Issues In Aging Archives - Page 7 of 7 - Center for Modern Aging Princeton

Getting Older, Sleeping Less?

Posted on October 8, 2019 by Editor

Until age 45, Mary Jo Anderson says, she was a “champion sleeper.”

“It’s like someone flipped a light switch,” she said. “When I entered menopause, I suddenly couldn’t fall asleep.”

At age 64, she had less trouble falling asleep but couldn’t stay asleep. She woke up almost every hour of the night and felt tired much of the time during the day.

Anderson was not alone. More than half of all Americans over 65 report they have difficulty falling asleep or staying asleep, according to the National Institute on Aging.

It’s a miserable feeling. While everyone else sleeps comfortably, you’re awake. Anxious or distressing thoughts occupy your mind. The longer you stay awake, the more you worry about not getting enough sleep. You fear you won’t be able to function the next day; you fret over how the lack of sleep may affect your health. A vicious cycle ensues: the more you can’t sleep, the more you worry about not sleeping, which keeps you awake. You start to dread bedtime and another night of trying desperately to sleep—and failing.

“It’s a cruel joke that life plays on us,” said W. Christopher Winter, MD, founder of the Martha Jefferson Hospital Sleep Medicine Center and author of The Sleep Solution: Why Your Sleep Is Broken and How to Fix It (2018). “When we’re young—working nonstop, with kids running around the house—we wish we just had more time to sleep. Then we get older and have more time, and your brain’s saying, ‘I don’t really want it anymore.’”

Plus, the media are full of alarming reports that connect sleeplessness with health problems. Chronic insomnia is linked to increased risk of developing obesity, Type 2 diabetes, hypertension, heart attack, depression or anxiety. Research also links insomnia to Alzheimer’s and other forms of dementia (although it’s not clear whether the insomnia is a cause or an early symptom). Sleep-deprived people are more prone to falls or car accidents as well as forgetfulness. And, according to the National Sleep Foundation, a lack of sleep is linked to overeating—especially the overconsumption of junk food—which can lead to weight gain.

On the flip side, people who do sleep well are more likely to be alert, function better mentally and are even more likely to maintain a healthy weight.

But there is hope for those of us who call ourselves poor sleepers. With a “sleep makeover”—changing habits that disrupt sleep, developing routines that promote sleepiness at bedtime—many older adults can get the sleep they need.

The Roots of Sleeplessness

Researchers divide sleep disorders into two general categories: dyssomnias and parasomnias. Any sleep disorder that causes daytime drowsiness is a dyssomnia. That includes insomnia as well as other conditions, such as sleep apnea or restless leg syndrome. Parasomnias are sleep disorders with odd or irregular behaviors that occur during sleep, such as sleepwalking or night terrors.

People with insomnia—difficulty falling asleep or staying asleep—may experience fatigue, low energy, difficulty concentrating, mood disturbances and decreased performance at work. Chronic insomnia isn’t an unavoidable aspect of normal aging, but sleep patterns do change as we age. It’s possible to understand these changes and not let them cause unnecessary distress that keeps you up nights.

“Among healthy older adults, the brain circuit that controls sleep just isn’t as robust compared to that of their younger selves,” said Steven Lin, MD, neurologist with Healthcare Associates in Medicine, PC, in Staten Island, NY. “Plus, older people tend to have medical or other issues that may interfere with normal sleep.”

People over 65 are more likely to suffer from chronic conditions, such as arthritis, which can cause pain that can awaken them at night. They may be more prone to bladder issues that necessitate repeated nighttime trips to the bathroom. For elders caring for a spouse or a loved one, sleep may be disrupted when they get up at night to tend to the person. Older adults are also more likely to take medications that affect sleep or cause daytime sleepiness even after a good night’s sleep.

Experts say it’s normal for older people to take longer to doze off at night, to sleep more lightly and to wake several times during the night.

The timing of sleep may change too. Older adults tend to become sleepy earlier in the evening and wake up earlier in the morning. One National Sleep Foundation poll found that about two-thirds of adults over 65 consider themselves a “morning person,” considerably more than in the general population.

Experts also say it’s normal for people to sleep more lightly as they get older. Sleep occurs in cycles that are repeated several times during the night, including dreamless periods of light and deep sleep and periods of active dreaming (REM sleep). Beginning in middle age, people naturally spend less time in deep and REM sleep. They tend to wake up more often, an average of three to four times a night. Older people also are likely to take more time to fall asleep and have more difficulty staying asleep.

Plus, an older person who’s sedentary—due to mobility issues, for example—may simply need less sleep. Ditto for someone who is retired, who need not arise at 6 a.m. every day or face the daily stresses of a job.

For older adults, a sleep makeover can start with simply recognizing these changes that come with age—and not getting too distressed about them. Try to minimize anxiety that might trigger more sleeplessness, Winter said

“Our sleep patterns change throughout life,” he said. “I’m 47. My sleep is not the same as it was when I was seven or 17. I have occasional nights where I’m lying in bed awake up until 4 a.m. I try to enjoy the quiet time, rather than getting stressed about it.”

Resetting Sleep Rhythms

One important step in a sleep makeover is to work with your body’s circadian clock—the natural rhythms that make us alert during the day and sleepy at night, and that include the waxing and waning of the sleep-promoting hormone melatonin. With exposure to sunlight during the day, the body’s secretion of melatonin tends to drop off. As it gets darker at night, melatonin secretion increases.

To reset your sleep rhythms, you should adopt a consistent sleep schedule with an emphasis on arising at the same time each day.

In addition, these steps may help:

Avoiding caffeine, alcohol, nicotine or other chemicals that interfere with sleep
Creating a comfortable sleep environment (cool, dark and quiet) in the bedroom
Establishing a calming, pre-sleep routine
Making an evening to-do list so you don’t fret over what’s ahead the next day
Eliminating late-afternoon and early-evening naps
Eating and drinking enough, but not too much or too soon before bedtime
Exercising regularly but not right before bedtime
Taking melatonin supplements under a physician’s supervision

An effective sleep makeover should also involve using light to your advantage. Get plenty of exposure to sunlight. Avoid electronic devices (e-readers, cell phones, tablets, TV or computer screens) that emit blue light, which can delay or disrupt sleep, in the hour before bedtime.

