Saturday, February 20, 2010

Alzheimer's: The Art of Losing

I found Ruth L. Ozeki’s piece, "The Art of Losing: On Writing, Dying, & Mom," of special interest because my grandmother suffers from Alzheimer’s. I wanted to learn how others deal with such a long-term loss of one who slips away slowly over several years. Though my grandmother’s health in other aspects is not bad, the fact that she cannot recall names, faces, places or family history is a death of sorts. It is a death of memory. Somehow families must push through with the awareness that their loved one is no longer who they once were in healthier times. We must learn to love a new person who looks a great deal like the old person, but may or may not remember us from day to day. We must learn to not hold anger or resent their loss of memories we revere, but learn to appreciate new memories we can create while they are still with us. I felt Ozeki really proved how important this step is. Ozeki’s adaptability enabled her to build new memories with her mother and prepared her for her mother’s passing. Ozeki’s piece was an inspiration to any person dealing with a loved one suffering from Alzheimer’s.

Ruth Ozeki discusses writing the article “The Art of Losing: On Writing, Dying, & Mom” which she was asked to consider renaming to “The Art of Letting Go”. Ozeki thoughtfully considers the alteration in meaning via a poem by Elizabeth Bishop titled “One Art.” Ozeki describes the poem as “clearly…a case where ‘losing’ and ‘letting go’ are not interchangeable.” Ozeki highlights some differences between letting go and losing: “When I let go, I’m in control; when I lose, I’m not. Letting go is a willful act; losing, a violation of my will.”

Ozeki then discusses the traditions her family’s Japanese culture and the custom of sitting zazen during spiritual meditation. Her mother as a 2nd generation Japanese American had so much distance from her Japanese roots that she did not meditate in the zazen position and this prevented her from attending her grandmother’s funeral. Her inability to sit in the position would be “an embarrassment to the family,” Ozeki explains. At the funeral in Japan Ozeki explains another Japanese custom called “honewake” or “dividing the bones, which is often practiced when a person’s family lives in different places.” She returned from Japan with some bones of her grandmother, which she was to deliver to her mother. The experience inspired her to film a documentary called “Halving the Bones.”

Once Ozeki’s father died, she asked her mother with Alzheimer’s to come live with her in 1999. She cared for her mother until her death in late 2004, but reflects on some of the exchanges that took place between she and her mother during those five years. Once mother expressed concern that the washer and dryer in the guesthouse she lived in would prevent Ozeki from washing laundry once she died and Ozeki rented the guesthouse to another person. Ozeki settled the concern by jokingly confirming she would bury her mom with the washer and dryer so she could keep her clothes clean in heaven. When her mother turned 90 in May of 2004, her mom was in disbelief that she was 90. She said she felt forty and when Ozeki confirmed that even she was “older than forty,” her mother replied, “You are? That’s terrible!”

Ozeki then reflected on the differences in how she handled the deaths of her father and her mother. When her father died, she wasn’t ready for it. She held much anger at him for not preparing for it. She drank too much during the grieving process. However, the time she spent with her mom prepared them both for her mother’s death. “I wanted to keep my wits about me. I didn’t want to run away." She also encourages that people “write your loss” – “I spent ten years losing my mom, little by little, day by day, but during that time, I wrote books, letters, e-mails, blog postings, stories, journal entries, and poems…I’ve been turning loss into letting go.”

Reference:
Ozeki R. L. (2008). The Art of Losing: On Writing, Dying, & Mom. Shambhala Sun Magazine. Retrieved from:
http://www.shambhalasun.com/index.php?option=com_content&task=view&id=3186&Itemid=244
All content © Village Memorial. 2009-2010.

Wednesday, February 10, 2010

Independence vs. Assistance

The elderly should be mindful of how much help they accept and caretakers should be cautious of offering too much help are the fundamentals of an idea called “wise independence”. Ruddick (1999) describes the idea of wise independence as “the capacity to plan and control one’s life, combined with the willingness to acknowledge one’s limitations and accept help in ways that are gratifying to the helper.” The elderly person and his or her caretaker should “create between them and for each other a workable balance between letting go and holding on, assertion and acceptance, intervention and letting be” (Ruddick, 1999).

A real risk exists when people let go of their independence to become too dependent on caregivers. Ruddick (1999) explains that, “a caring person should know that if she hovers and insists she may encourage in the person she cares for a despairing acquiescence that is as life-ending as the ‘fall’ she would prevent” (p. 58).

Clark (2003) experienced this situation with her mother who moved into a “nursing home for a few weeks rest.” Although her mother, in her late 70’s, had suffered debilitating arthritis for many years that was so bad that “she probably would have been confined to a wheelchair”, her independent life prevented it. Clark (2003) explained how “her [mother’s] need to do for other people was so great that she kept pushing herself, forcing activity on those aching joints willing them to function.” However, shortly after Clark’s mother entered the nursing home, she witnessed a drastic decline in her mother’s energy. Clark (2003) described that “as soon she began to take it easy, everything in her body slowed up…She could no longer take care of others” and she died a few weeks later.

A similar decline is occurring in an elderly relative who recently entered a retirement home. Pedro, who is in his mid 80’s, lived independently as a retiree without any caregiving assistance until two years ago when he suffered his first fall. Pedro. tripped over his rambunctious dog, Nero, and suffered a minor injury. Since then, Pedro began to accept the help of a caregiver. As Pedro began to increasingly rely upon his caregiver he did less for himself. He delegated errands, shopping, house care, yard care, and personal budgeting to his caregiver and thus began to require even more help until he moved into a retirement home in June this year. Since his arrival at the retirement home he has fallen multiple times. The last fall resulted in a broken elbow. He has since been hospitalized.

When Ruddick (1999) explains that “both living and caring well involve a changing process of adjusting, accepting and appreciating the living and caring that remains possible,” (p.58) I see how a lack of “wise independence” negatively affects the elderly. I believe that Pedro’s comfort level with caretakers just minutes away has led him to be less cautious when walking or moving about his apartment. In this sense, Pedro is becoming even more dependent on the caretakers and much less independent. I now fear for Pedro’s health, that it might decline even further now that he has no requirement to care for himself.

Wise independence is not merely just an encouraging idea; it is a vital component in the health and longevity of the elderly. Caregivers and the elderly must be mindful of the independence vs. assistance balance, so they do not create excessive vulnerability and dependence on the caregiver(s).

Reference:
Clark, M. H. (2003). Kitchen Privileges. New York: Simon & Schuster, Inc.
Ruddick, S. (1999). Virtues and Age. In M. U. Walker (Ed.), Mother Time. Women, Aging, and Ethics. (pp. 45-60). Lanham: Rowman & Littlefield Publishers, Inc.

All content © Village Memorial. 2009-2010.