe dreams while knowing they won't come true.

A perception is a way of regarding, understanding, or interpreting something; a mental impression often thought of as true. He had been the head of the house, taken care of finances, fixed computer issues, and solved problems, my perception was that I couldn’t do these things.

But then I had to and was surprised to find I could. Based on how he responded in the past, my perception was that he was often angry, but he really wasn’t, he was just trying to remember and organize his thoughts. So, I had to examine my perceptions and discard ones that weren’t true.

Finally, I had to accept this new life – taking on all the responsibilities, managing his new behaviors, and losing the person I loved and counted on. The definition that said acceptance referred to acknowledging what is now true and then deciding what to do about it was helpful.

In terms of accepting this new behavior, I backed him up by making sure that his actions caused no problems. I accepted that his brain could handle only one piece of information at a time or one task at a time; so, I broke everything down into small steps. I had to accept that we could no longer have meaningful conversations and our special little jokes and secrets were no longer available to him. Sometimes there were moments of discussion but he quickly forgot.

So much of our old life was gone and so much was missing in the new one. I looked at my realistic options and chose ones that worked best trying not to dwell on what was. I also accepted what I could –this was not to be a forever role but one I could go on for a while longer.

Then COVID19 and shelter in place arrived and the situation changed. We couldn’t take little trips, have family over, or go shopping. He couldn’t understand the virus or its implications. We came to a point that he didn’t want me to go anywhere without him, he didn’t want anyone in the house but the two of us, and he didn’t want to go anywhere.

I became a prisoner in my own home in many ways; the stress became unmanageable. His memory confusion and fears grew and my changes were no longer enough.

I wanted to believe that my love and my willingness to change me would be enough to keep him home. But that was no longer true. It has now become a matter of taking care of myself or taking care of him. And I have had to make the heartbreaking decision to find another “home” for him.

What has been your experience?

Holding onto a Positive Outlook

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There are always choices to be made. You can dwell on the sunny side of life or the dark and stormy side – you can cultivate a positive outlook or a negative outlook.

When your thoughts tend to view life challenges and situations as something you can deal with, you probably have a more positive outlook on life. When your thoughts tend to find the worst in everything or reduce your expectations by considering the worst possible scenarios, you probably have a negative outlook. As you can imagine, outlook makes a major difference in a person view of the world.

This outlook often starts with self-talk; the endless stream of unspoken thoughts running through your head. Self-talk can come from logic and reason or from misconceptions and misperceptions.

Judith T. Moskowitz, professor of medical social sciences at Northwestern University in Chicago, developed a set of eight skills to help foster positive emotions.
1. Noticing positive events
2. Savoring positive events
3. Expressing gratitude
4. Practicing mindfulness
5. Reframing events
6. Noticing personal strengths
7. Setting and working toward attainable goals
8. Displaying acts of kindness.

However, maintaining a positive outlook is more challenging when you are the primary care provider for a loved one. Let’s look at how Jennie managed to re-capture her positive outlook.

Jennie is an only child, who became her father’s primary caretaker after her mother died five years ago. He lives with Jennie, her husband, and their teen age sons. She manages all of his affairs, in addition to working, keeping the home, and doing things with her family. Jennie’s Dad was overweight and had Type II diabetes; so, she took him to appointments, kept him on a special diet, and cared for him with her husband’s help until recently when he was diagnosed with early onset dementia.

Now his demands and mood swings have increased dramatically and Jennie finds herself becoming more overwhelmed and negative about life.

Years ago, Jennie learned about cultivating a “positive outlook.” She quickly caught herself saying words such as “always” and “never” to describe temporary setbacks, blaming herself for things outside her control, and feeling hopeless.

She knew these thoughts and feelings were not necessarily true, but in part caused by what she said to herself – her self-talk. So, she made changes.

One change she made was to dispute the negative thoughts and make different explanations by focusing on changeable and non-personal possible causes.

A second change Jennie made was to interrupt a string of her negative thoughts by saying “stop” and, then, focusing on a more positive set of thoughts.

Finally, she set aside time for positive activities such as reading a book on her Kindle, having coffee with a friend, or spending time outdoors.

Jennie knew that a component of a positive outlook was gratitude, so she kept a gratitude journal. There was a lot to be grateful for - her job which was mainly online, their lovely home, her very supportive and helpful husband, and her healthy, vibrant children, for example.

She also knew that maintaining a sense of purpose was important. Studies she read said that when people see themselves as contributing to a higher purpose, they are more likely to have a healthier outlook on life and be more resilient. Her purpose was to take care of her family and her father. What was missing in her purpose was taking better care of herself given the added demands on her time and energy.

Jennie realized that her feelings of being overwhelmed and negative were a sign she needed to focus more on her own wants and needs. She decided on two adjustments: one was to set and keep boundaries with her Dad. They might not stop at Starbucks for a coffee or go shopping every time she took him for an appointment. The second was to incorporate more self-care.