Incorporating relaxation techniques, such as meditation or yoga, as part of your bedtime routine may help too, Lin said. Similarly, it’s a good idea to avoid anything too stimulating (a tense or engrossing novel, a violent film or the TV news if that upsets you) at bedtime.

But how do we stop thinking about those news reports about the dangers of poor sleep? They can trigger anxiety. And anxiety is the enemy of good sleep.

It’s easy to underestimate the number of hours you slept. Pay attention instead to how you feel the next day.

“Unrealistic expectations about sleep that are not helpful can add to a patient’s stress, and that can lead to chronic insomnia,” Lin said. Because older people sleep more lightly and wake more often, or simply need less sleep, they may worry about a lack of sleep even when they’re actually getting enough. That leads to more stress, which leads to more trouble falling or staying asleep, triggering a vicious cycle.

Experts advise against getting too hung up on how many hours you’re asleep on a given night. Sleep needs are individualized. There is no “gold standard” for how much sleep an older person needs; rather, it’s based on how people feel and how well they function on the amount of sleep they get. It’s more important to pay attention to how you feel during the day rather than how many hours you slept.

Adding to the anxiety, people can also easily misjudge the number of hours they are actually sleeping. Sleep medicine specialists call that paradoxical insomnia, according to David Luterman, MD, medical director of the Sleep Center at Baylor Scott & White in Dallas. For example, patients in the sleep lab—where sleep is monitored during an overnight stay—may report they didn’t sleep at all.

“Yet the measurements taken of their brain waves showed they were asleep for at least four hours,” he said. “The patient’s perception is ‘I’m up all night’ but that’s not really the case.”

If you’re feeling anxious about how little sleep you’re getting, try wearing a fitness tracker (such as a FitBit) that monitors sleep. These wristband devices may not differentiate precisely between REM, deep and light sleep, but Winter said they do tally the total number of hours you’re asleep with reasonable accuracy.

“If a patient tells me he’s sleeping only an hour or two a night, and the device is saying he’s sleeping six hours and 13 minutes on average, I believe the device,” he said.

Don’t Lose Sleep Over a Little Lost Sleep

We all experience sleeplessness at times. You may feel tired and worried about it, but it may not actually be worrisome.

Winter cautions against equating insomnia with sleep deprivation, especially occasional insomnia. Those studies that warn against the dangers of too little sleep, he said, relate more to people who never get enough rest: the single mom working two jobs who can manage only four hours of sleep a night; the hard-charging executive who gets up at 4 a.m. to work out; the person with chronic sleep apnea who awakes four to five times an hour at night.

It’s normal for people to experience insomnia for short periods after a stressful event, such as a divorce or the death of a loved one, Luterman said. During very stressful periods, he recommends considering the option of sleep medication, which may help avoid short-term, stress-related insomnia that turns into chronic insomnia. However, because older people respond differently to medicines than younger adults, sleep medication should not be taken except under a physician’s supervision.

“It’s a careful balance,” Luterman said. “You don’t want to rush to prescribe patients a sleeping pill when the root cause of insomnia may be something else.”

He added that the American College of Physicians recommends that, for patients of any age with chronic insomnia, the first line of treatment should be cognitive behavioral therapy (CBT) rather than medication. CBT is solution-oriented psychotherapy that treats specific problems by modifying dysfunctional thoughts and behaviors. Behavior modification might include simple steps like going to bed an hour or two later if you’re not feeling sleepy or devising a helpful routine for times when you can’t sleep. (When that happens, experts advise against staying in bed and tossing and turning; instead, get up and do something quiet, like knitting or reading boring materials, until you start feeling sleepy.)

In general, sleep medication is recommended only for the short term—several weeks at most. After a longer period, patients can build up a tolerance to sleeping pills (needing increasingly higher doses for the same results) or become psychologically dependent so that the idea of going to sleep without a pill causes anxiety. Follow your doctor’s instructions and stop taking the drug as recommended.

“When you compare the two—sleep medications vs CBT—research shows the results are the same, or CBT is a little better,” Luterman said.

When to See a Doctor

Anyone experiencing trouble sleeping that lasts more than a few months should consult a physician, to eliminate underlying emotional or medical conditions that may disrupt sleep, such as depression or restless legs syndrome, a condition that causes a twitching or tingling sensation and an uncontrollable urge to move the legs at night.

If insomnia persists, your doctor may prescribe a visit to a sleep clinic. That involves spending the night sleeping in a private room, with equipment that can help detect sleep problems by monitoring brain activity, eye movement, heart rate, snoring, body movements and more.

Before you go to the clinic, the doctor may ask you to keep a sleep diary for a few weeks, noting how much sleep you got, when you went to bed and how many times you woke up during the night. That information will be compared to the results in the lab.

Don’t Get Discouraged

While there are indeed many ways you may be able to improve your sleep, there is no one-size-fits-all answer. You’re going to have to experiment to see what works best for you. The solution may involve doctors and sleep clinics, or maybe simple changes in your routine will work wonders.

Vickie Parker, 67, was waking up every morning at 4:20 a.m. and couldn’t easily fall back asleep, even though she was still tired. So she developed a routine that seems to work: a trip to the bathroom, a heating pad to relieve pain in her shoulder, and turning down the thermostat in her bedroom by a degree or two. If that doesn’t work, she takes a low-dose sedative prescribed by her doctor.

And Mary Jo Anderson eventually found an unconventional solution that helps her fall and stay asleep: a podcast called Sleep with Me, which the New Yorker described as “the podcast that tells ingeniously boring bedtime stories to help you fall asleep.”

“The host talks in this lull-y, drone-y voice,” Anderson said. “He’ll tell a story or recap a popular TV show. On one, he narrates while he’s putting together an Ikea bed. It helps shut down your mind but it’s not interesting enough that you stay awake to hear the end. It’s been the best thing for me.”

Are Pets Really Good for Older People?

Posted on September 9, 2019 by Editor

An older couple put aside some of the food delivered by Meals on Wheels in order to have enough to feed their dog.

A widow delays an important visit to the doctor, fearing no one will care for her cat if she is hospitalized.

