Nothing is “normal” these days. While we don’t yet know how bad COVID-19 will ultimately be, we do know that people over 60 are at particular risk for complications, should they become ill. That has many grandparents sheltering in place and unable to be physically with their grandchildren.
However, many are making extra efforts to maintain a regular presence in their grandkids’ lives during the pandemic, albeit in a different form. As a grandparent myself, I understand how difficult it is to be apart. So I reached out to friends and colleagues to see how they were coping.
Here are some ideas they shared which you can use or adapt to strengthen connections with your family:
1. Create New Bedtime Rituals
Each night as he’s being tucked into bed, 4-year-old Teddy (with his dad’s help) calls grandma. Teddy recaps his day, and grandma Elizabeth tells him a story, helping to settle him down for sleep. Although they live just a few miles apart in Ottawa, Canada, Elizabeth hasn’t seen Teddy or his siblings (ages 8 and 18 months) since their city’s shelter in place mandate started in mid-March. This new evening ritual helps keep them connected.
How You Can Do This
Arrange a time with mom or dad to call just before bedtime, bath time or another quiet time in the evening.
Ask the child some open-ended questions, for example “What did you do today?” which promotes conversation, rather than “How was your day?,” which can often generate monosyllabic answers, says Elizabeth, a retired teacher.
Have a “Once upon a time…” story from your child’s life ready to tell — most kids love hearing tales of when their parents were about the same age; it helps strengthen the bond to know they’re just like mom or dad. Elizabeth also sends old photos to Teddy and his older sister, which creates prompts for further storytelling.
If you’re not adept at impromptu storytelling, you could substitute a beloved book or two to read, perhaps one that mom or dad loved as a child.
Eight year-old Nykka, Teddy’s sister, loves to cook with her grandmother. These days, that means grandma Elizabeth channels her inner Jamie Oliver while they create an elaborate pretend cooking show via FaceTime. It’s a way to simultaneously bond and to learn.
How You Can Do This
Choose a simple recipe that uses common ingredients on hand. Factor the child’s skill and age into the mix — if they’ve not yet mastered fractions or need help with the oven, you’ll likely need mom or dad to supervise.
Prop your phone or tablet on a stand and have the child do the same; you may want to adjust the picture to show the workspace while you narrate the process.
Reinforce proper preparation and safety rules, such as hand washing, avoiding cross-contamination, proper use of knives, using oven mitts and taking precautions when using the stovetop.
Thirteen year-old Kincaid, who lives near Minneapolis, FaceTimes grandma Cathy in San Francisco nearly every day, after he’s completed his schoolwork. He hangs out in his attic for some privacy, while they discuss To Kill A Mockingbird. They’re reading it together, while apart.
Kincaid’s dad, a sixth-grade teacher, suggested the classic novel; it was a book Cathy was also interested in rereading. Even better, Kincaid is starting to open up to his grandma about other things in his life, too.
How You Can Do This
Make sure the book is age-appropriate. Check with mom or dad first! You can also ask them to contact the grandchild’s teacher for suggestions. And, make sure it’s something you both will like. Otherwise, the effort is bound to fail.
Read the same edition in the same format, whether it’s a hard copy or e-reader version. It will make it easier to reference specific pages. If it’s not on your bookshelf, major retailers like Amazon and Barnes & Noble will deliver; some local bookstores may also offer delivery.
Almost all public libraries allow you to electronically “borrow” books for several weeks. It may require setting up an account or virtual library card; make sure to keep parents in the loop.
However you approach it, you can’t push it, Cathy says. “If he says he can’t really do it today, I don’t insist or make him pick a time, I just wait,” she adds.
IndieBound — search for independent bookstores by location
4. Learn a Language
Sophie, age 8, has been curious about learning Hebrew, a language her grandparents speak fluently. She had asked grandma Wendy to teach her, but busy lives meant only sporadic lessons until the pandemic hit. With Wendy sheltering in Utah with one of her sons and Sophie at home in northern New Jersey, they now hold weekly FaceTime sessions, practicing about 10 words at a time. They are up to lesson four, and Sophie is already speaking simple sentences. She loves that she and grandma have a “secret” language.
How You Can Do This
Wendy, a grandmother of five, says if you already speak another language fluently, start with words that a child can easily grasp, like greetings, objects and people.
Ask your grandchild to practice the words even when not doing lessons, but don’t make it feel too much like “homework.” Use repetition, songs, games and visuals to reinforce words already learned while slowing adding new ones.
Start early; kids are like sponges, and experts say the younger they are, the easier it is to pick up a second language.
You can also learn a new language together. Language learning sites like Babbel and DuoLingo, offer beginner level-lessons; you can practice together by phone, FaceTime, or Zoom.
Find additional opportunities to practice. A random phone call offers the chance to incorporate the chosen language.
Be patient, and praise frequently!
