According to an article in The New York Times, early detection for Alzheimer’s “would mean that new technology like brain scans would be used to detect the disease even before there are evident memory problems or other symptoms.”

The article goes on: “If the guidelines are adopted in the fall, as expected, some experts predict a two- to threefold increase in the number of people with Alzheimer’s disease. Many more people would be told they probably are on their way to getting it. The Alzheimer’s Association says 5.3 million Americans now have the disease.”

Journalist Sheryl Kraft, in her “MidLife Matters” blog at HealthyWoman.org, writes a very thought-provoking piece about what she sees as the fallout of such a change.

“Insurance companies would be privy to the results: would they deny coverage to those who have tested positive?  Let’s not even mention all the false positives that come with testing.”

What she’s referring to here is all the anxiety that goes with all those positives and those false positives.

This, from GenomeWeb addresses the issue of genetic test anxiety. The piece says, “…it turns out there’s a large pool of patients who are anxious about the stuff they might learn from a genetic test.” And that “some people might be anxious about finding they carry a gene that makes them more likely to develop diseases like Alzheimer’s disease – there’s no cure for it….”

But said anxiety is not exactly a new phenomenon. I mean, ever been a patient? Ever known a patient? Then you understand the fear of “finding out” if a test is positive or negative.

As we move closer to having more tests that can detect Alzheimer’s and other diseases sooner—and before a cure is created—I advocate equal attention be paid to the anxiety produced along the way. Not just lip-service attention, but funding for counseling and support. It’s one thing to study anxiety in a clinical way and discover that (surprise!) people who undergo medical procedures have it. It’s quite another to address these issues, to provide counseling and emotional support.

Among other things, anxiety causes people to isolate and turn inward, to think the worst and lose hope. These are side effects of such testing. That doesn’t mean we don’t test. It does mean, however, that we consider what “knowledge is power” means, in a real-world way.

Photo: iQuoncept

The post Alzheimer’s Testing: Are We Ready for the Test Anxiety? appeared first on The Faster Times.

♦

Paul Johnson, the veteran NBC traffic and weather reporter passed away June 29 at 75, at home in Orange County. Brown, who Angelinos (and residents of the OC) knew by his signature sign-off: “Buckle up, be careful out there”  underwent brain surgery for glioblastoma in January and remained off air while recovering. According to MSNBC: “Johnson decided to forego chemotherapy or radiation treatments, saying ‘he wanted to die with dignity and without pain,’ his wife, Nancy, said. ‘He spent his final days resting peacefully at his home in Orange Park Acres,’ she said.”

♦

Alexandra Grabbe, says, about caring for her mother, who died in her 90s: “Home care is not a job I thought I would ever look back on with nostalgia. I had moved into my parents’ house with the goal of allowing my elderly mom to die with dignity, in her own bedroom. Once she became bedridden, I cared for her for seven long months.  I didn’t know what to expect when the end drew near. People assume death to be a turn-off, so accustomed are they to the murders which dominate the local news and popular crime shows.  This assumption is wrong.  My mom’s passing was an incredible high.  Being there for her was the right decision.  Four years later, I realize how special this phase of my life was, how lucky I am to have lived it.” Alexandra, who, in addition to running an all-green bed and breakfast on Cape Cod, is working on a book about what she learned, and the experiences she embraced, while caring for her mother.

Alisa Bowman, on her Project: Happily Ever After blog, recently posted about her grandparents, who have been married more than 70 years. Her grandmother, who is 93, is in a nursing home. Alisa writes: “She has many ailments, but severe dementia leads the list. I lived with her one summer, but she no longer remembers that. She no longer remembers me at all.” Her grandmother also has MRSA, which means-according to the rules-there must be no physical, skin-on-skin contact with her. But her grandfather, who is 94, insists on kissing his wife-on the lips-goodbye during their visit.  She writes, “The aides are yelling, ‘Harry, wash your hands!’ They are shaking their heads. Skin to skin contact is not allowed with someone who has MRSA.” Alisa writes, “I think Grandpa either can’t hear them or he just doesn’t care. He loves her. He’s going to kiss her on the lips no matter what contagion she has.”

Hygiene factors aside, isn’t this what we all want, not only in old age but in life? To feel like someone is with us, loves us and not afraid of us because we are dying? Or because we are sick? To be loved and accepted for who we are at every stage of our lives. And, if we can be grown up about it, to do that for the person(s) we love.

Photo credit: Firenzesca

The post Getting Old (And Being a Grown-up About It) appeared first on The Faster Times.

I’ll admit it. I am obsessed with mother-child relationships. I write about them, think about them, find them fascinating and never grow tired of hearing stories about them. I’m not talking about shock-value stories, either. I’m talking about stories that reflect the complexity and layer of perhaps the most original relationship* of our life.