An older man living alone with a sick pet agonizes over a terrible choice: incur vet bills he can’t possibly afford or have his only companion euthanized.

Heartbreaking stories like these point to a difficult reality. While pets can benefit older adults’ health and happiness, they can also lead to financial burdens, near-impossible decisions or devastating grief.

Do the benefits of pet ownership really outweigh the risks?

Weighing Benefits with Costs

For many older adults, animal companions can make a huge difference in quality of life.

“People with pets in general are happier and healthier,” says Nicki Nance, a licensed psychotherapist and associate professor of human services and psychology at Beacon College in Leesburg, FL. “Pets require a structured schedule and daily exercise. They provide a sense of purpose, constant companionship, physical contact and humor.”

Those benefits can boost mental and physical health. An American Heart Association research review concludes that “pet ownership, particularly dog ownership, may be reasonable for reduction in cardiovascular disease risk,” with the most significant benefits associated with owners who walked their dogs regularly. The Human Animal Bond Research Institute (HABRI), a nonprofit, research and education organization, cites research that points to the benefits of therapy animals: they can calm older people with dementia and alleviate anxiety and distress for those undergoing cancer treatment.

Doctors often encourage their older patients to adopt a pet. But psychologist Hal Herzog, author of Some We Love, Some We Hate, Some We Eat: Why It’s So Hard to Think Straight About Animals (2010), questions whether the data is strong enough to warrant a doctor’s recommendation. While some studies point to health benefits, others show little or none. He also notes that studies show correlation but don’t prove causality: it’s not clear whether pet ownership makes people healthier, or healthy people are more likely to have the energy, motivation and financial resources to take care of pets. Most analyses, he adds, don’t factor in the lifetime cost of owning a pet in the United States, which can run upward of $10,000.

The hardest part of my job is having to tell an older adult that a beloved pet needs to be euthanized.

—James Moebius, veterinarian

The downside of pet ownership should not be underestimated. Pets pose a significant risk of falls. A cat underfoot, a dog that pulls too hard on a leash, or pet toys on the floor can cause a person to stumble and fall. A 2009 Centers for Disease Control analysis estimated that more than 86,000 injuries due to falls each year were related to cats and dogs, with the highest rates of injury occurring among people 75 and up. For older adults, a fall can have devastating health consequences; a hip fracture, for example, can lead to long-term impairment, nursing home admission or death.

Dogs need to be walked, all animals need to be fed and most must be groomed at least occasionally or have cages that should be cleaned regularly. These tasks are time consuming and can be hard for someone with limited mobility. Pets need trips to the veterinarian for routine wellness visits and illness. That can be traumatic, as well as costly, and difficult for a person who doesn’t drive.

Then there’s the trauma of losing a pet.

“The hardest part of my job is having to tell an older adult that a beloved pet needs to be euthanized,” says James Moebius, a veterinarian in Sachse, TX. “It’s even harder when it’s an older gentlemen who lives alone and who’s part of that generation that doesn’t express feelings. You watch him walk out alone, silently, without his little dog, and it just pulls your heart out.”

Making It Work

Barb Cathey, CEO and founder of Pets for Seniors, an adoption program in Illinois, admits there are ups and downs and often, unexpected outcomes. She helped a client named Betty to adopt a rescued dog named Zoe, and the match was a happy one. However, Betty’s family returned Zoe to the shelter a year later. A fall had forced Betty to move to rehab for several months, and no one could care for the dog. The shelter agreed to keep the dog until her owner recovered.

Meanwhile, Betty wasn’t doing well, refusing to even try to cooperate with her rehab therapist. Then her daughter brought Zoe for a visit. Delighted to see the dog, Betty immediately moved in her bed to make room. The therapist encouraged the family to bring Zoe back regularly to keep Betty motivated.

“Betty ended up getting better, with Zoe’s help, and eventually was able to take her back home,” Cathey says.

Before adopting a pet, a person should carefully consider all potential challenges as well as ways to minimize problems. A key first step: choosing a pet that’s a realistic match for an older adult’s physical capabilities and energy level.

“The worst mistake a senior can make is getting an energetic puppy or young dog,” Cathey says. Ditto for a dog or cat that requires lots of expensive grooming (such as a breed with long hair) or a young pet that’s almost certain to outlive the owner by many years.

Shelters have a hard time finding homes for older animals, but they’re often a good match for older adults.

Cathey worked with an older woman whose family gave her a Jack Russell puppy, a breed known for its high energy level.

“She would call me in misery because the puppy was too much for her and she did not want to hurt their feelings,” she says. “I convinced the family to let me find a new home for the Jack Russell pup and found an eight-year-old Pomeranian that was housebroken and just wanted to lay in her lap all day—just what she wanted.”

Shelters have a hard time finding homes for older animals, but senior pets often make a good match for older adults, according to Linda Ross, a retired counselor who worked with aging populations. Ross and her husband are in their 70s and are both healthy and active, yet they chose to adopt an older dog after theirs passed away in 2010.

“Older pets tend to be housebroken, quieter and less energetic,” she says. “And if they’re rescued dogs who’ve been homeless or in a shelter, they are just so grateful to have a soft bed and a good routine. We just love on them and they love on us.”

Finding Solutions

Those heartbreaking stories—the older couple who put food aside for a pet or the widow who postponed medical attention—were the impetus for the founding of the Seniors’ Pet Assistance Network (SPAN) in the Dallas area. Caseworkers for local aging-related agencies had noticed the challenges of elders living alone with pets, and how a little help might go a long way.

Now, SPAN serves low-income older adults in the Dallas area with regular deliveries of pet food as well as help with veterinary-care costs. Grant money pays for food for about 75 animals; volunteers deliver it once every other month and spend a little time checking on each client. SPAN’s clients also receive an allotment of up to $300 per year to cover routine vet care, including immunizations, heartworm medication, and flea and tick prevention.

“That’s significant, given that many live on as little as $1,200 per month in Social Security benefits,” says Laurie Jennings, SPAN’s co-founder.

For others, potential problems in pet ownership can be addressed with a little advance planning. Some veterinary costs, such as immunizations and spaying or neutering, can be minimized by taking advantage of low-cost clinics offered at animal shelters and pet-supply stores. For those who can afford it, pet insurance offers a way to help owners avoid wrenching decisions about vet bills. Owners pay a monthly premium but may be covered (depending on the type of plan) if pricey treatments are needed.