Resources
Grandparents Club — Wendy moderates this group on Vitality Society, a website for adults 60+
Bilingual language apps just for kids can be installed on both of your phones; you can go through each lesson together or use the app to reinforce pronunciation or writing
Bilingual cartoons and videos can be fun to watch together over Zoom and used as a jumping off point for discussion
5. Encourage Curiosity Daily
First grader Maddy, who lives in Minnesota, logs on to her computer every weekday morning at 10:30. Grandpa Jon, a retired high school teacher in a small northern Wisconsin town, is waiting for her, ready to discuss whatever has piqued her interest from her homework assignments or her imagination. They’ve talked about everything from climate and geography, to animals, art and science topics. The sessions last anywhere from 30 minutes to an hour and a half, depending on the topic and the tangents they go off on.
A discussion about George Washington and how his spies used codes to pass on information about British activities led to a rousing discussion of codes . . . including Morse Code. Before long, they had worked out a system of hand gestures for dots and dashes and began sending coded messages back and forth. On National Tell a Story Day, they studied the Statue of Liberty and had a good time making up stories of how people came to the United States.
How You Can Do This
Ask the grandchild to make a list of topics they want to talk/study about. In Maddy’s case, she listed everything from magic to dogs to pottery to how milk is made.
Remember, the main goal of the experience is being face to face and sharing, and listening to each other. Jon says his role is to listen and perhaps ask questions that stimulate her interests.
Be flexible. Come in with a plan but realize that kids will go off on tangents. Sometimes, the planned lesson should be set aside to tackle other issues or questions. The goal is to enjoy being together; you can always come back to the topic at hand another time.
Resources
Ducksters Education Site — a kid-friendly place to learn and explore; it will help grandparents explain topics and answer questions in elementary school friendly language
National Geographic Kids has tons of cool information, photos, and videos about the amazing animals that inhabit our planet, all in kid-friendly format
PBS Learning Media offers videos, interactive lessons, documents and more for kids in PreK to High School; teachers can sign up to access lesson plans and additional materials on the site
Open Culture — a collection of free educational resources for K-12 students and their parents and teachers
6. Play Classic Games
Henry, 7, and Anna, 10, from Long Island, love the impromptu FaceTime sessions with grandma Frances. Although they live about 30 minutes apart, they play classic games together, like Charades, which are a lot of fun for everyone. Many party games translate well to a virtual space — Simon Says, Scattergories, 20 Questions and Pictionary also work well over Zoom or FaceTime. These activities can be easily adapted to the children’s ages and interests.
How You Can Do This
Each “team” writes topics on small slips of paper and places them a bowl. One person on each side then chooses. Rotate play between the grandparents and the grandkids.
Make sure everyone has paper and pencils/pens for games like Pictionary or Scattegories.
Resources
Games like this one: a list of Pictionary-like games; many can be adapted for virtual play
Our Pastimes lists several Charade-like games, suitable for group play
7. Help Reach a Milestone
Every Tuesday at 4 pm, Ruby, 12, studies with her tutor and grandma Jane Isay. They’re preparing for Ruby’s Bat Mitzvah, a coming of age ceremony for Jewish girls. While the lessons are serious, they also have a lot of fun, says Jane, a grandparenting expert and author of Unconditional Love, a Guide toNavigating the Joysand Challenges of Being a Grandparent Today.
Since their in-person lessons moved online — with Ruby temporarily sheltering in upstate New York, Jane in Manhattan, and the tutor in the Bronx, Ruby finds them “less boring.” Jane helps keep the mood light — she encourages and praises her granddaughter’s progress by interspersing emojis and gifs throughout the sessions. This approach can work for many religious and life events, like confirmations, Scouting or extracurricular activities, such as debate team.
How You Can Do This
Set up a regular day and time to review materials with the tutor or adviser.
Keep sessions short, from 40 minutes to an hour, depending on the lesson and child’s age.
Offer plenty of praise and encouragement.
“Kids are adept at online interactions, but remember they’re also under stress during these uncertain times,” Jane says. “It helps to laugh together.”
New York-based journalist Liz Seegert has spent more than 30 years reporting and writing about health and general news topics for print, digital and broadcast media. Her primary beats currently include aging, boomers, social determinants of health and health policy. She is topic editor on aging for the Association of Health Care Journalists. Her work has appeared in numerous media outlets, including Consumer Reports, AARP.com, Medical Economics, The Los Angeles Times and The Hartford Courant.
Credit: Courtesy of Diana Isabel TibbsDiana Isabel Tibbs (right) has had success with telemedicine visits for her mother Caroline
If you need to see your doctor these days, there’s a good chance you’ll be offered a telemedicine visit. That means you’ll “meet” with your physician either through a video chat or a phone call. And even after the COVID-19 pandemic fades, experts predict, telemedicine — especially video visits — will be commonplace.
Research shows that for appropriate diagnoses and situations, telemedicine can be comparable, and sometimes more effective, than in-person care. And Medicare has recently relaxed its rules to more easily allow people 65 and older to use telemedicine. More than 20% of people over 70 have had a telehealth appointment during the pandemic, according to a survey by NORC at the University of Chicago.
Here are nine ways to help ensure a telemedicine appointment is as useful as it can be:
Before Your Telemedicine Visit
It will help to be prepared before the virtual visit begins.
1. List your symptoms, medicines and questions. “Be ready with as much detail about your current condition as possible,” says Dr. Joe Kvedar, president of the American Telemedicine Association and a dermatologist in Boston.
