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

This post is Part I of a 2 part series.  It precludes the practical detail of the action of mindful caring for our elders.

We are all born.  We all die.  And almost all of us have elders to consider as we ourselves age.  Without exception, that complex relationship, has its ups and downs (as well as karmic complications) through the relationship's continuum, and inevitably impacts our intentions to our aging loved ones.

At a certain point in a person's life, decision-making is necessarily abdicated due to advanced age or infirmity.  The decisions regarding the circumstances as to how their life will run its course is left to others:  adult children/family or institutions.  As adult children of aging parents, how do we consider what our relationship will be to our loved one's last laps?

For some, its a "no-brainer"; their parents have put into motion through long care term insurance purchase, or moving into an elder community that sees to the layered needs of the aging, or specifically voiced to their family how they would like to live the last years or decades of their life.  For these adult children, it's about follow through, respectfully adhering to their parent's wishes.  Even this ideal scenario is complex.  Possibly the adult children are not in a position physically, geographically or financially to honor these wishes.  Perhaps the aging community chosen is not so ideal, needs to be monitored on a regular basis.  Whatever the arrangement planned, the adult child's committed engagement is required, therefore, altering many aspects of their own independence.  Becoming clear to one's boundaries, capacity and level of commitment is essential.  Setting an intention that corresponds to the relationship you seek to create or maintain with the elder in your life is also required.

Many people claim there is a natural unfolding of this process, everyone involved takes their place.  Why make an intention if this is so?  Making an intention clarifies what you wish for in this relationship, shores-up the commitment with more of oneself.  The expected journey is long; challenges to the healing of a relationship, guaranteed.  An intention keeps us close to ourselves, and what we hope for, especially when the going gets rough and we question the endeavor.

Making an intention opens the field.  The field being one's perception, one's sixth sense.  It's possibly a growing up of the soul, an internal awareness of oneself and other.  It's a path of deepening oneself and one's possibility.  All the facts of the circumstance take a minor role and the relationship rises to the surface of prominent importance.  This is healing.  A possible healing of karma for those engaged and definitely a healing of what has been hard in the relationship.

With an intention, this is practically guaranteed.  How can I say this?  Because with an intention and a commitment to this journey comes a letting go of all that ultimately does not matter.  Whereas the details and circumstances are important, they are very secondary to what is shared. The cream rises to the top, a softening of oneself allows for perception to descend into parts of our self we didn't know we had.  This changes everything.  It also allows there to be this type of change in another.  If we only hold on to the details, the specifics, schedules and external needs-- and only allow that to run this lap, we miss the opportunity the  initial vow or intention created for us.

An intention might start with questions:  What percentage of my time do I want (not necessarily can) to spend with my parent?  With my parent's life affairs? What are aspects of our relationship that are  asking to be healed, would I like transformed? What are the grudges, resentments and hard parts we share?  How can I forgive?  How can I ask for forgiveness?  How much hands-on caretaking do I want to do (again, not necessarily can do)?  What is the necessary sacrifice on my part to do what I think I want to do?  Can I do this?  Can I get help with it?  All these questions are treated as an open inquiry.  Nothing is answered in a hard/fast, black/white way (at this point).  It's a beginning in fleshing out the feeling aspect of the proposed journey.  The decision-problem solving aspect of myself shouldn't jump in at this point, there will be plenty of time for that part to act.  In intention setting, its about allowing breath to enter the feeling center to create some room.

In this place of relationship a trust in something else besides the external occurs.  An adult child's anxiety and worry over the external details, the finances, the medical complications is background material.  It is almost always there, but for the most part doesn't take over our lives because the relationship's intention has helped us make it primary.  The connection, the vibration shared, the meeting and the healing is at the center.

Making the last laps rich, even under challenging and difficult circumstances is possible when this intention is in place.  Intention runs my actions.  I lose it, I return to it, I lose it again, but it is at the heart of what I want for my loved one and myself and steers me in the critical moments.  Our time, our financial resources, our individual direction; taking this on complicates our lives a little (or a lot) more.  Much like people making the lifelong decision to raise children.