To prevent falls, the CDC recommends that pet owners consider obedience training, installing night lights on walkways, moving the animal to another room or a crate at night, or even choosing a light-colored pet rather than one with dark fur.

And in the event that an older pet owner loses a beloved animal, veterinarians can often help with the grieving process by pointing them to a pet-loss support group.

Making Arrangements for Future Care

Jennings often hears from family members who tell her, “That animal is keeping my parent alive.” But on the flip side, it’s a source of worry.

“We have a client, a 97-year-old widow, who has a very ornery, 9-year-old poodle,” she says. “She lives for that dog and frets over who will care for the dog if something happens to her.”

Some older adults want to provide for their pets in their wills, according to Lori Leu, an elder law attorney in Plano, TX. She recommends checking with a friend or family member first to see if they’re willing to take the pet after the owner dies or becomes incapacitated. That arrangement should be put into a will, along with (if possible) a small bequest to help cover the pet’s expenses.

Although they are careful to avoid making promises, the people at SPAN try to help clients “rehome” pets if they can no longer care for them. It’s not always possible, but they do have success stories.

Jennings recalls Bobo, the beloved pet of an elderly woman who lived alone and was dying of cancer. Family members wouldn’t take Bobo, a pit bull mix, and because he was a little aggressive, Jennings despaired of ever finding a home for him. But a rescue group took Bobo, helped socialize him and found him a home.

When the young man who adopted Bobo learned of his previous owner, he offered to bring the pet to visit her one last time, just a few weeks before she passed away.

“So, we have this photo of Bobo, this massive pit bull, lying on top of her in her bed,” Jennings says. Now SPAN receives a holiday card each year from the young man, with a photo of Bobo sporting a Santa hat.

“You make wonderful human connections doing this work,” says Jennings. “It’s beautiful.”

Breaking the Age Barrier

Posted on May 3, 2019 by Editor

Art Russell, 60, counts at least a dozen 20-somethings as friends: the guys he fences with; a 26-year-old colleague at work; and several people who attend his church. Although he also has many friends his own age, Russell values those younger ones.

“They have a fresh perspective that reminds me to stay enthusiastic about life,” he said.

Unfortunately, Russell’s social circle is unusual.

According to a 2017 report by Generations United and the Eisner Foundation, most Americans rarely have meaningful interactions or conversations with others (not family members) who are 20 or more years younger or older.

“Intergenerational friendships are the exception rather than the rule: for the most part, age segregation prevails,” the report concluded.

Most of us live in age bubbles. People tend to socialize within their own age groups at work or in school. Families with young children flock to kid-friendly neighborhoods; young adults head to apartments and condos in trendy locations; older adults whose children have grown gravitate to retirement communities.

Even multigenerational settings—such as churches, synagogues or community centers—tend to tailor programming by age: a yoga class for seniors; a Bible study for young adults; a science camp for kids. As a result, most of us have few opportunities to make friends with people outside of our own age groups.

“All of this is counter to what we know about what people need to thrive developmentally,” according to Eunice Lin Nichols, vice president at Encore.org and director of Gen2Gen, a campaign to encourage intergenerational connections. “Experts agree that age segregation contributes to social isolation and can reinforce stereotypes and perpetuate ageism.”

Friendship Transcends Age

When Mary Ann Eaton, 91, broke her hip in early 2018, she hired Diane Cannon, 60, to drive her around and to help with chores while she recovered. The two women became fast friends; now they talk by phone at least once a day and get together often. The 31-year age difference seems irrelevant.

“It’s very easy to talk to Diane,” Eaton said. “We have the same sense of humor, we both love animals and we’re both hard workers.” (One of Eaton’s first requests was for Cannon to drive her to a class to keep her real estate license up to date.)

If more older people made younger friends, experts believe that could help address a number of concerns related to the aging of the US population. Intergenerational friendships might counteract the “loneliness epidemic” that was identified in a 2018 Cigna survey of more than 20,000 Americans over age 18. Nearly half of respondents reported sometimes or always feeling alone (46 percent) or left out (47 percent).

…millennials are awesome. Almost none of the young people I know fit the stereotypes.

— Art Russell, age 60

Older people tend to stay healthier, both physically and cognitively, when they have strong social connections. (One study showed that loneliness has an impact on mortality similar to smoking 15 cigarettes a day.) Also, when elders nurture friendships with younger people, it helps assure that those who live into their 80s and 90s can maintain a vibrant social life even if they outlive their peers.

Another advantage: intergenerational friendships promote mutual learning and enrichment and dispel ageist stereotypes. Even though he works in tech himself, Art Russell’s younger friends have tipped him on a couple of useful smartphone apps that he uses every day. When asked, he’s been able to offer them advice on relationships and careers.

“And I think millennials are awesome,” he said. “Almost none of the young people I know fit the stereotypes.”

That’s a common side effect of intergenerational friendships—ageist stereotypes are quickly contradicted.

“If we get isolated by generation, we only talk about what’s relevant to our own generation,” said Donna Butts, executive director of Generations United. “We are richer and more able to look beyond our immediate concerns when we’re engaged with people in other age groups. To really slow down and listen—that’s how we share our humanity with each other.”

Friends Gone Viral

A man in New Jersey befriended a woman in Florida by way of Words with Friends, an online game. Normally, that wouldn’t make the news. But in this case, the man is a 22-year-old African American rapper and the woman is an 81-year-old white retiree. A photo of their first meet-up went viral on social media, and the story made the New York Times in 2017.

