Silver Tsunami on Drugs

We know about the Boomer Bump. The huge demographic shift that is overtaking our economy and healthcare system is changing our family and social dynamics in many ways.  Our rapidly aging community means more caregivers of all ages, more sandwich caregivers and greater longevity but also more disability.

And it also means more drug addiction and more misuse of drugs and alcohol.

The tsunami for older adults using and misusing substances is tricky because we have social and cultural blocks to seeing and addressing the issue. Can’t Gramma enjoy her glass of wine? Why should Grampa be in pain if his doctor is giving him prescriptions? And the doctor says it’s OK, what’s the big deal?

But it is a big deal because we are seeing huge increases in the number of people in their 50’s and 60’s as first time users of marijuana and cocaine. I know, seems crazy right? But Gramps is not down on the corner scoring the stuff from some kid, he’s buying it at the senior center and in the assisted living lobby and it comes to his door in the high-rise.

And the numbers compound when you consider that 10,000 people turn 65 everyday in the United States.

We know that alcohol and drug use increase with stress and this is the group who are facing endless caregiving. Being a family caregiver is no longer a 12 to 18 month task while someone progresses thru a serious illness. Better healthcare means that caregiving will go on and on and on and, well, who would deny someone in that situation some wine, or some Valium or some Ambien or if you are exhausted, a little cocaine?

Most folks over 60 have an average eleven medications prescribed for them by an average of three doctors. The most prescribed medications for seniors are Benzodiazepines: Valium, Zanex, Ambien etc. They are central nervous system depressants. And highly addictive. And they mimic the symptoms of dementia—so family, and even physicians, can be fooled.

Opiates are prescribed for pain. But chronic use can actually lower one’s pain threshold. Chronic opiate use—with prescribed medications—can lead patients to feel more pain—so then it seems natural to ask for and take more and stronger pain meds.

Caregivers of people with chronic illness are living with huge unspoken resentment and grief. It’s not what they imagined retirement to be. Where is the fun? Where is the adventure they worked so hard to afford?

So why not some wine or one of those new drinks? Boomers who may have used pot in their 20’s and gave it up for work and family often romance the idea of being able to use pot again after retirement. But the pot they are buying today is not what they smoked in college. It is much stronger and laced with coke and speed and other drugs.

Check on Your Hospital and Your Doc

Here is an important article from yesterday's Wall Street Journal. The opening stats are a bit scary but all the more reason to not be shy when dealing with your doc or any hospital staff. Ask, ask slowly, and ask again. Do not be intimidated or rushed. It's your life. Caregivers--you too. Politeness has to go out the window. Take a look at this, and ask your doc if they have read it too:

Here's the link:

http://online.wsj.com/article/SB10000872396390444620104578008263334441352.html?mod=googlenews_wsj

The Best Death

We had a talk about death last night. It was a good talk. In fact, a great talk. Death is an open conversation for us. It’s always there weaving in and out of every conversation and through our running chats about food and books and friends and politics and yes, sex.

But there was something else last night. Cancer, I’m sure, opened the conversation, but somehow we went deeper than before. We talked about the how of death, and would we help each other die, and how would we know we were ready. What part would be pain, and what part would be exhaustion, and what part would be a sense of readiness?

And all day today as I went back to that conversation I realized something new—something that has changed for me and that, maybe, is also a bit of acceptance.

For so many years—especially in my younger years—I always imagined that a sudden death and an unexpected quick death would be the very best kind. When we play that hypothetical, “How would you like to die?” game I’d always thought that a plane crash or explosion or something sudden and relatively painless would be the way to go. I’ve heard many others say, “die in my sleep” or “die in my lover’s bed” or “die in my recliner watching my team win”…all to suggest that a fast, unexpected death would be the best kind.

But today I realized that I want more from death than that. Maybe this comes from being a control freak, or maybe its because I love process, or maybe it’s because I really do want to place each of my scarves in a friend’s hands—but I want time to know when I will die. I want to know it will be six months or six weeks. I would choreograph each of those scenarios very differently. I want to say good-bye and give my things to specific people. I want to make love dying. I want to say words and hand out books.

And given all of that I realized something about cancer that I never considered before: It may be the very best way to die. Cancer, for the most part, gives warning. Many cancers have some kind of timetable. Cancer lets you have at least a little time to say, “Wow, here we go. This is really going to happen. What do I want now?”

