The Care of Aging Parents: Making the Last Laps Rich (Part II)

In Part I on this topic, I centered the post around the idea of setting an intention of what we want in the healing and transformation of the relationship with one's aging loved one.  Opening to the feeling aspect of what it is we want prepares the ground for the details, and helps sees us through the challenges of what is put into play—what, hopefully, we and our parents want.  In this Part II, I will deal more with the nuts-and-bolts of how to provide the sustenance that makes these last laps rich and meaningful for you and them.

Once the intention is set, it is good to determine how you and your elder are going to work together.  Are they handing everything over to you, abdicating all control?  Or do they want to be co-determiners as long as possible?  How will this work, how is it imagined?  Part of the healing in the relationship is the sublime relating we do with them, and they with us.  The confronting the hard things in a soft way, the 'yes' and the 'no's. The disagreements, fears, the sensitivity to the taking control and having little say.  It's this territory that is fertile, if not a challenge to navigate.  This is where we attempt to optimize our Listening,  our Attending-to/Attention, our Observing.  This is where breath and a nuanced appreciation for what Is can transform the difficult transitions.

You see your elder aging, having a more difficult time doing basic things, like laundry, cooking and cleaning.  You might even notice a hygiene deficit or important memory lapses (not taking medications in a timely manner, forgetting to pay bills, etc.)  By this time, it's late in the game.  It's late in the game, because of Denial.  Denial on everyone's part.  Experiencing or noticing a decline in a loved one or self is not easily accepted and often minimized.  We want the old homeostasis, even though change is well underway.  We think it's ok for them to be left alone for a few hours, or even though their balance is somewhat shaky, it's ok as long as their cane is nearby.  This lack of acknowledgement of a decline is denial and it is dangerous.  The primary concern we should have is safety.  Are they safe 100% of the day?  They aren't if they're forgetting medications, leaving the kettle on when on the stove or not being hygienic.  Always best to err on safety's side.  Have more coverage, not less.

Decline comes in all gradations;  gradual to quick.  It's important that once it is underway, there are watchful others around regularly to gage needed interventions.  It might start with grocery runs, housekeeping every other week, or help with a weekly shower.  A decline in social engagement outside the home is a subtle marker as well.  This often happens when an elder realizes they are losing memory (uncomfortable conversing with people who know them but whom they don't remember knowing) or have lost a physical fitness that makes it uncomfortable to be more active.  Losing memory can be very subtle and effectively hidden  by vague responses.  Dementia is masked by depression and sometimes vice versa.  He/she that has created an intention to be the 'observer' engaged with the elder becomes responsible for this watching and deciding/co-deciding with the elder when intervention is required.

Every situation is so different. There are myriad ways people can creatively care for loved ones, and also myriad situations in which the caring transpires.  It may be a collective of family members, or a trusted caretaker or group of them who reports to an adult child who is far away.  Determining the elder's wishes (early on, if possible) is helpful in determining what can be set up (home care, elder care in a senior community, etc).  And of course what is physically and financially possible for the adult child.

Early on, it is vital to consider obtaining power of attorney and/or a medical healthcare proxy for your parent.  It is easier for you to manage your parent's finances this way, and there isn't any holdup when it comes to healthcare decisions.  Outside sources that may be of help are your elder's doctor's office (might have referrals to home care agencies, social workers, etc), and local community senior centers which have programs during the day. Also seek information about alternative resources to support your loved one's needs, be they day/night companions, meals on wheels, rides to doctor appointments, groceries, etc.  If your elder is coming from a hospital situation, case managers and hospital social workers are knowledgeable goldmines regarding external resources and medicare/medicaid insurance payment of needed medical supplies; mine them fully.  Visiting Nurse organizations will do a full home assessment to determine level of care required and make suggestions.  Often, Medicare/Medicaid and private insurances pay most of this service.

