Aging in Place with Grace

Leave me alone! I don’t want to move!

Spencer Johnson, M.D., author of “Who Moved My Cheese,” is quoted as saying, “The more important your cheese is to you, the more you want to hold on to it.”  This is a direct correlation to why we seem to want to remain in our homes for as long as we can.  Our home represents comfort, independence, familiarity and security to us.  At least that’s what we’d like to think.

The aging process is insidious and creeps up on us.  While time marches on, our physical and mental abilities seem to be marching backwards.  For those who wish to remain living in the home they have been in for a very long time, one consideration must stand out about all the rest. Is it safe to do so?  Being “safe” plays out in a myriad of ways from the physical (health care) to the environment (the design of the home) to the psychological and social (avoiding isolation and boredom). Answering these questions can lead to very enlightening discoveries and help identify future problems or issues.

So where do you start when you want to determine if remaining in the home is an option?  First of all, the fact that you have begun this thought process puts you ahead of the game in a variety of ways.  It allows you to address possible issues now before they become critical ones.  Second, you have control over this decision.  If you wait too long, this decision can be taken away from you.

A good place to begin is deciding what is most important to you so that, with forward planning, you can continue to enjoy your life in as safe an environment as possible.  Is it having the ability to attend social and community events?  Stay involved with family?  Continue to have access to libraries and learning opportunities?  What about transportation to and from doctors, etc.  Will you be able to maintain your home and property?  If not, who will do this for you?  And, of course, how much will it cost?

As you can see, there are a lot of questions to ask and to answer.  This process can help put your priorities in order and bring to the forefront, if any, changes you will need to make to continue to do these things safely.

So for instance, what about remaining safe within the building you call home? As we age, our eyes being to lose their ability to focus as well as they used to. So, for instance, it can become increasingly difficult to see changes in floor levels or even floor surfaces, causing stairs, throw rugs and clutter on the floor to turn into hazards for trips and falls.  Difficulty reading the oven temperature dials, locating items on shelves or in cupboards or even using the telephone can become frustrating and even dangerous.  The solutions to these issues can be as simple as removing all throw rugs, lowering or removing door thresholds, installing a telephone with alarm lights or shelving that pulls down closer to us. These aging changes play out in a multitude of ways and can affect how we move around, bath or cook to staying active and involved in our communities and families. Finding solutions to these issues before they become hazardous to you is where pre-planning is so advantageous.

At the top of my list is knowing that a time may come when I can no longer drive.  The day the car keys are taken from me is a day I dread.  However, if I plan ahead to live where there is transportation to where I want to go (health care, social events, libraries, community college), then I will be able to transition into this stage with less stress and angst.  If I have access to that transportation from where I live now, then I can successfully remain in my current home.  If not, then I need to plan on moving to a residence where I can.

Choosing to age in place is not as easy as it may seem, but continually assessing future needs and the options available to address those needs may make the road ahead less stressful and far more enjoyable – for all family members.

 

© Dr. Jill M. Bjerke 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to [Your Name] and [Your Blog Name] with appropriate and specific direction to the original content.

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Someone’s Trash – The Problem of Hoarding Part 2

English: Living room from a person with compul...

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In our last article, we defined what hoarding behavior is and why it causes so much havoc in not only the life of the hoarder, but on friends and family as well.  It becomes an issue that needs to be dealt with when it creates an unhealthy or unsafe living environment, disrupts family and friend relationships, serves to compound a mental health issue or isolates someone so much that it threatens their very existence.  Now let’s look deeper into how best to help someone with this behavior.

If you search on the term “hoard” you will inevitably see that it is said to be connected to obsessive-compulsive (OCD) behavior.  I believe, however, that while it may have an OCD component, it more frequently follows the path of an addiction.

Recently Lance M. Dodes, M.D., a professor at the Harvard School of Medicine and author of The Heart of Addiction (HarperCollins, 2002) and Breaking Addiction: A 7-Step Handbook for Ending Any Addiction (HarperCollins, 2011) became a consultant and advisor for us.  Dr. Dodes’ opinion on addiction is that, “Virtually every addictive act is preceded by a feeling of helplessness or powerlessness.  Addictive behavior functions to repair this underlying feeling of helplessness.  It is able to do this because taking the addictive action (or even deciding to take this action) creates a sense of being empowered, of regaining control – over one’s emotional experience and one’s life.”  Dr. Dodes labels this feeling a “trigger.”