Phones and tablets actually tend to work better than computers for video visits.
For example, Kvedar advises his patients to take pictures of any rashes or moles because it’s hard to see detail on video. Try to send your doctor’s office any pictures ahead of time. And write down all your symptoms so you don’t forget any during the telemedicine visit.
Having a written list of your medications, vitamins and supplements at hand will come in handy when your doctor asks what you’re taking, too. This information can also prevent you from getting prescribed something that could run afoul of your current medicine.
2. Take your vital signs. Think about what normally happens at the doctor’s office and replicate things at home as best as you can. Take your temperature, measure your pulse while you are relaxed and get on a scale so you can tell your physician your weight.
To take your pulse, place two fingers between the bone and the tendon over your radial artery, on the thumb side of your wrist. When you feel your pulse, count the number of beats in 15 seconds. Then, multiply this number by four to calculate your beats per minute.
“If you have a glucometer, make sure you have those readings. If you have a blood pressure cuff, make sure you have those readings. If you have other things that your doctor tracks with you to monitor your disease, have that information on hand,” recommends Kvedar.
You might be able to check your blood oxygen level and your heart rate — something very important for coronavirus — if you have a fingertip gadget called a pulse oximeter. They typically sell for $20 to $50.
3. Have your latest medical records nearby. You may have received medical care at different places, such as an urgent care facility as well as your doctor’s office. If so, you’ll want to have a copy of labs and studies with you during the telemedicine visit.
Then, if your doctor needs one of your reports, you can easily share it. This way, you’ll save time and money from unnecessarily repeating tests.
4. Set up the technology you’ll need. Test the telemedicine service on your mobile device or computer before your visit. Some applications work best on specific browsers (for example Firefox, Safari, Chrome, or Explorer). Ask the doctor’s office which browser works best.
If you will be using a computer, try to sit next to the wifi router for the strongest internet connection. Phones and tablets actually tend to work better than computers for video visits, though.
But should you plan to do the visit with an older smartphone, restart it to improve the memory speed and close all the other apps to make your device faster.
During Your Telemedicine Visit
If possible, log on the day before the telemedicine appointment begins to be sure technology is working properly. And don’t be tempted to multitask during your visit. Trying to do this while you’re at the store or driving is likely to prevent you from getting the best care.
5. Improve your picture and audio quality. You and your doctor need to establish a personal connection on video. That’s tricky if you can’t see each other well.
Go to a quiet, well-lit place away from people who don’t need to be with you during the visit. Turn off the radio, TV or any noisy appliance.
You don’t need professional studio lighting, but good lighting improves the quality of the visit, including your doctor’s ability to do a complete assessment. Don’t place your camera facing a light source, window or doorway. Backlighting makes it hard to see your face.
Is the camera right below your chin? Almost every doctor who does telemedicine has a story of a visit seeing mostly the patient’s forehead or a ceiling fan. Stably prop up the device to avoid excessive shaking and keep your whole face in view.
“I would use telehealth for the majority of my mom’s visits, if I can.”
If there is an echo, use headphones, turn down the volume on your speakers and move the microphone away from the speakers. In general, wired headphones have less interference than wireless headphones.
6. If you’ll be doing the telemedicine visit as a caregiver for someone, be sure that person is nearby. Even if you’re the one doing most of the talking, the doctor will need to at least eyeball the patient.
Diana Isabel Tibbs cares for her 79-year-old mother, Caroline Chacon, who has had multiple brain surgeries and dementia. Recently, her mother had persistent dizziness, so they consulted a new neurosurgeon by video chat. The virtual exam was surprisingly comprehensive.
“They checked her temperature and the back of her head where the incision was made. They had her do some tests with her arms to see how her balance was. They had her do the one where she closed her eyes and had to touch her nose, “says Tibbs. “And then they had this really large screen where they were able to pull up…her CAT scan, and we talked about that.”
Chacon has since had several telehealth visits in just a few weeks. “We saw a neurosurgeon, and she got fitted for another hearing aid,” says Tibbs. “I would use telehealth for the majority of my mom’s visits, if I can.”
7. Expect for some possible troubleshooting. Due to heavy use these days, many health providers’ telemedicine systems are at capacity or overloaded. If your call is glitchy or completely drops, ask your doctor if you can use something simpler, like FaceTime or WhatsApp. Sometimes switching devices or video conferencing platforms can keep a visit from being a flop.
If all else fails, the telephone is okay, but you may have to unblock unidentified callers.
After the Telemedicine Visit
There are a couple of things you’ll want to do when the telemedicine appointment concludes.
8. When the appointment ends, ask for a summary. That can clarify the important details of the visit. If the doctor’s office forgets to provide a summary, send the office a message recapping what you understood and ask if you got it all right.
9. Give feedback to the doctor’s office or your health insurer. Note anything that went well or poorly. That can help make your future telemedicine appointments even better.
Dr. Christine Nguyen is a clinical assistant professor at Stanford University Medical School and an online and audio journalist. She was a Gerontological Society of America Journalists in Aging Fellow. Find her on Twitter (@christinenguyen) and on her website.