She gave herself permission to set aside more time for herself and for her family daily. She accepted fewer clients. She held a family meeting and told them of her needs. The boys agreed to spend time with their grandfather twice a week so she and her husband could have time together if only for a walk, her husband agreed to take him to play pool twice a week so she could spend time with each of the boys, and the three of them agreed to spend Sunday mornings with him, so, she had a block of time to do whatever she wanted. She decided to give this plan a trial run for a couple of weeks to see if it helped her outlook.

Finally, she remembered that she had choices, she was in the habit of telling herself how stressed she was and how difficult this was . . . and it wasn’t easy.

So, she decided to make a concerted effort to focus on the good of the day – how nice the boys were with their grandfather, how willing her family was to help out, and that this would pass.

Sometimes, though, it was impossible for Jennie to maintain her positive outlook. When that happened, she just let it be knowing that it would pass as it had before. What have you found that helps maintain a positive outlook during the most difficult times?

Caregiver Burnout

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Most caretakers experience burnout at some point. When it occurs and isn’t addressed, they eventually become unable to provide quality care.

According to the 2015 National Alliance for Caregiving and AARP Public Policy Institute, an estimated 43.5 million American adults were unpaid caregivers and about 85 percent cared for someone related to them.

Taking care of a loved one with dementia, physical disabilities, or other age-related conditions makes demands on a person’s time, energy, and emotions — demands that, as the Cleveland Clinic warn, “can easily seem overwhelming."

In some cases, this feeling of being overwhelmed leads to caregiver stress syndrome. Caregiving stress syndrome is caused when caregivers neglect their own physical and emotional health to focus on caring for a loved one.

Numerous factors play a role in creating the stress; factors such as the constant demands of caring for a person and the changing relationship of being a loved one to that of being a caregiver.

Many place unrealistic expectations on themselves, thinking they can do it all and refusing to ask for help - often because they don’t want to burden anyone. Finally, caregivers can simply be beaten down by the emotional toll on them.

Caregiver stress syndrome is associated with numerous negative health outcomes. 40 to 70% of caregivers suffer from depression and many experience anxiety, anger and irritability. It can not only impact one's mood, but his or her long-term health and wellness. Chronic stress can lead to high blood pressure, diabetes, and a compromised immune system.

Symptoms of caregiver stress syndrome include changes in appetite, weight and sleep patterns; feelings of hopelessness, irritability and helplessness; withdrawal from friends and family; sickness; thoughts of self-harm; loss of interest in previously enjoyed activities; and emotional and physical exhaustion.

Feeling powerless is the number one contributor to burnout and depression. It’s an easy trap to fall into when you feel stuck in a role you didn’t want or that you can’t change. The good news is that you really aren’t powerless, though. While you don’t always have the extra time, money, or physical assistance you’d like, you can always focus on finding more happiness and hope. So, how can I do that, you ask?

Here are some ideas:

When faced with a loved one’s illness or the burden of caregiving, there’s often a need to make sense of the situation and ask “why me?” You can spend a large amount of energy dwelling on things you can’t change and for which there are no clear answers or you can focus on what you can do. The emotional traps of feeling sorry for yourself or searching for someone to blame is fruitless and gets you nowhere.

Acknowledge that, despite the resentments or burdens you feel, you are choosing to provide the care. Identify the positive reasons behind your choice; the deep, meaningful motivations that sustain you through difficult times.

Look for the silver lining. Think about ways that caregiving has made you stronger or how it’s brought you closer to the person you’re taking care of and to family members.

Don’t let caregiving take over your life, which can be a challenge in and of itself. Give yourself permission to invest time in things that give you meaning and purpose and make the commitment to take that time for you.

Focus on things you can control. You can’t make more hours in the day or force a relative to help. So, rather than stressing out over things you can’t control, focus on how you choose to react to problems.

Celebrate the small victories. If you feel discouraged, remind yourself that your efforts matter.

Reading about caregiver stress syndrome was an eye opener for me and explained that my feelings, as I provide care for my husband with dementia, are normal.

On one hand, I do feel resentment and I can feel sorry for myself. Caregiving is not something I ever wanted to do. It is taking over my life and I have little time and energy for me and my projects.

On the other hand, this experience has made me stronger, I do know that I am making a difference, and I do know that this is a choice I am making.