When deciding on an elder institution (if that is an option you are considering), ask a lot of questions, field them not only to the 'home', but other professionals.  Hospital nurses that deal with the geriatric population often have an interesting perspective.  They see people come in from different places in different conditions, they hear and are aware of the best and worst places.  From institutions, ask for family references.  What are the activities (i.e.,  are residents ever taken off campus?), is there music, art, plant, pet therapies? What is the ratio of care, caregiver to resident?  Is there a "care for the caretaker" program helping with staff burnout? You should be able to get a rating on the establishment from the better business bureau, possibly AARP, etc.  Once an institution is decided upon, it behooves you to form congenial, informed relationships with the staff; they see you frequently, they know your expectations, they are aware of your strong advocacy for your parent.  When things go awry, a steady, calm, rational response is much more powerful than a reaction.   The former elicits respect from staff.  The latter elicits defensiveness and does not bode well for the care of your parent.  This being said, uncharacteristic strong reactions infrequently provided (and merited), are a heads up, pull-up-your-socks reminder to caretakers, which can go a long way to improving care.

For all caretakers, at any level of care, at any point in time, it should be assumed burn-out, compassion fatigue, will develop.  It is a huge undertaking having the welfare of another in your hands.  Being connected to one's breath, finding nourishing quiet moments for oneself helps to soften the hardness, opens one to another type of rest and rejuvenation.  Take care of yourself; make sure those caring for your loved one are also taking care of themselves.  It is through this regular practice where the quandaries, obstacles and difficulties are often relinquished.  Less tension in your body and in your life allow for another understanding, a possible spark of creative genius in solving a problem, an attraction to the thing or person that is needed in a moment.  This is the miracle of this process.  The process of healing a relationship, transforming a life in the middle and at the end.  This is what makes the last laps so rich, even while it is so hard.

Unmentionables: Menses

Through history, “that time of month” has been a source of belittlement by others called all sorts of things by all sorts of people (unknowing, fearful, unfamiliar).  It is beguiling that something that often causes discomfort and pain would be a source of mockery and even disgust by others.  I’ve often seen menses in sort of miraculous terms, an incredible cycle that is as reliable as the sun and moon rising and setting everyday, the tides rolling in and out; a reminder to take good care, step back, slow down. Women’s cycles relate us to all of nature’s cycles.  This is a big thing. Even the experienced discomfort, has possibly been something through the ages that has enabled women to develop enormous strength and endurance and a capacity for introspection in the often enforced quietness of “bearing” the symptoms of their physiology.  Though most of us know in broad terms what goes on biologically during the time of a woman’s menses, I hope in this post to shed a little more light on it, to clarify the science of it and hence a better appreciation for this process which makes possible a continuation of human life on this planet, as well as holistic approaches to ease the monthly passage.

Physiology of menses

“That time of month” is a misnomer, as a woman’s cycle is in a continuous hormonal flux.  “PMS” (premenstrual syndrome) connotes the period prior to menses that includes bloating, headaches and irritability.  As in all hormonal fluxuations, temporary mental deficits (ie: memory, distractability) can be prevalent.  As anyone who has experienced the sometime disconcerting symptoms of hormonal flux through their continuum, navigating life, work and school takes self-patience and forbearance.

The endocrine system is the driver in a woman's menstrual cycle.  Ramped up production of estrogen (builds up the uterine wall in preparation for the possibility of a fertilized egg), then lutien hormone and finally progesterone aid in continuing this kind of miraculous cycle women experience every month.  This is a complex interplay of hormones that alternately surge and reduce in preparation of one stage or another in the cycle.  The dominant follicle in the ovary become a corpus luteum if unfertilized; it's primary function is producing large amounts of progesterone. Under the influence of progesterone, the endometrium (uterine lining) changes to prepare for potential implantation of an embryo to establish a pregnancy. If implantation does not occur within approximately two weeks, the corpus luteum will involute, causing sharp drops in levels of both progesterone and estrogen. These hormone drops cause the uterus to shed its lining and the unfertilized egg.  Hence, menses.

Men and women alike are controlled by the endocrine system's hormone play.  It's a kind of fantastically sublime regulator  When things are working right, it is usually very subtle.  Men (and I know you're reading this) who might have difficulty imagining what women experience in their menstrual cycles, can have a better understanding by relating to their experience to the hormone, insulin.  All humans have insulin coursing through their bodies at all times.  The wonderful intact check and balance system most of us enjoy prevents us from noticing the ups and downs significantly.  But with insulin, when we've eaten too little or too many carbs or concentrated sweets, we often can feel our insulin production wildly shift, trying to normalize.  We can get big highs and big lows, irritability, headaches or exhaustion are primary symptoms of insulin not behaving in its usual stealth manner. Men, if you've had this disenchanting experience, welcome to a woman's relationship to the hormones, estrogen and progesterone (primarily) and our nearly constant world spanning over four decades.