I lose my glasses, forget actors’ names, repeat stories to my kids. None of these slips are red-flag symptoms of Alzheimer’s. Nevertheless, I’ve had a battery of cognitive assessments, from memory screens to genetic tests and brain scans.
Why? Because the science of brain health is advancing rapidly. Given my distressing family history of dementia, I prefer to err on the side of “knowledge is power,” rather than “ignorance is bliss.”
Earlier this year, to my surprise, the U.S. Preventive Services Task Force (USPSTF) chose not to recommend cognitive screening for asymptomatic older adults, saying the “evidence is insufficient to assess the balance of benefits and harms.” While evidence of harms of cognitive screening is limited, USPSTF says, some studies have shown “higher stress, greater depression and lower quality of life in persons aware of a diagnosis of cognitive impairment.”
Once I discovered the growing body of evidence that it’s possible to reduce some risks of Alzheimer’s or delay onset, I had to know: Where do I stand?
I worry the net effect of this recommendation might be for people to think dementia testing is pointless — when its upside, underscored both by my own experience and experts’ insights — is huge.
Lifechanging, even.
“Cognitive screening” typically refers to brief tests like Mini-Cog, MMSE, MIS, and MoCA — the kind where you draw a clock face, recall words or count backwards by sevens to evaluate thinking skills. They’re part of Medicare’s annual wellness visit. The Self-Administered Gerocognitive Exam (SAGE) is a similar self-administered screen. Increasingly, people without symptoms also get other, prevention-focused tests — again, to assess status rather than to diagnose — including more detailed neurocognitive evaluations, physicals, labs and brain imaging (CT, MRI, PET).
I’ve had them all. Sadly, comprehensive testing isn’t financially or logistically feasible for everyone today. (My expensive scans, for example, were for a study I’m enrolled in.) Here’s why testing should be made more accessible and available:
To Get Clarity About Your Dementia Risks
Really: I’m no hypochondriac or test fanatic. But it’s one thing to hear of general risks and another to know your individual status. Once I discovered the growing body of evidence that it’s possible to reduce some risks of Alzheimer’s or delay onset, much the way doctors now assess cardiac risk factors for heart disease and stroke, I had to know: Where do I stand?
Thankfully, I aced them. Imaging showed no brain shrinkage or amyloid plaques, both dementia precursors. Yet, other testing revealed a number of modifiable risk factors setting me up for worsening future scores, including high homocysteine (an amino acid linked to dementia that’s remedied with B vitamins), a thyroid condition, sub-optimal cholesterol and a sad fat-to-muscle ratio.
To Motivate Behavior Improvements
There’s nothing like proof of weakness to motivate behavior change. For the first time in my life, I joined a gym and hired a trainer and began brain-beneficial high-intensity interval training. (Just walking — my old exercise — wasn’t enough, I learned.) I became even more vigilant about my Mediterranean diet, took prescribed supplements, learned “brain breaks” like mindfulness and more.
Two years on, my improved cognitive scores and lower cholesterol keep me going. As does finding myself in stronger shape at 60 than I was at 40. (True, I gained several pounds…but of muscle.)
I now run every choice I make through the lens of my brain health: Is this helping or harming?
For someone else, testing might raise urgency about lousy sleep, hypertension, poor glucose control or stress. Swiss researchers have suggested that having “motivational reserve” — motivation to improve one’s cognitive health — may even have a protective effect on the course of mild cognitive impairment.
To Establish a Cognitive Baseline
Would knowing my cognitive status also be a useful comparison to future changes? I asked this of some geriatricians. Absolutely, Dr. Howard Fillit, who’s also a neuroscientist and founding executive director of the Alzheimer’s Drug Discovery Foundation, told me.
“Data shows that fifty percent of people with Alzheimer’s aren’t diagnosed until the moderate stage,” he said. “People say, ‘There’s nothing you can do.’ That’s where I really go nuts.”
The sooner cognitive symptoms are noted, the sooner that any reversible explanations (like polypharmacy, low B12 or depression) can be considered. The sooner helpful medical care can begin, too; if not medication (the current crop is unimpressive), then joining clinical trials, putting memory supports in place or managing other conditions differently. For example, Fillit’s own father, a meticulous diabetic, repeatedly landed in the hospital before anyone realized he was misdosing insulin due to mild cognitive dysfunction.
To Help My Family
Some say they’ll worry about their cognitive status down the line. Not a great plan, said Dr. Leslie Kernisan, geriatrician and founder of Better Health While Aging, an educational site on health and caregiving. “There’s a gray area when people around you are worried before you are. You’re putting yourself and others at risk, but refusing to go to the doctor, mismanaging money, continuing to drive and ferociously resisting help.”
An average of two years of this turmoil ensue between family noticing symptoms and diagnosis, according to Fillit. By then, it’s usually too late to competently take part in detailed, dementia-specific advance planning.
“If you want to spare your family the norm, get evaluated,” Kernisan said.
To Ease Anxiety
Finally, many avoid cognitive testing due to a fear of finding out. I don’t get it. Research isn’t finding increased anxiety or depression from cognitive testing, as the USPSTF noted. Many people find relief in getting clarity, one way or the other. Anyway, most of us are the worried well: 97% of those 65-74 and 83% of those 75-84 don’t have Alzheimer’s.