What would it take to make friendships like this more common, rather than a newsworthy rarity? A number of initiatives are connecting older and younger people:

In Boston, a startup called Nesterly pairs older homeowners with young adults, especially students, who need housing. Housing is expensive in Boston, yet an estimated 90,000 spare bedrooms are going unused in the homes of aging empty nesters. The living arrangements have created friendships like that of Sarah Heintz, who’s in her 70s, and her roommate Dean Kaplan, 25. They share meals and enjoy talking politics.
Judson Manor, a retirement community in University Circle in Cleveland, offers a handful of apartments at no cost to 20-something graduate students at the nearby Cleveland Institute of Music, in exchange for performing for the residents. Friendships naturally arose between the older residents and the students. Viola student Caitlyn Lynch became so close to 90-something resident Clara Catliota that she asked her to join her wedding party. Catliota couldn’t travel to Oregon for the ceremony, so she hosted a wedding celebration for the couple at Judson.
A social services program called DOROT (which means “generations” in Hebrew) connects 7,000 children, teens and young adults with 3,000 older adults in New York City. The program enlists volunteers to serve as “friendly visitors” to isolated older adults, hosts intergenerational chess games and art sessions and provides opportunities for older adults to read to children. DOROT has sparked friendships like the one shared by Ramon Couzon, 78, and Vera Ruangtragool, 34. In 2015, Ruangtragool delivered a gift package from DOROT to Couzon shortly after his wife of 30 years died. He told Ruangtragool he was struggling with her loss; she responded by sharing how meditation had helped her find peace. Now, Ruangtragool visits Couzon weekly; the two chat before doing a 40-minute guided meditation. Both say they’re happier and more hopeful as a result of the friendship.

While programs like these can help connect people, experts say that awareness, an eye for shared interests and a little extra effort can lead to friendships that grow organically.

“It may start with something as simple as saying hello to your neighbor,” Butts said. “Everybody who lives in a neighborhood or an apartment building has the potential to have more interactions with people of other age groups.”

Intergenerational Collaboration

Intergenerational collaboration can also benefit organizations, Butts noted. Research shows that when teams involve people of different generations working together on an artistic or business project, they’re more productive and resourceful. Such collaboration can also spark intergenerational friendships.

That’s what happened when filmmakers Matt Starr, 29, and Ellie Sachs, 25, decided to remake the classic film Annie Hall with actors recruited from an older adult community, Lenox Hill Neighborhood House in New York. Starr and Sachs appreciated how the older actors consistently showed up on time early in the morning and were willing to work hard, even in hot weather. After the project ended, the young filmmakers and the elder actors continue to get together occasionally for lunch, a stroll in the park or even dance classes.

When young people don’t appreciate what older adults have to offer, Sachs said, “I think we just lose the potential to make incredible friends.”

Sachs said her new friends have shared guidance about love and life that she’s found more valuable than advice from her peers.

An intergenerational friendship has also enriched the lives of Courtney Cox and Carey Smith, both personally and professionally. In 2001, the two women started jobs in the same week in the art department of JCPenney. Cox was fresh out of school; Smith was returning to work after a hiatus to raise two kids. Despite the 27-year age difference, the two women made an immediate connection.

“If you’re creative, you tend to hang out with creative types,” Cox said. “I don’t notice the age difference. We have a lot of belly laughs. You don’t have that with everybody.”

Now, at 41 and 68 respectively, Cox and Smith have new employers and live in different cities but remain close friends. Recently, Cox needed graphic design help on a project for her current employer, so she hired Smith as a contractor. Smith traveled to North Carolina and stayed at Cox’s home during the three-month project. Cox said she often relies on Smith’s depth of experience, both in work and personal situations. Her older friend has faced some challenges—such as caring for a parent diagnosed with cancer—and was able to guide Cox when she faced the same situation with her own mother.

An intergenerational networking group in New York stages events that draw sold-out crowds.

That kind of mentoring doesn’t just benefit younger people; it also enriches the lives of the older people who serve as mentors. The Harvard Study of Adult Development, which has tracked more than 700 men over almost 80 years, found that those in middle age and beyond who invested in caring for and developing the next generation were three times as likely to be happy as those who did not do so.

“We were intended to live in community with one another, with older generations bringing wisdom, perspective and a lifetime of skills and experiences to younger generations, and younger generations bringing vitality and joy to the older generations,” said Nichols of Gen2Gen.

Younger people too see the need to tap into the wisdom of older adults. Charlotte Japp, 28, was “desperate” to connect with older mentors for advice on everything from maneuvering office politics to how to confront a manager about a difficult situation with a colleague. At the time, she was working at the online news site Vice; none of her colleagues were over 45. So Japp started CIRKEL, a networking platform that has organized a series of intergenerational events in New York that have drawn sold-out crowds.

Each event brings together older and younger people in a particular industry for informal mingling and structured discussions. A networking night for fashion professionals, for example, gave young millennials getting started in the field a chance to meet established influencers like Anna Wintour, 69, editor of Vogue, and Robin Bobbé, a fashion model in her 60s.

“For most CIRKEL attendees, the experience of coming to a party where the room is filled with people from all different ages is really new,” Japp said. “Many of the guests are having meaningful, enthralling conversations with someone from a different generation for the first time, and their view of that generation is shifting with each interaction.”

One of Art Russell’s younger friends, Robby Hare, 30, experienced that shift himself. Before getting to know Russell and other older people in his church, Hare thought of boomers as the authors of the ubiquitous Internet memes that disparage millennials. Now he sees them as allies.

“When you take time to get to know someone, you realize they don’t fit the stereotype,” he said. “As I got to know Art, I began to see him as a person and as a friend, not just an old guy. It’s really hard to be prejudiced against people you know and like.”

Spiritual Support at the End of Life

Posted on February 5, 2019 by Editor

This is part 2 in our series on spirituality and aging. Read part 1 here.

Eric Markinson identified himself as a chaplain when he walked into the hospital room of a man he calls Tommy, who was dying of alcohol-related liver disease.

“I don’t think you can help me much,” Tommy said. “I’m an atheist.”

Markinson, associate pastor of spiritual care at Grace United Methodist Church in Dallas, replied that he was there to help in any way that he could. In the conversation that followed, Tommy said he’d rejected the religion of his childhood, which taught that God was judgmental and unforgiving. Now he feared the judgment of his girlfriend and children over the years of alcohol abuse that had led to his impending death.

Even though he was an atheist, Tommy was in spiritual distress.

“At the end of life, people can struggle just as much with spiritual pain and guilt as they do with physical pain,” Markinson said.

Increasingly, medical and hospice professionals are recognizing the reality of this spiritual suffering, and they are focusing on ways to integrate spiritual support into the care provided at the end of life.

A chronic or life-threatening illness can trigger spiritual struggles even for patients who are not religious.