Steps to help prevent caregiver burnout include:
• Talk to someone about your feelings and frustrations.
• Set realistic goals. Accept that you may need help with caregiving, and turn to others for help with some tasks.
• Don't forget about yourself because you're too busy caring for someone else. Remember, taking care of yourself is not a luxury. It is an absolute necessity.
• Talk to a professional – a therapist, social worker or clergy member is trained to counsel individuals dealing with a wide range of physical and emotional issues.
• Know your limits and be honest about your situation. Recognize and accept your potential for burnout.
• Educate yourself. The more you know about the illness, the more effective you can be in caring for the person.
• Develop new tools for coping. Lighten up and accentuate the positive. Use humor to help deal with everyday stresses.
• Stay healthy; eat right and get plenty of exercise and sleep.
• Accept your feelings. Anger about your responsibilities or the person for whom you are caring is normal. It doesn’t mean you are a bad person or a bad caregiver.
• Join a caregiver support group. Share your feelings and experiences with others in the same situation can help you manage stress, locate helpful resources, and reduce feelings of frustration and isolation.

Self-compassion or extending compassion to yourself in instances of perceived inadequacy, failure, or general suffering is key. Kristen Neff, researcher and author, identified the following components of self-compassion as being composed of three main components – self-kindness, common humanity, and mindfulness.

But what if you are already experiencing caregiver stress, as I was. What worked for me was admitting I needed help, focusing on what I can provide, setting realistic goals, joining a support group, and self-compassion. It was important to acknowledge my need for time off and equally important to give myself permission to take it.

Yet, there are no easy answers, sometimes my ideas work and sometimes they don't. What ideas have worked for you?

 

Inner Critic or Inner Coach

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Do you ever have conversations with yourself; ones that take place in your head?

As Dr. Jessica Nicolosi, a clinical psychologist based in New York says, “Talking to ourselves is completely within the norm. In fact, we talk to ourselves constantly.”

This inner voice might “talk” throughout the day or be unrecognizable; a critic or a coach. An inner critic is negative and may arise when you’ve made a mistake or are working on something difficult. This critic demands perfection or surrender. You may be very familiar with the voice nagging you into believing that anything other than perfect is not worth trying. It points out previous failures and warns of things that stand in the way of getting what you want.

An inner coach is positive and more likely to arise when you are succeeding. The inner coach supports your efforts, motivates you to keep trying even when you aren’t totally successful, encourages you to work toward improvement, and helps you figure out what might be standing in the way of your performance - like a personal trainer for your attitude!

As a young child, you were like a sponge, absorbing information. Your values and perceptions developed based on how you felt and interpreted experiences with family, religion, society, friends, and the media. From those sources, your inner critic or inner coach was born. In most cases, the critic speaks louder than the coach.

There are several ways to overcome the inner critic; let’s look at two of them: The first way is to ask yourself the following six questions to quiet your inner critic:

1. Do I have an “all-or-nothing” point of view?
2. Am I demanding perfection instead of rewarding progress?
3. Am I exaggerating the challenges or making excuses for why I can’t possibly succeed?
4. Am I hungry, angry, lonely or tired? Is this interfering in my ability to make sound decisions?
5. Is this line of thinking going to help me or discourage me?
6. If I wanted to be more positive, what would I say to myself?

Seven steps for dealing with the inner critic:

First, listen to your inner voice for a week without judging or interacting with it; the longer you can listen the better. You may even want to record what the voice says in a journal.

After listening and observing for a while, you’ll be able to figure out your inner critic’s personality and habitual ways of talking to you.

Then, study your inner critic: now that you have your notes & observations ask yourself, “where did you hear these critic voices before?” “Whose voices are you really hearing?” Was it a well-meaning teacher/relative who reprimanded you in the past?

Perhaps, your parents’ judgment and point of views are coming through; however, now, they show up as self-created negative comments sabotaging your personal well being.

Ask your inner critic: How true is this? For example, if your thought is “I’m a failure,” then ask yourself “how is it that I have financial success and enjoy a balanced family life? By doing a reality check, you empower yourself instead of believing what your inner critic says. A question that can be helpful is “Does it really matter if I am - or not?”

Next, name your inner critic – choose a name that is not attached to anyone close to you and has a non-favorable, gloomy or even a cynical meaning for you. Have fun and use your imagination!

Then, create an imaginary persona for your inner critic. Is it male or female? How does it dress? What does it sound like? How does it smell? Is it old or young? The clearer your picture, the better; by giving a name and an image to your inner critic you equip yourself to effectively manage it.

Talk to your inner-critic. It is highly unlikely that this voice will disappear from your life, but you can quiet it. The inner critic is not used to being challenged, and it really wants to protect you from harm. So, create reasoned, positive arguments to reply to negative comments.

For example, if the critic said “You never do anything right.” Acknowledge the statement, and answer by saying that everything is OK, and you are in control of the situation. Ignoring, talking back to, and telling your inner critic to be quiet for a while can also be temporary ways to deal with it. You can order it to sit out of a conversation, or even wait in the car.

Finally, since the voice is here to stay, how about transforming it from a critic into the coach?

Your Inner Coach won’t say you are a failure or aren’t good enough. Instead, it will say: “This can work, and if it doesn’t you can make adjustments and try again. It isn’t the end of the world.” This Inner Coach recognizes that the journey to success has failure along the way, and that no failure is final and counsels “You’ve got this. Go!” rather than saying “Stop. Be safe.”