I discovered one such story recently, written by journalist Francine Russo (she wrote for Time), author of They’re Your Parents, Too! How Siblings Can Survive Their Parents’ Aging Without Driving Each Other Crazy. She has an interesting piece in The Huffington Post about Supreme Court nominee Elana Kagan’s mother, who was a long-time neighbor of Russo’s. Now forget politics for a minute. The reason this article was so fascinating to me was because it zeroed in on exactly what my clinical supervisor said so long ago—the mother’s the mother. Even when you’re a Supreme Court nominee you’re totally aware of your mother’s expectations for you—and how you did or didn’t meet them.  Kagan tells Russo in a brief exchange in which the author says how proud her mother would have been: “…our newest nominee to the Supreme Court of the United States said dryly, ‘My mother only wanted me to get married.’”

See?

Why does it matter to us? Should it? Why do we have to defend ourselves against our parent’s running commentary—even if it’s only in our heads?

*And not to be equal opportunity about this, but the same thing could be said about dads.

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Miller spent her career examining the complexities of the parent-child bond. Her best-known book, The Drama of the Gifted Child and the Search for the True Self (originally published as Prisoners of Childhood), begins with this line: “Experience has taught us that we have only one enduring weapon in our struggle against mental illness: the emotional discovery and emotional acceptance of the truth in the individual and unique history of our childhood.”

Over at Psychology Today, I wrote about the movie in the context of adoption. But what the film is really about is healing emotional wounds from childhood (and what happens when you don’t). This is what makes “Mother and Child” everyone’s story.

Karen (Annette Bening) became pregnant at fourteen and was forced by her mother to give the baby up for adoption. Karen and her elderly mom have a terse, rigid and distant relationship today.  They live together, just the two of them (Karen has never married). They are forever joined over the incident but at odds over it thirty-something years later. Karen’s loss—her wound—steers her every waking moment.

While it’s often true that the cause of the problem has a parent’s name on it, the solution has only our own.  The character of Karen raises one of the most important questions anyone could ask her(him)self: How long will I keep defining myself by this wound and is it really working for me? (I don’t know—maybe it is.) I find this the perfect question to ask on Mother’s Day, the most ambivalence-generating holiday there is.

Mr. Garcia told me in a phone interview that, indeed, he made the film with the idea of adoption as a love story. “You go into it with the best of intentions, and there is a selfish aspect. Sometimes it turns out beautifully and terribly and sometimes it’s a mixed bag,” he said. “I wanted to honor that you never know which way it’s going to go.”

He’s right. Naturally, this applies to any relationship between mother (or father) and child. And then there are those childhood wounds that go with it.

Which brings me back to Alice Miller. In her writings Miller addresses the need for us to recognize our needs, feelings; to be aware of our wounds. This is not the end goal, of course; the goal is to progress, to move forward past the awareness and heal. At some point we should want to move beyond our wounds-transcend and incorporate them.

Accepting the unique history of our childhood, as Miller suggests, should be used to help us heal ourselves and our relationships with our aging parents. Otherwise we are aging, grown-up prisoners, as she notes, but of childhood.

And healing can happen, though as “Mother and Child” and real life shows, sometimes not in the way we imagine.

The post Mother’s Day: The Most Ambivalence-Generating Holiday of All appeared first on The Faster Times.

I have watched the TV show Hoarders once, but in visiting the homes of patients as an LCSW have seen the effects of real-life hoarding played all too often. It’s difficult not to stare at what is typically-though not always a mess. (Some who hoard are in fact anal about it.). Not to ask “why?” and “how?” In other words, not to judge.

There have been recent reports and books written about this hoarding phenomenon, a disorder which, by the way, is not listed in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a manual that lists criteria for clinicians to use for diagnosing and identifying all types of mental disorders. Yet. That may change with the new edition, set to be published by the American Psychiatric Association (APA) in 2013.

In the current issue, the DSM-IV, hoarding is listed under Obsessive-Compulsive Personality Disorder, as one of 8 criteria for diagnosis. It’s described as:  “The inability to discard worn-out or worthless objects even when they have no sentimental value.”

It seems as though it deserves its own category.

National Public Radio recently aired a story about how researchers are realizing that hoarding behaviors begin in the mind. At the University of California, San Diego Department of Psychiatry, psychologist Catherine Ayers, a specialist in anxiety disorders and late-life hoarding, is researching treatment for older adults who hoard. Currently, she’s using a form of behavior therapy and cognitive remediation that focuses on building concrete skills.

That’s a good thing.

Hoarding resembles an addiction, progressing in severity over time. Which means it affects the family members, too. For some people the worsening of symptoms is slow and steady, for others it’s rapid and frantic.  If a big clean-up is imposed to rid the house of clutter but no follow-up treatment is offered to treat the underlying disease process, the person will typically replenish the clutter and then some, much to the dismay of the interveners. That’s the pathological part. Remember that if you care about someone who hoards, so you don’t find yourself too angry that your efforts to clean up once and for all failed, over and over again. Be gentle with them—and yourself.