Worth remembering: None of these tests can definitively say if you have, or will get, Alzheimer’s. Not even testing for the APOE-4 gene variant that carries a higher Alzheimer’s risk. Yes, I welcomed this controversial test, too. Though curious, I knew it doesn’t predict anything; it’s just another bit of useful data to inform choices and plans.
Like so many, I’ve experienced dementia’s dreadfulness up close, as it haunted five beloved relatives and upended our lives. Keeping a sharp proactive eye on this specter feels far less stressful than letting it sneak up on me unawares.
(Next Avenue invites opinion pieces that reflect a range of perspectives. Doing so helps our readers learn about views from a multitude of experts.)
Immanuel Lutheran Communities invites you to send a note of cheer to brighten the day of a resident on campus. The Smile Program is a way for the greater community to connect with residents across campus during the pandemic.
All ages are encouraged to draw, write, paint or otherwise create their note of cheer to bring a smile to a resident’s face. These pieces of cheer are to be an uplifting note, poem or letter of encouragement to let them know you are thinking about them at this time. Thank you for your kindness and support of this program!
Chances are, the coronavirus has upped your worries about your personal finances. And if you’re nearing, or in, retirement, the pandemic-triggered stock market plunge may be making you especially upset. So, my two Friends Talk Money podcast co-hosts and I just released a new episode specifically dealing with money advice for the pandemic.
Below are highlights from the episode. You can listen to the 35-minute podcast below or from anywhere you like to stream podcasts.
My co-host Terry Savage, a syndicated personal finance writer and author, offered a few tips about the 80 million stimulus checks the U.S. government is sending out. “You will get a letter in the mail from the government telling you how, where and when your stimulus payment is being sent,” Savage said. “And you can reach out and tell them if there’s a mistake.”
Those Stimulus Checks
Savage suggests visiting the Internal Revenue Service’s new Get My Payment site to check on the status of your stimulus money. You may need your 2019 federal income tax return (if you filed it; the deadline is July 15, 2020) and your 2018 federal income tax return.
Her depressing warning: “Unfortunately, there will be a lot of problems” with the stimulus-payment system, since it’s new, untested and in huge demand.
The stimulus checks are not taxable, Savage noted, and won’t affect eligibility for federal benefits.
Savage had important information specifically for parents: “If you have children under seventeen who are dependents on your tax return, you get an extra five hundred dollars in your stimulus check. But if your child is eighteen or older, you don’t.”
Our Commitment to Covering the Coronavirus
We are committed to reliable reporting on the risks of the coronavirus and steps you can take to benefit you, your loved ones and others in your community. Read Next Avenue’s Coronavirus Coverage.
Retirement Planning in the Pandemic
Krueger, a small-investor advocate and creator of the Wealthramp site for finding a financial planner, offered an empathetic voice about retirement planning during the pandemic. “I don’t know anyone whose retirement plans are not impacted,” she said.
But, she said: “Try as much as you can to avoid taking money out of tax-privileged retirement accounts to get through this time,” adding: “just because you can, doesn’t mean you should.”
Her reasoning? You’ll owe taxes on money you withdraw, plus you’ll miss out on potential earnings on what your 401(k) money would have earned if you hadn’t taken it out.
And Krueger also advised not selling any stocks or equity mutual funds solely because the market has dropped so much in 2020. “It’s a disaster to sell stocks at their lowest point,” she said.
The 4% Rule and Retirement Withdrawals
I noted the new analysis by retirement analyst Wade Pfau, a professor at The American College of Financial Services, on how the pandemic has changed his thinking about what’s known as “the 4% rule.” Traditionally, financial advisers have often recommended retirees taking out about 4% of their portfolio a year to make their money last their lifetimes. But due to today’s low interest rates and the stock market drop, he is now using 2.4% as his benchmark for retirees who take “moderate” investment risks.
Savage said Pfau’s view “makes perfect sense to me.” But Krueger scoffed at the withdrawal rule, saying “people are best served when they realistically assess what they need.”
Add your talents to our talented team.
Immanuel Skilled Care Center & Post-Acute Care at The Retreat at Buffalo Hill
Moving forward while learning lessons about grief and living with the loss
By Jackson Rainer
For more than 25 years, I served as a psychology professor and researched grief and bereavement. I consulted and taught individuals, couples and families to meet the demands that chronic illness exacts, to build safety nets and resilience in the presence of stress, and to create space for the problems that the loss of a loved one brings. I was widely published, including a well-received book (Life After Loss: Contemporary Grief Counseling and Therapy), and produced professional audio and video recordings on end-of-life and palliative care.
Throughout, I struggled with the truth that my wife lived with a genetic cancer syndrome causing chronic health concerns, including multiple presentations of vicious cancers over the course of 33 years. She was as well-educated as I; we met the challenges of her illness with state-of-the-art treatment and care, including two decades of participation with the National Institute of Health’s research projects related to Lynch Syndrome.