The following is a four step process for enhancing your inner coach.

The first step is to figure out what you want to accomplish. Sometimes the reason you don’t notice your success is because you don’t have clear goals. For example, saying, “I want to lose weight” is a big task! Telling yourself, “I want to stick to the diet I choose for one month” or “I want to lose 5 pounds” provides a more attainable, specific finish-line.

The second step is to set yourself up to accomplish a goal by determining what you need to do and breaking the goal into small steps – steps leading in the right direction. That way you know you’re on the right track.

For example, you might want to find a new job. The steps might include updating your resume, registering with an online classified service like Indeed, researching the industry in your area, and contacting prospective employers. Along the way, you can see your progress and redirect yourself from getting off-track.

The third step is to remove obstacles and problem solve. Identify things that stand in the way. Most of the time, with planning and problem-solving, an obstacle can be removed or, at least, set aside for a while.

Things to watch for include making excuses for why you don’t follow through, scheduling too many things for the same time, and making choices that bring you further from your goal.

Finally, give yourself a well-deserved pat on the back for progress you have made. Remember you are shooting for progress, not perfection! The bigger the success, the bigger the reward.

The inner critic reigned in my life for years and as I took on the role of care-provider for my husband who has dementia it became even louder. As a child, I was expected to be perfect, anything else was unacceptable and therefore I was unacceptable – not good enough. I internalized that message; so, the ideas that progress rather than perfection could be the goal and that success is fraught with failure were foreign to me.

Providing care for a loved one was a difficult, stressful undertaking for me – particularly because it was a role I never wanted or was prepared for. Then the virus showed and the critic’s voice became even stronger. It was unrelenting with messages such as “you should be helping him more,” “you shouldn’t have yelled,” “it’s not his fault, why aren’t you more patient?” “you should keep trying to fix it for him.” The ranting went on and on.

The name I gave the inner critic was Judge Judy. She stands there in her black gown pointing a finger at me yelling “you should have.”

I have been using the above guidelines. . . and am working to turn my life-long inner critic into an inner coach. My inner coach is more compassionate and reminds me of what I have done and am doing. She reminds me of my mentor, Alice, who had only kind words and thoughtful suggestions for me about how best to move forward. But it is a work in progress, changing old ways of being into more helpful ones. What might you recommend?

I Can’t Do This Any Longer

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My husband has dementia and my goal is for him is to stay home as long as possible. Yet, after four years of living with the behaviors and chaos involved, there are days when it seems as if I just can’t be his care giver or provider one minute longer. The quick answer is “don’t take it personally, it’s the disease” but that’s easier said than done – this is a wearing, discouraging, and overwhelming journey many days. But yes, I could answer the same questions, remind him over and over, and listen to the same stories thirty and forty times.

Then, the coronavirus arrived and the stresses tripled. He doesn’t understand the virus, he is home with nothing to do, he can’t go anywhere, and he is unable to have company. He asks even more questions and doesn’t remember what is said from moment to moment. I am more fortunate than many caregivers, though. My family is supportive, money is not an issue, we have a lovely home, we are physically healthy, he takes care of his personal needs, and he is with me.

I was allowing the discouraged feelings to be; not trying to get rid of or manage them, and that was fairly effective. When I was particularly discouraged it helped to ask “what do I need right now?” and then meet that need be it taking a walk, talking to a friend, or playing the piano. The bottom line was to do something for me. However, after eight weeks of sheltering in place with no breaks, those strategies were no longer effective.The truth is:
1. My values won’t let me place him in a care facility.
2. Neither of us want to live in a retirement community.
3. Neither of us want a home care provider coming in to provide respite care.
4. I don’t want to be a caregiver; yet, I am choosing to do so for various reasons.
5. Having him home is overwhelming at times and yet he is doing okay. His short and long term memory are poor, but he tries and does his best at all times.
6. My coping skills are no longer enough.

Obviously, then, if I am to continue keeping him home, my personal care plan has to be adjusted. With this in mind, I am making six changes.

The first change is to ask family members to do things with him to give me a break as we did prior to the shelter in place order.
The second change is to do more things that make me happy: shopping online, having my nails done, and getting the carpet cleaned.

The third change is to let go of certain expectations about his capabilities and what he can accomplish.

The fourth change is to take charge – tell him what to do and how to do it rather than give him choices and let him figure out how to do something because he does better with that structure.

The fifth change is to give myself permission to work on my projects for periods of time.

Finally, I am researching helpful tips on line, challenging my perceptions, monitoring my self-talk, and improving my attitude.

I am experimenting with this new plan and will alter it as needed. Because despite the frustration and discouragement, my goal remains the same: having him stay home as long as he is safe and hurting no one

The person you care for may not have dementia but a chronic, debilitating or fatal illness. However, the issues remain the same – how to live well while caring for another. What suggestions might you have?