In this journey we make, while there are hurdles, there is also a satisfying ride, a relaxing into the sublime elements of being connected to oneself and another more fully, an allowance of a natural unfolding.  Witnessing the external decline of another, whether mental or physical, isn't what you were afraid it would be.  The other's hallucinations, disorientation, good/bad pain days are experienced in a different way as this more subtle relationship is taken on.  The distinct impression of seeing our loved one with one foot in one world and the other foot in another more opaque world is touching and awe-inspiring. We see more of each other, a broader spectrum beyond personality and that is gratitude personified.  It is in this healing relationship one feels one's fortune; and it is reflected back from our loved one, having been shared.

I bring up intention in this first part, because it must precede the nuts/bolts and problem solving of the circumstantial details.  Otherwise, the external drives our actions, not the intention.

Memory and the Body (Part II)

As an umbrella term including all age related cognitive impairments, dementia in industrial and developing countries is epidemic. The number of cases of dementia worldwide in 2010 was estimated at 35.6 million.(1) Rates increase significantly with age, with dementia affecting 5% of the population older than 65 and 20–40% of those older than 85. (2)  While western medicine is trying to figure out the "cure" and management for this condition, it also would be useful to understand and explore the energetics and the relationship of the culture at-large to this malady.

In science terms, what is happening to those experiencing some form of dementia?  This is a neurological disease, meaning that the neurons and the connections in the body that serve them (synapses, transmission factors) are impaired.  This may be due to an accumulation of protein plaques as part of normal aging, atrophy of vessels effecting subtle communications to the brain, inflammation, inadequate blood sugar, and traumatic brain injury.  In energetic terms, it could be said, there is a block or impingement in the flow of qi or prana:  an energetic (and organic) circulation problem.

We are energetic beings living in layers upon layers of an energy charged world. We are influenced by these layers of energy (universal and material) and we concurrently influence the macrocosmos in how we tend and don't tend our own energy fields.  Life force (the condition of our energy fields, qi, prana) is thinnest at both ends of life's spectrum: infancy and old age.  Because of this, these two populations (as well as the ill) are extremely sensitized to energy.  They are practically osmotic in their internal reception to energy.     They are supremely (non-cognitively) aware of surrounding tensions and are impacted profoundly by even mild (negative, tense) stimulation.  In past posts, when I have mentioned the term "a deeper listening capacity", these populations are living there.  Not out of choice (which would be ours if we choose to nourish that in ourselves) but because their energy fields are thin (or "holey"); there is little to no buffer for them. For most of the rest of us, we have the buffers of ego and personality which usually supersede  these delicate places.  The daily dying we do, the moving in and out of sleep and dream states, straddling these (energy?) "other" worlds are transitions those experiencing dementia obliquely traverse.

For the infant and elderly populations, cognition and reason are not available (not developed yet or disease altered).  Hence, an experience of pain does not always register through the brain's pathways, but is nonetheless energetically experienced.  The sensitized "outsider" looking on would recognize its manifestation as irritability, restlessness, uncharacteristic (negative-based) behaviors.  Between 25% and 50% of older adults experience persistent pain. Seniors with dementia experience the same prevalence of conditions likely to cause pain as the elderly without dementia. Pain is often overlooked in older adults and, when screened for, often poorly assessed, especially among those with dementia since they become incapable of informing others that they're in pain. Beyond the issue of humane care, unrelieved pain has functional implications. Persistent pain can lead to decreased ambulation, depressed mood, sleep disturbances, impaired appetite and exacerbation of cognitive impairment, and pain-related interference with activity is a factor contributing to falls in the elderly. (3)

In the dementia literature, it is stated 40-50% of patients with the illness are depressed.  From my observations, depression and anxiety are prevalent as a past history in these patients.  What's first, the 'chicken or the egg' is the question that comes to me.  From a qi perspective, experiences of anxiety and depression are blocks in the flow of emotional health; it is the plaque in our feeling center that prevents joy, gratitude and acceptance.  Whereas there is an organic, physical/mental atrophy present in dementia progression, considering the flow of qi, life force in our emotional lives is also an imperative.