Then She Died
In the summer of 2016, she began to fail for no apparent reason. Her research teams and physicians had no explanation, nor could they offer any further course of treatment. As she lost energy and strength, I became more alarmed.
The principal investigator of her study told me, “Jack, she has outlived this disease longer than any of us ever expected. She is a medical marvel and there is nothing further that we have to give. It may be time to call in hospice.”
One of her gifted practitioners, a neurologist, suggested that her body “just had enough,” which he termed idiopathic metabolic myopathy, diagnosed when the body unexpectedly stops translating nutrients into chemical energy.
They were right. Her body was exhausted and said “No more!” She died over the course of five weeks as an in-patient in a local hospice, attended to by personal and loving friends with whom we had worked over the years.
The Process of Grief
I arrogantly thought I was ready for my wife’s death. But it took me no time to realize that the experiential nature of grief is very, very different from academic study or clinical facilitation of others through the process. My spouse, lover and favorite playmate was gone. For years, I had taught that the process of grief does not change a person as much as it reveals another part of the self. What I quickly learned is the understanding of myself as student, professor and scholar had little relevance to living as a 61-year-old man whose wife of 38 years had died.
There Are Benchmarks
Much has been written about the natural process of grief. Those in the presence of loss are taught to stay in motion, however that looks personally, and to talk about their feelings of the impact caused by the absence of the deceased. Much is made of the first year following the death of a loved one. There is such focus to understand and explain the loss and come to terms with voids created by the absence of the deceased.
Meeting the markers of the “firsts” such as holidays and birthdays are places for attention, coupled with the erroneous belief that getting over such hurdles will lead to an easier acceptance of the loss.
Little is discussed of the second year, when those who grieve begin to assume a new identity reflecting new circumstances of life. The second-year experiences surprise us in that our loved one will always be absent, yet somehow present. Personally, I became uncomfortably aware of the discrepancy between the world that is now and the world that was.
The Sadness of the Second Year
Sadness is more than an abstract feeling. It penetrates the source of a person’s being and emerges when there is nothing, nothing, nothing to do except live with the loss. It is about resignation and invites one to turn attention inward, to take stock and to adjust.
For me, sadness continues to fine tune my memory in order to tolerate the good, bad, and ugly of my marriage. Over time, sadness has become a bass note to the day-to-day music of my life.
Time has a different meaning. Like all of us, I rely on chronological and sequential time to stay in the rhythm of the day (I have a young friend who calls this “the default world”), but in this second year, I live in what I’ve learned is kairos time, when an hour can be forever, a year a moment. I don’t understand this very well, but trust that time as we typically know it is not real. It is neither an event nor a thing, but a human-mind interpretation of a sense.
For some strange reason, I believe that I can simultaneously grasp the past in memory, the present by attention and the future by expectation. This is the oddest experience and more than a little squirrely. Life goes on in a linear way, so for many of us grieving the loss of a loved one, the second year forces us to face the harshness of loneliness because the social support of others fades.
What to Do?
In grief, it is never a good idea to curl up into a ball and wait for the will to live to pass away, as appealing as this thought may be. Better, acknowledge the loss and the truth that things do change.
Companionship counters loneliness. While I miss the companionship of my wife, I want the company of others. Such proximity allows an honoring of her spirit, rather than focusing on my intellect. The presence of others bears witness to the struggles of life.
Realize, with “real eyes,” as Rockland, Maine spiritual director Deirdre Felton says, “Doors are opening. Doors have closed. Take a breather and spend time with the new chrysalis that will hatch in its own time, with a new version of yourself, still who you are, but now somehow different.”
By Jackson Rainer
Jackson Rainer is a board certified clinical psychologist who practices psychotherapy with individuals and couples at the Care and Counseling Center, Atlanta. He is a Professor Emeritus of Psychology with the University System of Georgia.
(Across caregiving and community, business and intergenerational attitudes, the pandemic and how we respond to it could change us forever. Next Avenue turned to some of our Influencers in Aging, a diverse group of thought leaders, for their insights, counsel and opinions of what could lie ahead — if we choose.)
This is a dark age for many of us. The coronavirus pandemic has put global populations at risk, stripped millions of people from jobs and savings and isolated us in ways many have never experienced. For those of us of who are older, the danger is elevated. But the lessons of history offer perspective.
Humanity survived and thrived in the wake of earlier pandemics. The pain inflicted by invisible enemies like the Black Death, smallpox, and the Spanish Flu was devastating, but the world recovered.
In this moment, as we face physical isolation, financial loss and threatened health, finding purpose may actually save lives.
We have survived even worse — our own inhumanity. That’s why this is a time to turn again to the work of Viktor Frankl and his powerful book, Man’s Search for Meaning.
Our Commitment to Covering the Coronavirus
We are committed to reliable reporting on the risks of the coronavirus and steps you can take to benefit you, your loved ones and others in your community. Read Next Avenue’s Coronavirus Coverage.
Frankl was the prominent Austrian neurologist and psychiatrist who wrote of his personal experiences in the Auschwitz concentration camp. He observed that prisoners who found purpose in the face of unimaginable conditions were far more resilient and likely to survive than those who did not.