Keys to Maintaining a Health Lifestyle

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How do you want to spend the rest of your life - going slowly downhill until death or being the person, you want to be despite life’s challenges and stressors? Maintaining a healthy lifestyle plays a vital role.

If your answer to that question is to be the person I want to be despite life’s challenges and those challenges include being a care-giver, your goal is more difficult. Let’s look at how the physical, intellectual, social, emotional, spiritual, and functional dimensions of wellness play a role. They are key!

As the old Spanish proverb says “A man too busy to take care of his health is like a mechanic too busy to take care of his tools.” As the mechanic of your health and a caregiver, you must maintain your mind and body, as well as that of the person you care for.

My husband and I are 81 years old. We met when we were 12 and have been married 62 years. Born and raised in Ohio, we moved to California, lived in Washington State for several years, and then moved back to California to be near our family and more sunshine. While we are basically healthy, we have the typical age-related aches and pains. I recently had cataract surgery and he experienced memory loss after having abdominal surgery three years ago. Whether the memory loss was caused by the trauma of the hospital stay, the effect of the medication and anesthesia, or something else, I will never know, but the change was dramatic and lasting.

While the surgery may have been necessary, our lives changed markedly. Yet despite those changes, we remain committed to aging well and the dimensions of wellness play a major role - although they mean different things to me and to him. So, let’s briefly review how we manage.

The first dimension, physical wellness, typically covers exercise and nutritious eating. In a recent study, researchers analyzed the exercise, functional limitations, excess weight and obesity, self-perceived health status and chronic health problems within the over 65 population and found they are increasingly less physically active. However, even if one’s lifestyle has been inactive; it is never too late to change.

Of course, an older adult’s workout will be different than the workout of a younger adult or teen. Cartwheels and handstands may no longer be wise. Consider consulting a fitness trainer who specializes in working with older clients or your doctor as you get started and develop an exercise plan that includes strength, balance, and core training. This plan keeps you on track and maintains focus on your goals.

Although, aches and pains may occur, being active and more than a “couch potato” is a primary factor in the pursuit of physical wellness. Older adults who exercise tend to have improved immune systems and digestive functioning, better blood pressure and bone density, a lower risk of dementia, diabetes, heart disease, osteoporosis, and certain types of cancer. People too busy to take care of their health are like the mechanic who is too busy to take care of his tools.

Our exercise plan includes daily walks and stair climbing, playing a little tennis or pickleball, and using the exercising room.

Just like exercising, eating nutritiously is an important part of maintaining physical wellness. Eating nutritiously helps manage weight, energizes the body, and provides necessary nutrients. Eating nutritiously also lowers the risk of developing chronic health conditions such as heart disease and diabetes.

For older people, being underweight may be related to lack of food, not eating nutritiously, or having an illness. Being overweight may increase the risk of heart disease, high blood pressure, diabetes, and bone issues. Did you know that during the past 30 years, the proportion of obese older adults has doubled?

Guidelines suggest that a 60-year-old, woman who exercises very little should consume about 1,600 calories a day and a man who exercises very little should consume about 2,000 calories a day. Maintaining one’s healthy weight is crucial and healthy weight varies depending on height and body frame. The Harvard School of Health suggests the following guidelines for healthy eating:

While the Healthy Eating Place offers guidelines for healthy eating, let’s look at three less healthy foods: saturated fat, sugar, and salt.

In the book, Salt Sugar Fat: How the Food Giants Hooked Us, Pulitzer Prize-winning journalist Michael Moss goes inside the world of processed and packaged foods. Moss found that by “Employing scientists to dissect elements of the palate and tweak ratios of salt, sugar and fat to optimize taste, the processed food industry has hooked consumers on their products the same way the cigarette industry hooked smokers on nicotine.” How scary is that!!! So, let’s look at those substances a bit closer.

For years, people were told to banish all fat from their diets. However, thinking has changed because even though people switched to low-fat foods, they were no healthier. Perhaps, because they cut back on healthy and harmful fats.

Now experts realize the body needs some fat from food; it is a major source of energy. Fat also helps a person absorb certain vitamins and minerals and is needed to build and maintain cell membranes.

Unsaturated fat is a healthier choice than saturated or trans-fat. Sources of unsaturated fat include avocados, nuts, whole grains, olive oil, and fish. Unsaturated fat helps reduce the risk of high cholesterol levels and provides other health benefits.

Sources of saturated fat are palm and coconut oils, cheese, and red meat. Saturated fats increase blood cholesterol, which increases the risk of heart disease, and causes other health problems. As a rule of thumb, liquid fats are better for a person than solid fats.

Eating too much sugar has negative health effects, as well. An excess of sugar can lead to weight gain, blood sugar problems, teeth decay, and an increased risk of heart disease, among other conditions.