Finally, one of the things not often considered in the global dementia epidemic, is the place of the larger community.  For those in robust health, entertaining the notion we all are dying a little bit each day, navigating the dying process through dream states, minute loss of one function or another, is difficult to entertain.  As was said, we have the ego and personality buffers that are considerably removed from the truth of momentary dying.  But putting ourselves in the experience of one with cognitive deficits, means to enter that supremely sensitized energy state.  It is possible to straddle the cognitively 'clear' world one lives in while being in a rich and interesting relationship with someone who doesn't have those attributes.  It means listening more deeply, becoming more observant to energy manifestations and intrigued by the being that Is.  It means detaching a bit from what I think is Real.  It means setting aside my preconceived ideas as to what is meaningful and the probable emphasis on rational thought.

1.  Alzheimer's Disease International (2009). World Alzheimer Report 2009. p. 38. Retrieved 11 March 2012.

2.  Sadock, Benjamin James Sadock, Virginia Alcott (2008).Kaplan & Sadock's concise textbook of clinical psychiatry (3rd ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. p. 52. ISBN 978-0-7817-8746-8.

3. Hadjistavropoulos, T et al.; Herr, K; Turk, DC; Fine, PG; Dworkin, RH; Helme, R; Jackson, K; Parmelee, PA et al. (2007). "An interdisciplinary expert consensus statement on assessment of pain in older persons". Clinical Journal of Pain 23 (1 suppl): S1–43. doi:10.1097/AJP.0b013e31802be869. PMID 17179836 

Shega, J; Emanuel, L; Vargish, L; Levine, S.K.; Bursch, H; Herr, K; Karp, J.F.; Weiner, D.K. (2007). "Pain in persons with dementia: complex, common, and challenging". Journal of Pain 8(5): 373–8. doi:10.1016/j.jpain.2007.03.003. PMID 17485039.

Blyth, F; Cumming, M.R.; Mitchell, P; Wang, J.J. (2007). "Pain and falls in older people". European Journal of Pain 11 (5): 

Present to Death

Death and dying and contemplating this passage for oneself is a sobering reckoning most of us visit privately and with others at least a few times in life's journey.  A recent experience of this topic discussed among friends stayed with me for several days, and I feel compelled to write about it.

We all die.  And, if we are honest, we are afraid to do so.  If we had a chance to choose how to die, it would basically come down to a choice of the least unpalatable means (wishful thinking) for most of us.  What interested me in the aforementioned conversation among friends was the general insistence felt among the many in the conversation that they be present to themselves and the experience of dying; they wished not to miss the process, not to be in a drugged stupor nor apparent absence of dementia, but to experience their life to the fullest right up to the end.

As a nurse, all I could think was, "may the angels not be listening to this."  This human existence is an endless series of rounds of suffering (and joy).  There is no avoidance of pain.  It's our birthright and payment we make as human beings.  Experiencing our thresholds of pain in different layers is a valuable, even an illuminating materiality that can bring a richness to one's life.  That experience is something we take on willingly, especially if we know there is an end to it, a reprieve in sight (i.e. childbirth, brief uncomfortable procedures, a really bad headache, a divorce with a court date).  Pain medications are a god send when you need them.  Our pain thresholds decrease as we age.  The more frail we become, the more acutely we feel pain.  Pain medication and adjunct therapies that address pain receptors in our bodies/brains (clinical aromatherapy, bodywork, energy work, acupuncture, qigong) should be freely accessed if possible.

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A question came to me when discussing this idea of being fully "present" right up to the end:  How could we not be present to this cataclysmic event, same as the impossibility of not being present to our birth?  We are born as Whole selves.  Seemingly our purpose is to find how to live this wholeness in the time we are given.  We don't spend a lot of time knowing or experiencing this.  We don't know how, but (hopefully) spend a lifetime working toward being in relationship to the Whole that we are.  But despite this lack, we are still One.  A muscle is still a muscle even if it is atrophied.  We can't miss our passing because we're in a coma, or in a medication-induced delirium.  To imply this, is to believe Presence is a cognitive state.  It is not.

The body is an incredible dimensional, layered and impossibly complex organism.  Some type of life is going on in a person living in a coma. Arnie and Amy Mindell have proven this in their studies of coma patients.  You just have to hang 
around people in these altered states for a period of time to sense this is true.  We on the outside are 
not privy to this passage they are moving through.  But there is no mistake the experience of moving 
toward a death is not passing them by.  In the case of quick, usually violent deaths (it is my opinion), 
the layers of ourselves (body, energybody, spirit, soul) are separated.  And there is a need to re-assemble 
before a passing is complete.  There is a presence in this, an actual energetic movement toward the 
Wholeness we are in body on earth, and probably beyond.