For all the war against this thing and all the battles waged, and all the agendas that insist we should have no cancer consider this: If you accept that you will die, and you know you will die of something, cancer could be the best way to die.

Marie Howe Reads at SUNY Albany September 20th

For Albany readers: Here is an upcoming event that you should not miss. Marie Howe, poet, teacher, caregiver, and as of next week, Poet Laureate of New York State, will be reading her poems at SUNY Albany next Thursday September 20^th at 8pm. The reading and ceremony will be at Page Hall, 135 Western Avenue, at 8pm.

My favorite of Marie’s books is called, “What the Living Do”. Here is the poem that titles her stunning collection of poetry:

WHAT THE LIVING DO

by Marie Howe

Johnny, the kitchen sink has been clogged for days, some utensil probably fell down there.

And the Drano won't work but smells dangerous, and the crusty dishes have piled up

waiting for the plumber I still haven't called. This is the everyday we spoke of.

It's winter again: the sky's a deep, headstrong blue, and the sunlight pours through

the open living-room windows because the heat's on too high in here and I can't turn it off.

For weeks now, driving, or dropping a bag of groceries in the street, the bag breaking,

I've been thinking: This is what the living do. And yesterday, hurrying along those

wobbly bricks in the Cambridge sidewalk, spilling my coffee down my wrist and sleeve,

I thought it again, and again later, when buying a hairbrush: This is it.

Parking. Slamming the car door shut in the cold. What you called that yearning.

What you finally gave up. We want the spring to come and the winter to pass. We want

whoever to call or not call, a letter, a kiss--we want more and more and then more of it.

But there are moments, walking, when I catch a glimpse of myself in the window glass,

say, the window of the corner video store, and I'm gripped by a cherishing so deep

for my own blowing hair, chapped face, and unbuttoned coat that I'm speechless:

I am living. I remember you.

Check Your Language

The language of cancer: victim, survivor, thriver, patient. What do you call yourself and what do others call you? Below is a link from New York Times Health Pages and author Susan Gubar, who wrote the terrific book called, "Memoir of a Debulked Woman" about her ovarian cancer experience.

In the article below she writes about cancer's language and how we identify ourselves. She raises the tricky linguistics versus timing question: if you are not at the five year mark can you claim "survivor? If your cancer was 20 years ago can you still play that card? I live with these questions . I'm a cancer caregiver and a cancer...what? survivor? patient? person?

Gubar is simply a great writer. So click on the link below and take a look. And share this one with your friends.

http://well.blogs.nytimes.com/2012/09/06/not-a-cancer-survivor/?smid=pl-share

The Guardian

by Joseph Mills

I don't think my brother realized all
the responsibilities involved in being
her guardian, not just the paperwork
but the trips to the dentist and Wal-Mart,
the making sure she has underwear,
money to buy Pepsis, the crying calls
because she has no shampoo even though
he has bought her several bottles recently.
We talk about how he might bring this up
with the staff, how best to delicately ask
if they're using her shampoo on others
or maybe just allowing her too much.
"You only need a little, Mom," he said,
"Not a handful." "I don't have any!"
she shouted before hanging up. Later
he finds a bottle stashed in her closet
and two more hidden in the bathroom
along with crackers, spoons, and socks.
Afraid someone might steal her things,
she hides them, but then not only forgets
where, but that she ever had them at all.

I tease my brother, "You always wanted
another kid." He doesn't laugh. She hated
her father, and, in this second childhood,
she resents the one who takes care of her.
When I call, she complains about how
my brother treats her and how she hasn't
seen him in years. If I explain everything
he's doing, she admires the way I stick up
for him. Doing nothing means I do nothing
wrong. This is love's blindness and love's
injustice. It's why I expect to hear anger
or bitterness in my brother's voice, and why
each time we talk, no matter how closely
I listen, I'm astonished to hear only love.

"The Guardian" by Joseph Mills, from Love and Other Collisions. © Press 53, 2010. 

Spirituality in Healthcare

I'm at a conference on Addiction Care and Addiction Medicine so of course spirituality comes up for discussion. The dominant model is Alcoholics Anonymous and Alanon, NA etc. which have a core of spirituality. But it's interesting how much spirituality is pervading medicine and healthcare in general, especially at a time when we are moved to resist religion in healthcare. Perhaps we are learning from AA and Twelve Step approaches that there is more than a semantic difference between religion and spirituality.