Which brings me back to the TV show, or rather,  viewers and their comments. I’ve heard people  say they feel “superior” when they watch the drama unfold on screen. They say it with a touch of arrogance, impatience, disdain, directed at the people, rather than the disease. The first time I heard it I thought it was odd, a fluke. Then I heard it again. And again.

I reminded myself, humbled, not to judge that either.

To find a therapist who specializes in the treatment of hoarding, contact the American Psychological Association.

Photo credit: Hoarders

The post Hoarders: You Feel Superior to Them, Right? Wrong. appeared first on The Faster Times.

Both sites reported that surveillance video showed wife Christine Newton-John (Mrs. Mason) , 41, pulling her husband Mr. James Mason around the pool by his arms and legs. Repeatedly. She was sentenced to 4 years in prison, The Huffington Post reports.

There are many twists and turns to this story.   As a clinician, the intake (gathering of information at the opening of a case) might possibly take hours. On the surface, this case might be interpreted by some as being about an individual who became fanatical about exercise, who took the concept of healthy living to a twisted extreme. Or about a May-December romance gone awry.

According to the Associated Press, Mason was a longtime friend of his wife’s family. He knew her as John Vallandingham before she had gender reassignment surgery in 1993 and changed her name. They married in 2006.

After reading that detail, people will focus on the sexuality of the new spouse. But this story is not about that. Now dig deeper. What the story is really about is someone exploiting the trust of someone more frail and dependent, of trying to control and dominate. It is about elder abuse. This can happen in first marriages, too (and in third marriages), and it can also happen between parent and child, between spouses of same and opposite sex, between any two people when the balance of power is shifted because one is more dependent on the other. It can be physical, mental, emotional and fiduciary. Thankfully, it does not always happen, but it can. And does.

When an unfortunate soul and his family are desperate to get the care an older adult needs, it can happen. At one point in time someone from the  family may have even looked up to the new wife for being such a “go-getter,” and for trying to “help” her spouse. Even this makes little sense. According to police (you will see via the link) Mr. Mason was, in fact, afraid of water.

Was this woman a narcissist? Sadist? Mentally ill? All of the above? Yes, it matters that we ask these questions aloud and talk about them to build our own awareness.  The story states that there had been other reports of abuse in the marriage, but does not provide details.

This story strikes a chord because we want to trust that people are generally good.

Which is why we need to trust our gut when we feel something is just not right.

Photo credit: Flickr/zik ” Tây

The post A Young (Transsexual) Wife Exercises Her Older Husband to Death. And the Lesson Is…? appeared first on The Faster Times.

I read the article in The New York Times, “Facing End-of-Life Talks, Doctors Choose to Wait” (Jan 12, 2010) with interest, but ended up feeling something important was missing.

The piece, which came out earlier this year, cites a study published online in the journal Cancer. The Times reported that “many doctors, especially older ones and specialists, say they would postpone those conversations [meaning the end-of-life ones], according to the findings of the study.

My experience working with dying patients, visiting hundreds of elderly people diagnosed by their physicians with end-stage diseases who had only weeks to live, taught me that even—or especially—the most brilliant (and often the nicest) doctors might be more frightened of discussing death than their patients are.  That doctors are human like the rest of us, and, like the rest of us, are at times timid, ill-equipped—scared, perhaps—to talk about death in a personal way. Saying doctors “choose” to wait makes it sound like their choice is always altogether rational, planned and born out of ethics.

As a clinician, there was nothing more painful for me than to receive a doctor’s order to speak to a patient about hospice only to find out the doctor hadn’t told the patient and family why. Or being dispatched to a patient’s home (or hospital room) only to have the patient’s family—or the patient—tell me in tears that they couldn’t get the doctor to tell them anything.

I fear that many people fail to realize that going on hospice is actually a choice that the patient gets to make for himself or herself—or it should be. But it’s almost impossible to make such a choice when the treating physician who guides the care plan avoids the subject. The public has the idea that most people receive hospice care for months. Some do. And they will tell you it was a blessing. Many of the patients I met received palliative care for a week or so, some for only a day or two.

When I was new to the field more seasoned social workers and nurses told me that doctors only like to focus on solutions, that this explained why they never discussed “What if” with their elderly patients, even the seriously ill. What if, as in, What if the treatment doesn’t work? “That’s your job,” my colleagues told me, like they were relieved someone new was coming in to relieve them of doing just that.