Over the years of working with people affected by hoarding behavior, invariably at some point they reveal certain details about a past event that has caused them to feel hopeless and helpless and often will say that they never hoarded things until that event happened, hence my tendency to relate hoarding behavior to an addiction.  When a client says they never hoarded things until their son died or they became divorced, they are experiencing this “trigger.” Similarly, an upsetting memory of never having a new dress in childhood is another example of how past events are played out through hoarding.  This is evidence of a spark that causes this person to react in a way that, to them, restores their control. The person experiencing this feeling of helplessness is now coping by deciding when, how much and what they will save or collect, as this visually surrounds them with things that comfort them and give them false security of a restoration of power, even if it is saving every newspaper or plastic bag or continually purchasing unnecessary items.

In order to create or return a living or working space to a healthy and safe one, it is obvious that the choices of what to keep and what to get rid of are going to have to be made, but not by us.  The overall goal is to guide the person into recognizing what has triggered the feeling of not being able to let go or discard something and to redirect it to a healthier choice. The core concept is that the person is not tied to the object or item itself, but to the memory of what that item represents.

Arguably, this is a difficult and exhausting process and is fraught with unfaced feelings, anger and the old helpless/hopeless cycle.  And unless there is support from family members and friends, the road becomes all the more difficult.  Many have given up on this person, thinking that they will never change.  The families and friends often experience a feeling of hopelessness over this person’s behavior and have either accepted it or ignore it. They become enablers for this addiction.  But for the hoarders and their families who are willing to face their fears, it is possible for them to carve out a new way of thinking and behaving. It takes time and patience to tackle cleaning up spaces that have become overwhelmingly chaotic.

Does this work every time?  Definitely not.  Hoarding is one of the most difficult behaviors to change, if it can be changed at all.  But that does not mean that someone with this problem should give up – quite the opposite.

These feelings are nothing to be ashamed of.  If a person can admit they are a hoarder, they have taken the biggest step there is to finding a way to solve the problem.  If you or someone you love has experienced hoarding and would like to find ways to cope with this disorder, it is wise to seek treatment from a mental health professional first, however a word of caution.  If the person who is hoarding does not feel that there is a problem with this behavior, there is little anyone can do to help; for it is very true that “you can’t change what you don’t acknowledge.” When a therapist asks us to become part of a treatment plan (as the majority of therapists will not carry out therapy in a patient’s home), we work at the direction of the therapist.  But whether in treatment or not, the goal remains the same: creating clean and simple spaces.

 

© Dr. Jill M. Bjerke 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to [Your Name] and [Your Blog Name] with appropriate and specific direction to the original content.

 

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Someone’s Trash – The Problem of Hoarding

English: Compulsive hoarding Apartment Deutsch...

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“Someone’s trash is someone else’s treasure.”  Have  you ever heard that saying?  For people who hoard, this is actually their reality.  The definitive issue with hoarders is that they have great difficulty in distinguishing between the real and the perceived value of something.  Or put another way, it is the excessive acquisition of possessions and the inability or failure to use or discard them.

The causes behind hoarding are very complex, which makes it difficult to diagnose and treat. Hoarding has been associated with obsessive-compulsive and personality disorders, depression, addictions, post-traumatic stress disorders, a traumatic loss or aging with mobility limitations.  It has also been theorized to be genetic and to affect a specific part of the brain.  If it is difficult, then to determine why is happens, it becomes even more difficult to treat or to instil any kind of behavior changes.

People who hoard have been described as “pack rats,” “obsessive collectors” and “cheapskates.”  It becomes an issue that needs to be dealt with when it creates an unhealthy or unsafe living environment, disrupts family and friend relationships, serves to compound a mental health issue or isolates someone so much that it threatens their very existence.  Hoarding behavior has been documented as starting as early as 7 years of age.
Research and treatment of people who have hoarding behaviors has shown the following as common motivations for not being able to part with possessions:

  • Items are perceived as valuable
  • Items provide a source of security
  • Fear of forgetting or losing items
  • Constant need to collect and keep things
  • Obtaining love not found from people
  • Fear others will obtain their personal information
  • Physical limitations and frailty
  • Inability to organize
  • Self neglect
  • Stressful life events