What Purpose Can Do for Us
Frankl’s words, “life is never made unbearable by circumstances, but only by lack of meaning and purpose” are a call to action today. Finding purpose, a fundamental requirement for human health and well-being, will not cure the coronavirus, but may well mitigate its effects and enable a more rapid recovery.
In this moment, as we face physical isolation, financial loss and threatened health, finding purpose may actually save lives.
Researchers agree that purpose in life increases overall well-being, improves mental and physical health, enhances resiliency and self-esteem and decreases the chances of depression. A strong sense of purpose is associated with slower development of age-related disabilities, reduced incidence of cardiovascular disease, improved cognitive health and longer lives. Finding purpose can promote energy, satisfaction and protective preventive health behaviors.
As Dr. Philip Pizzo of Stanford University, another Next Avenue Influencer in Aging, wrote in a recent piece for the Journal of the American Medical Association, “having a purpose, seeking social engagement, and fostering wellness through positive lifestyle choices are important in reducing morbidity and mortality and improving the life journey.”
While each of us sees purpose through our own lens, there is common ground. Some suggest that purpose is found at the intersection of our talents and skills and a need in the world. Others say it is the thing that drives us and keeps us going when things get tough.
Certainly, contributing to and caring for others is a shared instinct and aspiration. Social connection, engagement and sense of community are also key parts of the formula. Importantly, a loss of purpose can be a symptom of isolation.
That is a risk we all face today. So, if isolation is the enemy, how can we preserve and elevate our sense of purpose during a period of social distancing?
7 Ways to Find Purpose in the Pandemic
Here are seven ideas:
1. Call and email. Connect with family, friends and colleagues, particularly with those who are alone. This is an opportunity to renew and mend relationships and offer comfort to those in need.
2. Volunteer. Help others by reaching out to community organizations to offer assistance. The benefits of volunteer service are powerful, both for beneficiaries and for volunteers themselves who often realize enhanced physical, mental and emotional well-being related to their service.
We’re living history today, and this is our opportunity to record it.
3. Prioritize learning. Determination to learn can foster a sense of purpose. Reading connects us to new people, places and ideas. Online courses and periodicals expose us to fresh perspectives. Virtual museum tours, music lessons and performances, poetry readings and cooking classes are all available.
4. Write. Writing challenges us to organize and express our thoughts. Begin a journal. We’re living history today, and this is our opportunity to record it.
5. Exercise. Set daily goals and do what’s possible. The health benefits are obvious, but fitness goals can also be a manifestation of purposeful living.
6. Count our blessings. A sense of awe and gratitude are associated with purpose and an increased inclination to engage in altruistic behaviors that make a contribution to others.
7. Plan for what’s next. This pandemic will ultimately be controlled, so now is a time to prepare for recovery —at home, in business and in community. Things may be different, but human beings have proven to be remarkably adaptable and we’ll adapt to this as well.
Of course, all of us will have good days and bad as the coronavirus pandemic plays out. But each of us can choose to adopt positive attitudes and control our own response to the circumstances.
Let’s take the lessons learned from reading Viktor Frankl and live this difficult time with purpose.
During the coronavirus pandemic, here are 10 thoughtful ways to help others
The last few days, I’ve been receiving calls and texts from friends and neighbors. One person was running to the drug store and asked if I needed anything. Another friend wanted to be sure I had food. And another called just so we could talk about how surreal life during the coronavirus pandemic feels.
Your neighborly acts of kindness can make a difference in someone’s life.
Being alone can be difficult. Over the years, I’ve deliberately created a network of friends and neighbors who know my circumstances and don’t mind lending me a hand.
In the days to come, more of you will be confined to your home. Many of your neighbors might be alone, ill, afraid or in need of assistance — especially if they are physically distancing themselves from other human beings.
Our Commitment to Covering the Coronavirus
We are committed to reliable reporting on the risks of the coronavirus and steps you can take to benefit you, your loved ones and others in your community. Read Next Avenue’s Coronavirus Coverage.
10 Ways to Show Kindness
Now is the time to reach out to one another.
Do you know the people who live on your block or in your apartment building? If you don’t, put a note on their door with your name and phone number. Explain that you live next door or down the street. Tell them you want them to feel free to ask for help.
Many people are uncomfortable asking for help. Instead of just saying, “Do you need help?” offer to do something specific for them.
Here are examples of what you can do:
1. Before you run to the grocery store, drug store or a restaurant to pick up take-out, call and ask your neighbors if they need you to pick up something for them.
2. Volunteer to walk their dog(s).
3. Would if be helpful for them if you put their mail and newspaper beside their front door?
4. Does their yard need maintenance? Ask if they would like you to mow their yard, shovel the snow from their driveway or water their wilting flowers.
5. Do they need assistance putting their trash out or bringing the empty cans back into the garage?
6. If you have extra soap, toilet paper or other staples, leave a care package at your neighbor’s door.
7. Cook a meal or a batch of cookies and share them with your neighbor.
8. If you’re looking for ways to engage your children, have them make cards and crafts for the neighbors. Just to be safe, place items in a zipped bag with instructions to wait seven days to open, for germ prevention.