It is a social worker’s job to help the patient process end-of-life issues. But it is the doctor who creates the care plan, who sets the tone of treatment, who leads the care team to best serve the patient. It is the doctor who writes the clinical orders therefore it should be the doctor who also understands that waiting too long to discuss death can do more harm at the end of an individual’s life, than good.

Photo credits:

Photo by kswgoodfriends

Flickr/IQuoncept Flickr/novamade Flickr/aaronmac1

The post End-Of-Life Talks That Never Happen: Why? appeared first on The Faster Times.

My realization came when I was 40, a few months before my mother died at 82. After my father passed away she was stricken with dementia and Parkinson’s Disease and admitted to a nursing home. “You’re her granddaughter, right?” the nurse asked, filling out a financial contract. “When will her daughter be here to sign?”

Mom looked up, eyes blurry behind her glasses. “This is my baby,” she whispered, voice thin as air.

“That’s right,” I said, patting her liver-spotted hand.

♦

My parents were almost 42 and 44 when I was born in 1961—today that seems young—and my two siblings were already away at college. “You were a change-of-life baby,” my mother told me often, “a great big surprise.”

Now I have friends, pregnant for the first time, older than my mother when I was born. It is wonderful that, these days, most “change of life” babies are not mistakes, but rather meticulously planned and pined for. The conscientious, scrupulously prepared moms boast about their readiness to parent, and finally being mature enough to do a good job. They’ve got college funds invested, and Baby Einstein tapes feeding through their well-monitored bellies. From mom’s perspective, all is well.

“The baby will keep me young,” they might even say.

My mother said that, too.

Maybe from her perspective, I did. From my point of view, I wasn’t doing such a good job.

All kids fear death, but many a child born to older parents intuitively understands their folks will die sooner. They know younger parents have more energy and stamina and, all things being equal, time left on the planet. My parents never wanted to discuss that.

“Talking about it makes me feel old,” my mother said.

For the record, there will be moms that have babies at 47, and then live to be 90 and healthy; but many will die younger—a combination of genes, illness, and fate. Plastic surgery, dermal fillers, and Botox can make aging easier to deny, make older moms look like older sisters, but even if parents partake of them, they should address the fears my folks never would.

♦

Back at the nursing home there were apologies. “I don’t know what to say,” the nurse said.

No one does,” I told her, and signed the document.

She looked from my silver-haired mother to me. “You’re too young to have a mother this old,” she whispered.

“I’ve heard that all my life,” I reassured her. That day alone I’d heard it from the ambulance driver, the attending physician, two healthcare aids, the hospital discharge planner, and that 45-year old friend, six months pregnant with her first child.

Only my friend had the look of fear in her eyes. That’s because there is something, in all her planning, she wasn’t facing—the fact that her child could someday be in the same situation. First, a child of older parents, then a caregiver of older parents, then the adult child of parents who have passed away. I figured she’d deal with it when she was finally ready. If she wanted my advice I’d tell her to start talking to the little one about it early, in words and concepts he could understand. Let him know that she would teach him all she could about herself, so that the part of her that wishes she could be with him for the duration of his life will, in fact, live on inside him forever.

I’d tell her to make that her truth. She would, however, have to trade it for the illusion that her baby will keep her young.

I hope, for her child’s sake, she doesn’t wait too long.

This essay, in slightly different format, was originally published in the Los Angeles Times. Photo credit: Eythor

The post Too Young To Have a Mother That Old? appeared first on The Faster Times.

I should know. I have cared for both my parents and have a license in clinical social work. I worked for a huge healthcare system in their home health department and I heard family stories. Lots of them.

I heard about the kids who cared for their grandparents—and their aging parents. And I heard complaints about the kids who didn’t care. In the privacy of their homes, with oxygen tanks whirring and IVs dripping, I talked to my patients about their cancer, about hospice, about God, about no God, and about running out of money. I tried to explain that you can’t make a narcissistic mother more loving at age 75 (nor should you expect to) and that, no, your father is probably not faking memory loss at 80. I heard patients weep, saw the fear in their children’s and grandchildren’s eyes when the reality of death registered; saw other people get on their cell phones to avoid the conversation, or turn on the TV to drown it out.

Now, for the first time in years (and because The Faster Times suggested I do) I’m writing about my experiences in hopes of understanding the bigger picture of aging—and aging parents (and grandparents)—as well as the personal. What I’m going to do is scour the media and post about news as it relates to aging + parents, and items that about aging that can relate to parents as well. I’ll look at the story with a clinical eye, hoping to shed some light (and insight) on the story behind (and beneath) the story. This is what I think helps us make better decisions for ourselves and those we care about and for.

I hope you’ll find something here if you are caring for a sick parent, a parent who always seems to need help you don’t know how to give (or want to), or a parent who won’t accept the help you’ve offered. I hope you’ll find you’re not alone.

Photo credits:

Jenya Campbell

ShahidulNews

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