What's a girl to do?  No one has control (or even an awareness most of the time) of what their hormones are doing.  But since we do know the discomfort brought on by one's menstrual cycle is hormone-related, supporting one's optimal endocrine function  would be a positive start to reducing the symptoms.  As we know with insulin, if we take care not to make insulin production go into over drive or shut down, we don't get the labile shifts that cause havoc in the body and which in turn causes the suffering.

Attitude.  Susun Weed is the guru of great attitude when it comes to women's health and cycles.  She's "crunchy" (as in granola-girl crunchy), but even if you don't swing that way, her attitude is empowering and positive.  Her little article: Blood mysteries - Susun Weed - herbal medicine - women's health .. is a refreshing boost toward getting a new attitude to our not-to-be-denied function.  Appreciating instead of resenting this incredible process is an act of self love.  Women in general, need a lot more of that right kind of feeling. And it starts with us.

Diet/Nutrition:  Again, Susun Weed has some great advice in Ten Tips for Women with PMS.  Many of her suggestions require self care (like making infusions, taking the time to be mindful of additions you might want to make to food or drink, etc).  This in my mind is a woman's saving grace.  Not only does it instill self awareness and introspection, it actually forces us (unless we want to be fully miserable) to take the time our body is asking us to take and make preparations, consider interventions needed, slow down.  It's kind of great we get these reminders.  It's an aspect of our gender that is extremely valuable.  

Because estrogen increases two weeks prior to the mense date, it might be a good idea to not promote a further elevation of estrogen levels by using soy products or other estrogen-enhancing nutrition at that time.  Also, increasing calcium and magnesium in one's diet decreases unwanted symptoms (Susun mentions this in the above article and emphasizes we should get this through foods not supplements).  Drinking lots of water (abates headaches), (or better yet, infusion teas like stinging nettle-high in calcium, supports the adrenals) helps keep us in flow, the pain, cramps, unwanted symptoms on the move.  Listening to the body's needs is singularly important.  Taking time to listen to what the body is asking for goes a long way to knowing yourself and your cycle symptomology.

Exercise/Movement:  Moving your body regulates your body. Movement primes the cells and system (including endocrine), encourages mutuality and cooperation within the organism.  Most women can tell a huge difference in their menstrual symptoms from the months they have a well integrated exercise regimen and the months they don't.  Exercise improves all circulations within our systems, and is a cornerstone in dealing with daily and/or chronic tension (stress). Moving the body in enjoyment and pleasure is key to sustaining healthy periods.

Practical Rest:  Sometimes our periods hammer us into submission.  Why wait to get layed-low?  Be pre-emptive. Get to bed early when you feel it coming on, take naps when you can, lay down and put your feet up (against the wall feels great). And while you are lying there prostrate, possibly groaning, take some nice deep breaths and send your inhales to where it hurts and imagine their removal on the exhales (out the closest exit sight).  Working with your breath in this way aids circulation, prevents you from minimizing or holding your breath (never a good idea).  It also empowers you to be your own healer.  The weight and heat of a warming hot water bottle on your pelvis is a comfort.  Almost better is sending the living Qi in your hands right to the areas that are hurting while breathing is hugely beneficial.  Never underestimate your own healing energy. You were made for yourself.
 
 resources: 
Red Moon Herbs ~ We create potent herbal products, focusing on ...
 has wonderful combination herbs for PMS and "moon" days.  great products!

some light reading for those heavy days:
Moon Days is a literary, passionate, and profound collection.Twenty-six writers explore the "silent" parts of women's lives; reawakening our memories of embarrassment and shame and transforming them to wonder, excitement, and laughter.

Amazons in Appalachia by Awiakta

RED by Karen Murphy

The Red Tent: A Novel by Anita Diamant (Aug 21, 2007)

 Menstrual facts gleaned from:  Menstrual cycle - Wikipedia, the free encyclopedia