The American Heart Association says the maximum amount of sugar a man can consume daily is 150 calories or 9 teaspoons. The maximum amount of sugar a woman can consume is 100 calories per day or 6 teaspoons.

Consider this, there are about 10 teaspoons of sugar in a 12 oz. can of coke. So, one can of coke is over the daily requirement.

Salt causes the body to retain water. When someone eats too much salt, extra water stored in the body raises the blood pressure. Higher blood pressure causes greater strain on the heart, arteries, kidneys and brain.

Americans typically eat about 3,400 mg of sodium per day. The Dietary Guidelines for Americans recommends limiting sodium intake to less than 2,300 mg per day—that's equal to about a teaspoon of salt!

We follow the Mediterranean diet. We also limit salt and eat fresh food rather than canned food. Our downfall is sugar and we really do need to do a better job of decreasing our intake.

There are other culprits, as well. While smoking, drinking, and prescription drugs, impact physical wellness; their negative impact is often overlooked and downplayed.

The Bureau of Labor Statistics found the average American spends approximately one percent of an annual gross income on alcohol purchases, which is about $565 per year. Similarly, iSpot.tv notes that 187 commercials about 70 prescription medications collectively are aired almost half a million times on TV and drug companies spent $2.8 billion during a 9-month period of time in 2018.

Cigarette smoking is the leading cause of preventable disease and death in the United States. Smoking accounts for approximately one in five deaths yearly. In 2016, an estimated 37.8 million adults in the United States smoked cigarettes and more than 16 million Americans live with a smoking-related disease such as asthma or emphysema.

The results of smoking occur disproportionately among older people because there is typically a long period of accumulated damage. Lung cancer is the largest cause of excess smoking-related mortality over the age of 60.

No matter the age, to quit smoking improves health and adds years to one’s life. My Dad smoked for 50 years, had progressively debilitating emphysema, and died at age 71. I never smoked and have already outlived him by 10 years. His smoking may not be the only reason he died so young, but it was a factor.

Similarly, a research study suggested that the greatest increase in marijuana use was observed among people 65 years and older. More adults use marijuana medicinally than recreationally. However, that may change as recreational use of marijuana becomes legal in more states. While the effects of marijuana smoking by older adults must be explored more thoroughly, almost everyone agrees the public health consequences of opioids are far worse.

As people age, physiological changes occur and they metabolize alcohol at a slower rate. Therefore, an older person may experience the effects more intensely and for a longer period of time than a younger person; even experiencing effects without increasing the amount of alcohol they drink. It is also true that older women are more sensitive than older men to the effects of alcohol.

Drinking too much alcohol over a long period of time may lead to the masking or worsening of health problems and more susceptibility to accidents or falls. While a glass of wine with dinner isn’t a cause for concern, the cumulative effects of drinking alcoholic drinks can take a toll. That toll may include inflammation, skin problems, high blood pressure, brain damage, and dependency. We drink very little.

Finally, a third concern in discussing physical wellness is prescription drugs. While there is a time and need for medication, medications are often over prescribed and abused. Think about this:

“The statistics on medication usage among elderly patients in the US are eye-opening: more than one-third of prescriptions drugs used in the US are taken by elders. The average elderly patient has more than five prescriptions; the average nursing home patient has more than seven.”

Pain is more prevalent in older people, as is the use of medication for pain management. Older people experience various life changes and an increased likelihood of having pain and physical illness – a very popular solution is prescription drugs.

A doctor described patients who “doctor shop” until they found a doctor who would write the prescriptions they wanted to have.

My husband’s experience may be an example of what can happen with the overuse of medications. As an older adult, he had a tendency toward memory loss. However, he took no prescription drugs prior to surgery.

During the surgery, he was given a large amount of anesthesia and during his nine-day hospital stay was given numerous medications. After the hospital stay, his memory never recovered.

While he exercises regularly, eats nutritiously, manages his weight well, and does not smoke or drink, his physical wellness has been compromised. Presently, we take no prescription drugs.

The physical dimension of wellness includes exercising, eating nutritiously, and other factors. So, whether you are a care-giver or a person needing care, physical wellness is a priority. You are the mechanic in charge, it is up to you to keep your mind and body healthy as best you can.

Exercising the brain is as important as exercising the body. The old saying “if you don’t use it, you lose it,” applies. So, the second dimension of wellness, intellectual, refers to active participation in scholastic, cultural, and community activities. It is valuing many experiences, getting excited with new ideas, and sharing. It is responding to challenges and opportunities, making plans, developing strategies, and solving problems. It is the ability to engage in clear thinking and recall, and to think independently, creatively, and critically.

Maintaining intellectual wellness expands a person’s knowledge and skills needed to live a stimulating, successful life. To improve intellectual wellness, one should value creativity, curiosity, and lifelong learning.