“Patients who are challenged by illness are likely to need assistance to find strength, hope, meaning, comfort and healing,” said Ann M. Callahan, author of Spirituality and Hospice Social Work (2017) and associate professor in the social work program at Eastern Kentucky University. “Health care providers may not be able to prevent spiritual suffering, but they can support spiritual well-being.”

When Congress created the Medicare Hospice Benefit in the 1980s, it included reimbursement for spiritual care. Hospitals and physicians now routinely ask patients about their religious and spiritual preferences as part of the intake process. Medical schools teach courses in spirituality as it relates to patient care. And chaplains are trained to offer spiritual care not only to those in their own traditions but also to people of a variety of religions, as well as those who are atheist, agnostic or “spiritual but not religious.”

“We are trained to meet people where they are and to be a nonanxious, supportive presence,” Markinson said.

All of this emerges from a growing body of research suggesting that religious or spiritual ties can promote healing and improve patient outcomes. Studies show that many patients want their physicians to discuss their spiritual beliefs; among those at the end of life, 70 percent would want their physicians to know their beliefs, and 50 percent would like their doctors to pray with them. Studies also demonstrate that most hospitalized patients believe spiritual health is as important as physical health and that many rely on faith and prayer to cope.

Spiritual Distress

The diagnosis of a chronic or life-threatening illness can trigger spiritual struggles for patients, whether or not they are religious.

“One is inevitably led to ask, ‘What is my life all about? Am I ready to die? Is there something I am still missing in this life?’” said Ruben L. F. Habito, professor of world religions and spirituality at Southern Methodist University’s Perkins School of Theology. “With such questions may come some kind of fear, anxiety, a sense of regret, a sense of longing. These thoughts and sentiments arise from the core of one’s very being, that realm that can be called ‘spiritual.’”

Some patients experience spiritual distress or spiritual suffering—an inability to connect with what gives their lives meaning—and some medical professionals say this diagnosis can cause just as much suffering as physical pain. In one small study, 96 percent of patients with advanced-stage cancer said they experienced spiritual pain.

With help, that pain can often be alleviated. Working as a team, medical professionals, chaplains and social workers can help address the spiritual suffering of those facing the end of life.

“Patients can transcend spiritual suffering by finding meaning and making sense out of their experience,” Callahan said. “This might require the help of a spiritual care provider and the services of other professionals, volunteers, family members and friends.”

In a nation that’s increasingly diverse, offering spiritual help can be tricky.

Help might come in the form of prayer, scripture, rituals (such as anointing or last rites) or spiritual counseling, or even assistance in helping a patient, when appropriate, to reconcile with an estranged friend or loved one. Markinson was able to help Tommy initiate a conversation with his loved ones, who forgave him. That provided some closure and helped assuage some of the spiritual pain compounding his physical suffering.

But offering spiritual help can be a tricky proposition, given the increasingly diverse spiritual landscape in the United States, as well as the fact that more people are identifying as spiritual but not religious.

Over the past 30 years, training for chaplains in theology schools has evolved to prepare them to serve patients of different faiths and spiritual practices—either directly, or by connecting them to resources related to their personal beliefs. Chaplain programs give students a basic understanding of all the world’s major religions. Student chaplains also learn to let patients take the lead in their spiritual care.

“Before, chaplains might have gone in as spiritual guides and talked to patients,” said Jeanne Stevenson-Moessner, professor of pastoral care at Southern Methodist University’s Perkins School of Theology. “Now, we’re learning to first listen and then converse. It’s a real shift.”

Instead of offering a few pat words of wisdom, which might ring hollow, chaplains are taught to first listen to the patient’s words, pay attention to nonverbal clues and then tailor their care accordingly, Stevenson-Moessner said. This patient-led approach helps ensure that the chaplain’s guidance is truly relevant to the patient’s particular spiritual struggles, as well as appropriate for that patient’s beliefs.

For example, if a patient talks about regrets or expresses a desire for forgiveness—whether from God or a higher power—the chaplain can offer reassuring insights. That might come in the form of a Bible passage or traditional prayer for a Christian, or a passage from Rumi or the Tao for someone who identifies as spiritual but not religious.

Spiritual Turmoil

While spiritual beliefs may offer comfort, they can also provoke turmoil.

Some patients with regrets may worry that God is punishing them with a life-threatening disease, for example. Others, whose spirituality emphasizes the connection of mind, body and spirit, may view a diagnosis of life-threatening illness as a sign of failure, said Laura Howe-Martin, a psychologist and assistant director of behavioral sciences at UT Southwestern Medical Center’s cancer institute in Dallas (TX).

Some patients feel enormous pressure to maintain a positive attitude, based on a belief that it will affect their disease. Caring professionals call it the “tyranny of the positive attitude,” according to Howe-Martin.

“We know that the mind and body are incredibly related,” she said. “But some interpret the research to mean, ‘If you think this way, it increases your risk of cancer’ or ‘If you have a good attitude, you’ll live longer.’ We just don’t have any data to back that up.”

A key part of the chaplain’s role is to alleviate any unhealthy emotions, whether they originate in rigid religious beliefs or open-ended New Age spirituality, said Michael Washington, palliative care chaplain at Baylor Scott & White Medical Center in Dallas.

Resolving spiritual distress can help patients make better end-of-life decisions, such as when to discontinue treatment if it’s not likely to prolong life significantly. Sometimes his counsel helps patients find their voices when they no longer wish to continue treatment and their families aren’t supportive.

Good spiritual care can also make bereavement easier for those left behind.

“After patients pass, the bereaved can have a lot of untoward health effects,” said Reeni Abraham, an internal medicine physician who advises a course on medicine and spirituality at UT Southwestern Medical School. “Having a death that’s the least distressing is not only important compassionately for the patient but also for their support system.”

Spirituality also offers an avenue for a deeper relationship between patients and their physicians, Abraham added. If she notices a Bible or a devotional at a patient’s bedside, she might inquire: “How are you doing? I see that you’re reading the Bible. Do you want to tell me more about that?”

In situations like this, physicians must tread carefully, always following the patient’s lead and never proselytizing. But when the patient expresses an interest, and the physician feels comfortable, shared prayers or spiritual conversations are healing to some.