Tonight's dinner speaker talked about evidence-based medicine and he explained that the previous debate about using AA in Treatment Programs is coming to an end because AA practices and participation is now evidence-based. There have been enough longitudinal studies to confirm success and positive outcomes: Patients who participate in three AA meetings a week do better than those who go to one meeting, who still do much better than those who do not attend any 12 step meetings. He also mentioned that there is now a heated debate around requiring spirituality training for ICU nurses.

But perhaps the biggest marker  for institutionalized medicine though is that "Attention to spirituality" is a prerequisite for medical treatment programs that are certified by the Joint Commission on Accreditation in Healthcare.

Caregivers and Addiction

I am in Hyannis, Massachusetts this week for a conference on Addiction Care. Lots of information in the seminars on family caregivers and addiction, and the consequences for people in addiction recovery when they become family caregivers.

In yesterday's seminar on "Addiction Over 65" I learned that there is a rapidly growing new group of folks becoming first time drug addicts and the drug is methamphetamine. Yeah--that's the stuff made in bad labs and that fuels the TV show "Breaking Bad". The craziest factor is that folks over 65--in middle and upper income demographics-- are using meth to feel young again and to cope with the stress of caregiving.

The other shock  was learning that the over 65 crowd is using more marajuana--four times more than ten years ago. But these are not hippies bringing their old habits into their senior years, these are first time addicts.

This is Grandma's brain on drugs.

Seminar on Caregiving and Special Needs Planning

Concerns about money and lack of planning lead to the biggest fights and the most fear in caregiving families. It helps to get good information and perspective ahead of the crisis--and since most of us are or will be caregivers sooner rather than later it makes sense to think about it now.  A colleague, Andre Turman, sent me the info below about a workshop he is providing in the New York Capital Region that is for caregivers and families.  If you'd like to attend give him a call. His contact info is below:

On October 15^th from 6-8pm @ The Century House in Latham, we will be hosting a dinner presentation for families and caregivers of loved ones with special needs.  This educational seminar will focus on the need for implementing a comprehensive plan covering essential aspects in providing a desired sustainable lifestyle for their loved ones with a special need or disability.

The title of the presentation is:

“Caring for a Loved One with Special Needs”

Are you completely prepared for sustainable care?

We have limited seating for this event, and would like to reserve a few seats for you to offer to your families and caregivers you feel would benefit from attending.  If possible, we would like for you to include this event in your monthly newsletter and online calendar.  Reservations for the dinner are due no later than September 28^th, and invitations will go out the week of October 1^st.

Below are the topics to be covered during the presentation:

• Teamwork approach
• Financial and Legal resources
• Manage Care and Social Service partners
• Purpose of Special Needs Trust
• Family Protection

Thank you,

André Turman, CSNA®

Certified Special Needs Advisor
Financial Advisor

Merrill Lynch Global Wealth Management

Southern Saratoga County Office

449 ROUTE 146
CLIFTON PARK NY 12065-3239

NMLS # 66187

Phone: 1.518.383.8945

The Eve of Back to School

It is the last day of summer and the eve of the New Year. We will both grieve and celebrate tonight. It’s been a wonderful summer. We had great adventures traveling alone, and with friends, we saw great cities and beautiful beaches. This year it felt like we had more really great books to share than any other summer I can remember. Work has been good, and John’s health continues to improve. I feel so grateful for the goodness that surrounds us.

This night –Labor Day--always feels like New Year’s Eve to me—the influence and habit of so many years of back-to-school preparation. I bought new notebooks this week even though 90% of my work is now on the laptop. But I had to have some new school supplies.

We did three cemetery walks this weekend. The longest at Albany Rural Cemetery—that one has been part of our walking habit for many years. Over the years we’ve pieced together lots of Albany literary history via her dead, and today Prospect Hill—closer to home and smaller but a poignant mix of old and new.

Some people find graveyards morbid but I have always loved them. I grew up a few doors from one and it was our playground, camp and hangout. It was also where I went to pray—even as a kid. I find a sense of tonic in walking through a cemetery. Dead people put everything into perspective.

At Prospect Hill today we looked at a fresh grave that was just dug for a burial tomorrow morning. As we looked down into the grave John said, “Are you ready for that?” It’s quite clarifying to be able to say, “Yeah, I mostly am”.

On this night also—like on Day of the Dead—we’ll eat spicy chocolate and talk about the new season coming, we’ll attempt a schedule –harder this year with book deadlines pressing--and we’ll laugh and dance and make love. Back to school tomorrow. Life is good.