So, we may have these temporary distractions of suffering, agony, trauma, violence which ultimately leads to our death, but our innate divinity is always present.  It's the thing that leads us Home, through this important transition.  We seemingly are in preparation our entire lives for this moment, are living this truth in small ways almost on a daily basis; through our system changes, relationships, the almost inconsequential letting go and acceptances that is our daily bread.  The cultivation of a deeper understanding of the layers of presence possible to be earned in a lifetime, is a support to an actualization at (bodily) death.  It is impossible not to be present to one's own death.  The cells, the energy fields within our body system are constant cues, despite our denial variations or momentary circumstances that seem to remove a consciousness from the equation.  The reality of the breath and depth of consciousness sinks in.  Consciousness... Presence are not cognitive activities.  They are a fuller, deeper, more whole experience, connected within, connected without.

Resiliency

Etching by CJ McGannon

Our beings, on the long life trek we make in this existence, are models of a tremendous resiliency.  The ability to sustain and survive the small and large nicks and breaks to our hearts, bodies, psychs, souls and minds endured over a lifetime is just short of miraculous.  A broken heart, a catastrophic accident, traumatic events, repeated loss, soul numbing extended misery circumstances-- how is it we don't die a million times over with the suffering and pain this life provides us on almost a continual basis?

Resiliency.  The body alone is a wonderful example of responsive rebound.  The body's design, from its replicating cells to its innate protection properties irrepressibly urges:  "Live!"  Vital organs are protected by bony prominences.  The ever mobile joints are useful and guarded by their artistically layered ligaments, tendons and fascia and well oiled by the buoyant, slippery synovial fluid.  Who could imagine twenty eight feet of intestine would be useful crammed into half of the torso's relatively small cavity?  And yet it is useful; brilliantly.  Incredible. And the tremendous cooperative symphony this complex organism creates between the parts, harmonizing the whole, whether it be useful bacteria in the mouth/saliva jump-starting the digestion process (actually initiated in the use of the eyes, nose and brain) or the pumping action of the heart in concert with respiration.  When something goes awry in one aspect of the body's function, there is a usually graceful accepting of the workload by another aspect. The spleen, liver, pancreas and kidneys all function in some capacity to filter toxins from the blood.  If the spleen is removed the pancreas and liver pick up on the function of the missing spleen's work.  Sometimes it is seamless, sometimes it is a dysfunctional undertaking.  But the body is a community and in relationship to its parts.  And most of all, because of this relationship, it is tremendously resilient.

The Three Shades, Rodin*

Similarly, the psych has a host of coping mechanisms to buffer the suffering experienced through our timeline.  It's actually quite remarkable, even elegant.  The strain of the brain and ego to return to a semblance of  "normalcy" in a crisis, has useful initial functions like denial, projection, isolation or rebound reactions to put into play when necessary, when the pain is too great, in order to survive.  This is how we carry on.  This is irrepressible life force trying to find a way to survive.

Even though we are programmed from the get go to move toward death, dying can be a difficult business; the collective body doesn't want to do it, even when it is unbearably tired of the struggle.  We have this incredible resiliency, life force that streams through us resisting capitulation with a universal energy. Our being is made to struggle, overcome, or at least to die trying.  And even in the process of the inevitable surrender of the body to the dying process, quite often resiliency is seen as the Spirit takes over this urge to live and adapts.  Again, one area in the community of the self fails, lets go; another part picks up the "life" action and becomes resilient, and rebounds.  Amazing.  This sophisticated organism we inhabit is a finely tuned orchestra; layered, complex and multifaceted, even when it is at its most dilapidated. From this point of view, it's hard to imagine that the spirit doesn't transcend the body post mortem.

Honoring this meta collective aspect of the divine in us seems mandatory. 

* " These identical male figures--known as shades, or ghosts from the underworld--are closely related to Rodin's figure of Adam.  However, rather than awakening to life as Adam does, the Shades embody death, sleep, and a loss of consciousness."  (description of statuary at Rodin Museum, Philadelphia)