“We hope this kind of spiritual support provides for increased comfort and better relationships with patients’ health care teams,” Abraham said. “The goal is to advance health, and health is a conglomerate of many things. It’s a holistic approach to a patient.”

Spiritual Assessments

Most hospitals and many doctors now take a spiritual history or spiritual assessment as part of the patient intake process. Spiritual assessments provide yet another way to understand and support patients in their experience of health and illness, according to Abraham.

“It’s important to treat patients holistically,” Abraham said. “I firmly believe that really helps us to advance care. That’s beneficial for physicians as they build relationships with their patients, and as they walk beside their patients during all the milestones in life that they’ll see together.”

The spiritual assessment also helps identify beliefs or faith affiliations that could affect a person’s treatment plan—such as a Jehovah’s Witness, who might refuse a blood transfusion for religious reasons.

One of the most popular models is the FICA Spiritual History tool, which asks patients questions about faith and belief (“Do you have spiritual beliefs that help you cope with stress?”), importance (“Have your beliefs influenced how you take care of yourself in this illness?”), community (“Are you part of a spiritual or religious community?”) and address in care (“How would you like me to address these issues in your health care?”)

“The goal is to find out what is important to the patient,” said Marita Grundzen, associate director emerita of Stanford Geriatric Education Center at Stanford School of Medicine. “Some might say, ‘I’d like my pastor to visit,’ or ‘I’d like to have communion.’ Another might say, ‘I’d like access to the outdoors. I can better heal with a nature scene outside of my window.’”

Spiritual Sensitivity

Sally Mandler and her husband, Gene Beasley, both consider themselves spiritual but not religious; Beasley used to joke that he was a “born-again pedestrian.” After Beasley had a stroke last March—on top of pre-existing Alzheimer’s disease—Mandler enlisted the help of an in-home health agency, which sent caregivers to assist with bathing, dressing and other needs. Many were young men from Ghana with a strong Christian faith and, in one case, a lack of sensitivity to those with different beliefs. One man insisted on praying “in Jesus’ name” over Beasley at bedtime.

Even with his compromised cognition, Mandler saw the distress in Beasley’s eyes, and asked the caregiver to leave.

Professional caregivers do usually try to avoid offering spiritual input that may be viewed as intrusive or inappropriate. Yet when the patient identifies as spiritual but not religious, the definition of what is appropriate may be unclear.

Open-ended questions can help tease out what’s important to patients and to find ways to support them appropriately, Washington said.

“I ask, ‘What will be meaningful to you at this time?’” he said. “The answer is whatever the patient tells you.”

If the patient asks, Washington might offer a prayer to a Higher Power, rather than God or Jesus. Or he might help a patient reflect on legacy and what he or she hopes to leave behind. Sometimes it may mean helping the patient to find closure by forgiving a family member or by asking for forgiveness. Sometimes it’s simply a promise by the chaplain to be there at the end.

“I am meeting the needs they have and respecting their spirituality,” he said. “It’s not about my faith background. It’s about the patients and what is meaningful to them and to their families.”

Sometimes, sensitive spiritual care may even mean keeping religion or faith out of the equation entirely.

“If I ask, ‘What gives your life meaning?’ and the patient says, ‘Fishing,’ then my response is, ‘Great. Let’s talk about fishing,’” Abraham said.

Stevenson-Moessner notes this trend toward treating mind, body and spirit together is part of ancient medical tradition. In indigenous cultures, religious leader are also healers; Hippocrates noted in 460 BC that the spiritual and the physical were intertwined.

“It’s nothing new,” she said. “It’s just that we’ve reclaimed it.”

What Spirituality Means to Older People

Posted on January 10, 2019 by Editor

This is part 1 in our series on spirituality and aging. Read part 2 here.

For many years, the Catholic faith was central to Debra Cook’s life. She grew up in a Catholic family, sent her children to Catholic schools and was an active leader in her parish.

But now Cook, 65, of Dallas, finds herself looking beyond the walls of her church as she gets older. In recent years, her parish shifted toward a more conservative understanding of Catholicism; meanwhile, Cook’s beliefs have become increasingly more expansive.

She stopped going to mass every week, a step that once would’ve been unthinkable. Instead, she spends an hour outdoors early each morning, quietly observing nature. Cook completed an ecumenical Christian formation program that prepares participants as spiritual leaders or spiritual directors. This fall, she’ll lead a study program called the Soul of Aging, which deals with issues involved with aging but offers no specific religious doctrine.

“I still view myself as a Jesus follower,” she said. “But my view of God has gotten so much bigger. I’ve realized there’s more out there that I don’t understand.”

Like Cook, many older adults say spirituality is an essential source of wisdom and guidance that not only helps them to cope with the challenges of aging but also to live more consciously, with a sense of wholeness and purpose.

“Older people want meaning,” said Michael Gurian, author of The Wonder of Aging: A New Approach to Embracing Life After Fifty (2013). As people live longer lives, “we have the freedom now, in a miraculous second lifetime, to soul-search and soul-find.”

Spirituality, he adds, can help people cultivate the “realistic optimism” that will help them better navigate later life.

Spiritual but Not Religious

The assumption that people become more religious as they age and confront their mortality is generally regarded as a myth among professionals who work with older adults, according to Holly Nelson-Becker, author of Spirituality, Religion and Aging: Illuminations for Therapeutic Practice (2018). Similarly, there’s no research that suggests an overall trend of people becoming more spiritual as they age. Older adults do represent the most religious demographic group in the United States, but Nelson-Becker suspects that’s because members of the older generations grew up when it was more common for people to participate in an organized religion.

“What we do know is that people’s religious and spiritual trajectories change over time in many ways,” Nelson-Becker said. “People get enthusiastic, motivated, discouraged, and become more spiritual, more religious, less so, and otherwise in and out.”

Some, like Cook, find themselves veering away from religion and into a growing segment of the population that demographers call the “SBNRs”—spiritual, but not religious. Defining exactly what that means, however, has posed a challenge.

‘Spirituality’ means different things to different people.

“Religion includes ethical principles, rituals, beliefs and practices, transmitted over time and shared by a community,” said Nelson-Becker. “The definitions of spirituality vary far more widely. Spirituality is a somewhat fuzzy concept that means different things to different people.”