A major concern is that as people age, they can lose their mental faculties and perhaps their independence. Ways to maintain sound intellectual health in addition to being active and eating well include drinking sensibly, keeping in touch with others, asking for help, and doing something you are good at.

Another aspect of intellectual wellness is keeping the brain sharp. The brain, like the rest of the body, changes as you grow older. Many people notice gradually but increasing forgetfulness as they age; it may take longer to think of a word or to recall a person's name.

A recent meta-analysis reported that the global prevalence of dementia is somewhere between 5 and 7 percent within people aged 60 or over. By the age of 85 years and older, between 25 and 50 percent of people display symptoms of dementia, which is all encompassing because the brain’s functioning affects everything you do from remembering to brush the teeth to taking medications.

Maintaining a high level of intellectual wellness can occur when you learn a foreign language, subscribe to a journal, read a book, attend exhibits, plays, and musicals, explore different intellectually stimulating pass times such as crossword puzzles or board games such as Scrabble and Chess.

So, you can see what an important role intellectual wellness plays in maintaining a healthy lifestyle. Without intellectual wellness, a person won’t be able to make healthy lifestyle choices.

We eat well, drink minimal alcohol, keep in touch with others, and have a close family.

While my husband is not interested any of the pass times mentioned above, he does take Prevagen, we make jigsaw puzzles, he plays pool, watches television, and we exercise regularly.

The third dimension of wellness is social. Social wellness is having positive interactions with and enjoying being with others. It is feeling at ease during work and leisure times, as well as expressing one’s feelings and needs to others. It involves developing and building close friendships and intimacy, practicing empathy and effective listening, caring for others and the common good, and allowing others to care for you. It is recognizing the need and taking the time for leisure and recreation.

Social wellness occurs when a person lives in harmony with the environment and the community. Volunteering is one way to engage in social wellness because it can give a sense of satisfaction and purpose; however, it is not the only way. There are a variety of opportunities available for older adults to increase their social circle and add value to living. Those activities include doing fun things, pursuing a hobby, finding exercise and companionship by participating in a sport, or joining a group and making new friends.

Approximately 20 percent of Americans feel lonely and isolated during their free time which is another valid reason for maintaining social wellness. Socially isolated people are more susceptible to illness and have a death rate two to three times higher than those who are socially connected.

People who maintain their social network and support systems do better under stress. Similarly, a strong social network can create a good mood and enhance self-esteem. Touching, stroking, and hugging have been found to improve health; just as laughter is good medicine. Cholesterol levels rise when human companionship is lacking and close friendships cause higher levels of immunoglobulin.

The current health crisis and call for social distancing only heightens the problem. Many cities and states are initiating outreach programs to seniors. An added concern is created for people with loved ones in nursing homes, assisted living facilities, and memory care who can no longer visit and maintain physical contact with their loved ones.

Being socially active is a key to wellness. Particularly with the restrictions created by the corona virus, loneliness is a major issue and must be considered. I connect with friends and loved ones via email, Skype, and phone. My husband is not interested in volunteering or joining groups; so, we get together with family members because they know and understand the situation.

The fourth-dimension is emotional wellness. The term emotional intelligence (EQ) comes to mind. For many people, emotional intelligence is more important for attaining success in life. than intelligence (IQ).

Howard Gardner, developmental psychologist and Harvard Professor, named skills that must be developed for high emotional wellness. The four skills are:
1. Self-awareness - Listen to your true feelings, recognize the effects of your emotions and have confidence in your capability to manage them.
2. Self-regulation – Have a say in how long an emotion lasts. Use various strategies such as re-framing a situation in a more positive light, taking long walks, or meditating to mitigate negative emotions such as anger, anxiety, or depression.
3. Self- motivation - Inspire yourself with clear goals and a positive attitude. Even if you currently have a negative attitude, you can learn to think positively with effort and practice.
4. Empathy - Recognize how other people feel. The more skillful you are at understanding the feelings behind the signals someone gives, the better you can control the signals you send.

Another aspect of emotional wellness is resilience. Those who master emotional resilience tend to be prepared for emotional emergencies and adept at accepting what comes at them with flexibility rather than rigidity. Emotionally resilient people know and maintain their boundaries, practice acceptance, don’t pretend to have all the answers, make a list of self-care habits, and enlist a support team.

Imagine the important role emotional wellness and resilience play in maintaining a healthy lifestyle especially when providing care for another person. Finding ways to adapt and accept the changes that are occurring is key.
Emotional wellness is an issue both of us must work on. We get discouraged. Sometimes, he is angry at himself and sometimes he is sad, but the moods pass quickly. I must learn to acknowledge my feelings and be compassionate with both of us. This is so very difficult in so many ways.

Spiritual wellness is the fifth dimension of maintaining a healthy lifestyle. It is being connected to something greater than yourself and having a set of values, principles, morals and beliefs that provide a sense of purpose and meaning for life, then using those principles to guide your actions.