9. Go online and join your neighborhood group to communicate with those who live nearby. Websites like Nextdoor already exist or you can create a private group on Facebook. Just remember, many of your neighbors might not use social media. Some people don’t text. Find out how your neighbor prefers to be contacted.
10. Even if your neighbors say they don’t need help, continue to offer. Accepting assistance from a stranger can feel awkward.
Your neighborly acts of kindness can make a difference in someone else’s life.
How family caregivers, people with Alzheimer’s and others will benefit
Last week, the House of Representatives joined the Senate in giving final approval to a five-year renewal of the programs and services of the Older Americans Act (OAA). This represented a strong bipartisan reaffirmation of the value of the law to maintaining the independence of people 60 and older. President Donald Trump is expected to sign the legislation soon.
Why should you care? For one thing, the Older Americans Act’s efforts assist 11 million people each year all around the country, with services ranging from congregate and home-delivered meals to transportation services to elder abuse prevention to part-time employment. For another, the new legislation will provide new initiatives — and continue current ones — helpful to family caregivers, people with early-onset Alzheimer’s and low-income older Americans, among others.
Highlights of the Reauthorized Older Americans Act
The bill’s two main highlights: reauthorizing the Older Americans Act for five years and providing a 35% increase in funding over that time period. It also reaffirms that this law addresses two growing societal challenges: 1) social determinants of health (economic and social conditions influencing difference is health status) and 2) social isolation and loneliness.
61% of home-delivered meal participants said they’d skip meals or eat less in the absence of these programs.
One program that addresses social isolation is the Older American Act’s congregate nutrition program. By law, it must provide participants with a meal, nutrition education and a socialization opportunity (although the coronavirus pandemic will alter this, as explained below).
I’ve worked on a grant program with the National Association of Nutrition and Aging Services Programs, funded by the RRF Foundation for Aging, which studied the value of socialization. It found than 90% of older adults surveyed said the main reason they participate in the program was for socialization.
The Older American Act’s reauthorization would bolster efforts in this area by directing the U.S. Assistant Secretary for Aging to develop a long-term plan for supporting state and local efforts to combat social isolation, involving screening for social isolation as well as education on preventing and responding to negative health effects associated with social isolation.
How It Will Help With Caregiving and Nutrition
For caregivers, The Older Americans Act legislation will: provide new grants to home care workers; continue funding the 2018 RAISE Family Caregivers Act for another year (as Next Avenue explained, that law helps relatives and partners who provide medical assistance to loved ones); and, for the first time, provide caregiver and long-term care services to those with early-onset Alzheimer’s disease.
On the nutritional front, the bill addresses two other trending issues for older adults. It takes into account cultural considerations and medically tailored meals for the federal nutrition program and the legislation provides screening for malnutrition for the first time.
Before the bill passed, evaluations of some existing Older Americans Act programs demonstrated their significant value to beneficiaries.
For example, 61% of home-delivered meal participants said they’d skip meals or eat less in the absence of these programs. And a review of the law’s National Family Caregiver Support Program found that its caregiver services reduce caregiver burden as well as help family caregivers continue in their role for longer.
What the Older Americans Act Needs
The only real shortcoming of the Older Americans Act is inadequate funding.
It received just 1.1% a year, on average, in federal money from FY 2001 to 2019. The nutrition programs have fared slightly better, but when adjusted for inflation, total funding appropriated for Older American Act nutrition services during those years actually fell by 8%.
The Older Americans Act reauthorization wouldn’t have happened without the bipartisan leadership of Reps. Suzanne Bonamici (D-Ore.), chair of the subcommittee with jurisdiction over the law; Bobby Scott (D-Va.) and Virginia Foxx (R-N.C.), chairs of the committee with jurisdiction, and Sens. Susan Collins (R-Maine), Bob Casey (D-Pa.), Patty Murray (D-Wash.), and Lamar Alexander (R-Tenn.), all of whom played a pivotal role in the Senate.
Help Due to the Coronavirus
A very recent demonstration of the day-to-day importance of the Older Americans Act just occurred last week.
In the early hours of March 14, the House passed the Families First Coronavirus Response Act, which included $250 million in emergency funds for the senior nutrition programs of the Older Americans Act. It responded to expected major changes in the operations of senior nutrition programs due to the pandemic. Many thousands of congregate recipients will likely become home-delivered recipients for an undetermined length of time.
Further, this funding will help meet the growing demand for providing shelf-stable meals and congregate meals in alternate ways, such as “grab and go” options.
The Senate is expected to pass the bill with these funds later this week and the President has signaled his support.
Paul Downey, co-chair of the American Society on Aging’s public policy committee, said: “It is gratifying that in these uncertain political times one thing that both Republicans and Democrats agree on is the importance of passing the Older Americans Act. It is critical to the health and well-being of millions of older adults in the United States.”
Bob Blancato is president of Matz Blancato and Associates, a 2016 Next Avenue Influencer in Aging and winner of the American Society on Aging’s 2020 Hall of Fame Award.
Immanuel Lutheran Communities invites you to send a note of cheer to brighten the day of a resident on campus. The Smile Program is a way for the greater community to connect with residents across campus during the pandemic.