It is obvious that hoarding is a very complex issue, so working with someone who hoards is very complicated as well.  After all, they have justified to themselves, their families, employers, landlords, etc. as to just why it is so important for them to hold on to their books, animals, teapots, plastic bags and other “things.”  When I ask why they can’t let go of the massive number of items, here is a sample of what I hear:

  • “This is perfectly useful, I can’t just throw it away.”
  • “One day, this might come in handy.”
  • “I bought this doodad to help me get organized.”
  • “This is a precious memory.”
  • “I’m saving this for…my children/grandchildren…when I get another dog…when I lose weight…”

Now imagine hearing that when trying asking them about what to do with every single item when we start sorting! While I do not discount the validity of these statements to the hoarder, the goal is to alter their way of thinking so that they can restore their living space to a healthy environment.  But this is easier said than done.  For me to help them learn how to make decisions that will prevent future hoarding, I need to know why this specific client feels they need to hold on to these items.  In other words, what drives a person to do something that leaves their home full of garbage, of floor to ceiling newspapers, of no where to sit or sleep or with not even any place to prepare food or bathe?  What decision tools can we provide them that will get them on the road to a healthier lifestyle?  It all starts with the most important first step of all:  the initial consultation, which I always do at no charge.  This is my opportunity to build a bond of trust and to ask both the client and the client’s family a lot of questions that will guide me in customizing a plan of action designed specifically for them.

(to be continued….)

© Dr. Jill M. Bjerke 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to [Your Name] and [Your Blog Name] with appropriate and specific direction to the original content.

 

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Aging in Place is more than Bathroom Grab Bars!

Now, more than ever, the concept of remaining in our homes well into our senior years is becoming increasingly attractive.  But before we make that decision, there are some serious issues that need to be considered.

First and foremost is our health, for no matter how safe we make our home, we need to be healthy enough to live on our own, or at least with a minimum amount of assistance.  Without a doubt, within the last 10 years there has been an explosion of services that can now be provided in the home, which can help us remain there longer.

Second is the structure itself.   A single story floor plan with a minimum number of stairs is ideal.  But it’s possible to live on just one floor of a multi-level home if there is enough appropriate living space, including bathroom and kitchen access.  A few of the most prominent features that should be considered when buying a home or retro-fitted an existing one are:

  • Appropriate floor lighting, especially at night
  • Replacing faucet and door knobs with lever-type handles
  • Non-slip floor surfaces, contrasting floor colors and a minimum number of floor height transitions
  • Appliance “garages” to keep them accessible on the surface instead of in cabinets
  • Increased task lighting (such as in the kitchen or next to a favorite chair)
  • Roll out or pull down shelves
  • Visual indicators for smoke/carbon monoxide alarms, doorbells and telephones

Along with this is the importance of eliminating extra furniture and clutter that can clog up hallways and create access barriers to bedrooms or living rooms.  As our eyesight changes, it is harder to see these barriers and they can truly become a safety issue, especially when using a walker or cane to assist in mobility.

Home builders have certainly come to realize the importance of the features mentioned above and incorporate some of these into their new home construction.  But there are issues outside the home that are significant as well:

  • Distance to stores or health care offices
  • Lawn care and snow removal
  • Gates or fences for privacy and protection
  • Sidewalks or other hard surface areas around the neighborhood
  • Access to public transportation or availability of other transportation options

As we age, our ability to take care of and protect ourselves and our property and our capability to travel to stores, health care, entertainment and other locations all begin to change as time passes.  If we can think about some of these issues now, before they cause difficulty, then the transition to aging in place becomes much less stressful.  Certainly companies who provide in-home health care and homemaker services, property maintenance and senior transportation can all meet our needs, but they may not be in our budget, so other solutions must be sought before they become a critical dilemma.

As they say, “Choose wisely and choose well.”  Think about the things that are so essential to you, what you treasure and what you feel you cannot live without.  It could be going out for lunch with friends or working in your garden.  Perhaps traveling to see relatives across town or walking along the river.  Plan now for how you can continue to do those things as your ability to do them changes and someone makes these decisions for you.  Life is what you make it.  Make it great!

© Dr. Jill M. Bjerke 2012. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to [Your Name] and [Your Blog Name] with appropriate and specific direction to the original content.

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