Spiritual wellness means having a sense of purpose and living a life that reflects one’s beliefs and values. The path to spiritual wellness can involve meditation, yoga, prayer, affirmations, or specific spiritual practices that support a connection to a higher power or belief system.

Compassion, the capacity to love and forgive, altruism, joy, and fulfillment help a person enjoy spiritual health.
Spiritual wellness can be assessed by answering four questions. A "no" to any one of them may indicate an area to improve the state of spiritual wellness. The questions are:
1. Do I make time for relaxation in my day?
2. Do I make time for meditation and/or prayer?
3. Do my values guide my decisions and actions?
4. Am I accepting of the views of others?

Spiritual wellness is key to maintaining a healthy life style. People who are care-givers experience many ups and downs and a spiritual connection is so beneficial.

I practice mindfulness and see myself as being spiritual. While my husband was never a “spiritual” person, he definitely has a set of beliefs and values that guide his life still and he has a strong purpose - to keep living.

Functional wellness is the sixth dimension and I define it as managing oneself in life. Age-related functional decline can be subtle. My eyes are an example. I needed reading glasses many years ago and the prescription needed to be stronger and stronger over time. My eyesight worsened so that I was unable to drive or accomplish certain daily tasks. I was fortunate; cataract surgery solved the problem.

One in every eight senior citizens, though, need help with one or more basic daily tasks. One study found that the most important factor associated with functional decline is the number of days the person took off from regular activities, the number of hot meals he or she consumed per day, and his or her cognitive status. Also, interestingly, people who believed their health was worse than it was previously were significantly less likely to improve their function.

What can someone do to prevent functional decline? The answer will likely sound familiar: eat a healthy diet, exercise regularly, manage chronic diseases that you might experience, and stay active. Since having cataract surgery, I am functionally healthy. My husband not so much, I am basically living his life for him.

We have talked about the six dimensions of wellness in this article – what they involve and how we apply them. Remember that Spanish proverb “A man too busy to take care of his health is like a mechanic too busy to take care of his tools?” Well, if you are the mechanic  of your body and wellness plays a major role in keeping you healthy enough to take care of someone else. What is your next step?

Developing Mental Strength

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I have taken over most of the household duties and responsibilities since my husband had surgery three years ago. The circumstances of the surgery led to a marked decrease in his long- and short-term memory. I sometimes resent having to do those duties and responsibilities and to deal with his questions, paranoia, forgetfulness and irrational thinking on a daily and hourly basis. Retirement communities, assisted living, and in-home assistance didn’t work out; so here we are.

Yet, I am fortunate, my family is close, we are financially sound, we have a nice place to live and we are physically healthy. So, how do I get past the feelings of self-pity that often sneak in?

The website offered good ideas. It suggests that people who are “mentally strong” use life’s inevitable hardships as a way to grow more resourceful. So how can I develop mental strength?

The article offered nine tips that made sense to me:
1. Face your feelings. Don’t distract from uncomfortable emotions just experience them.

2. Recognize warning signs of a downward spiral. Take action to prevent yourself from living a discouraged life.

3. Question your perceptions. When you feel sorry for yourself, you may be focusing on the bad things in life and overlooking the good. So, ask yourself do these thoughts represent reality?

4. Turn negative thoughts into behavioral experiments. Don’t let negative thoughts turn into self-fulfilling prophecies; but conduct behavioral experiments to prove those thoughts wrong. When you think something, “I could never be a care provider,” respond with, “Challenge accepted!”

5. Reserve your resources for productive activities. Refuse to waste time and energy in misery. Instead, devote your resources to productive activities that can improve the situation.

6. Practice gratitude. It’s hard to feel self-pity and gratitude at the same time. So, recognize what you are grateful for in life—right down to the fresh air and clean water.

7. Help other people. It’s hard to feel sorry for yourself when you’re busy helping those who are less fortunate. You may find you are more fortunate than you thought.

8. Refuse to complain. Don’t try to get sympathy by complaining. Instead, take action to make things better or accept situations that you can’t change.

9. Maintain an optimistic outlook. Certain life problems can’t be prevented or solved. The loss of loved ones, natural disasters, and certain health conditions are problems we face at one time or another, so, keep an optimistic outlook about your ability to handle whatever life throws their way.

Developing mental strength is similar to building physical strength. If you want to be physically strong, you need good habits such as lifting weights. You also need to get rid of bad habits, such as eating too many snacks. Developing mental strength also requires you to have good habits and to give up destructive ones, such as self-pity. There is no doubt that being a care-provider is a difficult job fraught with frustration and sadness.

However, by developing an increased ability to regulate your thoughts, manage your emotions, and behave productively despite your circumstances, you will grow stronger and be more able to do the job. How mentally strong are you?