Nelson-Becker was part of an interdisciplinary team of 50 experts that developed standards of spiritual care in palliative care. They hammered out this definition: “Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.”

Life Changes Spur Shifts

Many who embrace spirituality later in life say they were spurred at least in part by changes in their life circumstances. After retirement, or a shift to part-time work, or fewer family responsibilities, they have more time for reflection.

“When you’re in your 30s, it’s all about go, go, go and get, get, get,” said Debby Thomas, 67, a real estate agent in Garland, TX. “Once you get older, those are not necessarily your top priorities.”

Thomas grew up in a Protestant church and converted to Judaism when she married in her 20s. When her marriage ended, she fell away from religion entirely. In her mid-50s, she discovered Unity Church of Dallas, a New Thought church that prescribes no doctrine but views Christian teachings as a practical path to health and happiness.

Thomas believes that maturity makes her more accepting and open to new ways of expressing her spiritual beliefs.

“When I was young, I was too busy arguing with [the church’s] dogma,” she said. “When you get older, you make it more personal, rather than trying to change the world to match your beliefs.”

Foundation for Living Longer and Healthier

One nationwide study of more than 1,000 obituaries found that people with religious affiliations lived nearly four years longer than those with no ties to religion, even after adjusting for other factors, such as gender and marital status. But researchers caution that it’s virtually impossible to separate the benefits of religion from related factors, such as the social connections among people in faith communities.

Anne Sadovsky, 77, is clear that the social and the spiritual, together, have enriched her life. A motivational speaker and real estate expert in Dallas, she’s benefited from the social support of “the Dalai Mamas,” a prayer circle of seven older women, ages 62-78, that’s been together for more than 10 years.

The women meet for birthdays and holidays, but the glue that bonds them is prayer. Via email, they share prayer requests for themselves and others. Often, they will schedule a time when they all pray at once, wherever they are, for a specific need. Originally the women met at Unity Church of Dallas, where Sadovsky is a member, but the group stayed together even after some moved to other churches.

“When the husband of one of the women died, we were all right there,” Sadovsky said. “I had major back surgery, and they were there for me. One stayed with me at the rehab facility and gave me my first shower after surgery.”

Each woman prays according to her own understanding, Sadvosky said, but following Unity principles, they don’t see prayer as “begging or pleading” so much as a way to connect with divine energy.

“It’s a very powerful, loving support group,” she said. “Word has spread that our prayers are powerful; people we don’t even know will [ask for prayers].”

Some spiritual practices may have health benefits. Meditation, for example, may help reduce blood pressure.

Being a part of a group like the Dalai Mamas may have a positive impact on health. While the number of studies examining the links between religion, spirituality and health is mushrooming, according to Nelson-Becker, “The findings are difficult to align because they look at different factors, control for different factors, and ask slightly different questions.” While there appears to be a correlation, there’s no proof of a cause-and-effect relationship.

Some spiritual traditions do explicitly encourage adherents to avoid unhealthy behaviors. In exploring longevity hotspots, Dan Buettner identified a community of centenarians in Loma Linda, CA, in his book, The Blue Zones: Lessons for Living Longer From the People Who’ve Lived the Longest (2008). Many were Seventh Day Adventists, who don’t smoke, follow a plant-based diet, exercise regularly and maintain a normal body weight.

Research also suggests that some specific spiritual practices, such as yoga, and meditation or prayer, may have health benefits. Meditation, for example, may help reduce blood pressure or relieve some menopausal symptoms, like hot flashes.

The Wonder of Aging author Gurian, 65, spends an hour each morning meditating in nature. He’s a practicing Jew but has lived around the world, and his spirituality draws on elements of many other religions, including Baha’i, Hinduism, Unitarianism and Christianity.

“I think genuine happiness can come from having a spiritual practice,” he said. “As mind and body connect, that helps some people to end an addiction or to eat more healthfully. Also, there is something happening in the brain as people do spiritual practices. Spiritual practices direct more blood toward the temporal lobe, and that is good for de-stressing.”

Art as Spiritual Practice

Spiritual expression can range from communal activities like worship, scripture study or prayer, to personal practices such as journaling, meditating or spending time in nature.

For Donna Bearden, 71, her spiritual practice centers on art and learning. She’s married to a retired United Methodist pastor but describes herself as spiritual but not religious.

“My spirituality could not develop within the church,” she said. “I believe a spiritual journey has to involve doubt, searching, asking hard questions. I couldn’t ask those questions without raising eyebrows.”

Bearden expresses her spirituality through art, writing and photography. She starts each morning writing in a journal and often heads outside with camera in hand. She’s fascinated by mandalas—a circular symbol in Hinduism and Buddhism that represents the universe—and creates them with the photos she’s taken.

“There is a zone artists and poets and other creatives talk about, the idea that words or an artist’s creation comes not from them but through them,” she said. “I have felt that zone, that connection to something greater than I.”

A Sense of Purpose

If there’s a link between spirituality and longevity, it might be ikigai (“what makes one’s life meaningful”), a Japanese term that Buettner cites in his work. Many faiths teach concepts of intrinsic human purpose that don’t require a youthful body or a sharp intellect: tikkun olam, the Jewish calling to repair the world; the Christian teaching of serving others; or the Buddhist idea of the bodhisattva, a person who chooses to strive for Buddhahood for the benefit of all sentient beings. Spiritual practices, such as meditation, can help people clarify and focus on their sense of higher calling.

Spirituality can also help older people turn outward when loss or physical limitations could easily spur them to turn inward, according to Missy Buchanan, author of Living with Purpose in a Worn-Out Body: Spiritual Encouragement for Older Adults (2008).

“It’s the belief that ‘I’m here for a reason,’” Buchanan said. “Maybe I hurt today, but I can still do something good for somebody.”

For Cook, her work as a spiritual group leader provides a new sense of purpose and direction. In earlier years, she focused on career, raising kids, status and money—her family once lived in an 8,400 square foot home (“Isn’t that ridiculous?” she said). Those things don’t define her anymore.

“Now it’s about living a life in accord with who I was created to be,” she said. “The work I’m doing in spirituality is life-giving.”