Senior Toronto blog

March 30, 2018

On being useful (or not)

It seems to be written into our DNA. Just about all of us want to be useful, reach out to others, play our part. Even little children like to help out. Whether we’re motivated by affection, a sense of moral obligation, or a need to prove ourselves worthy, most of us try to support our friends, family and colleagues. And of course, while we’re working, we’re paid to be useful. Once we stop working, we may feel bereft, unneeded. And if as we age we become more frail and need to receive help rather than giving it, we may start to ask ourselves, in consternation and distress, what the value of our life is now.

We’re creatures of our society, and our society places a high value on productivity, particularly through paid work. Never mind that we may have earned a living for years; once we’re retired, we’re viewed as a burden. We’re accused of sucking up all the health care resources, and left to languish in hospital beds, waiting months for a long-term care placement because there isn’t enough long term care. Or we languish at home because there isn’t enough home care for us either. We have outlived our usefulness, says our society, and so we are warehoused and neglected and shunted out of sight.

It’s not just seniors and the disabled who suffer from our preoccupation with usefulness. For generations, we have regarded the non-human world largely in terms of its usefulness to us. Plant and animal life and natural resources have all been bent to our needs, and we are only now just beginning to wake up to the devastating effects of what we have done to the earth.

Usefulness has its place, it helps us get along better and ease each other’s burdens, but I don’t think we should use it as a primary measure of our worth. Most of us value our own lives enormously, quite apart from our usefulness, and unless we are very ill or in pain or despair, we fight hard to go on living. If we feel that way about ourselves, we can assume that other people feel that way too. Life is clearly precious in itself, and we try to live as best we can. We need to incorporate that truth morally and feel it emotionally, place it in the centre of our moral universe. Some might find support for this in religion or philosophy. In a pinch the Golden Rule would do. We are not just a means to other people’s ends.

February 28, 2018

Giving up the car

The old rust bucket on my driveway is showing its age. It has served me well for 14 years, especially when I was working. But now the repairs are getting more frequent and more expensive. The car is growing old, and so am I. Never a driving fan, I find my worsening eyesight, slow reflexes and creaky joints now make me very uneasy behind the wheel. So I’m not driving it much, and that makes things even worse for the battery and brakes. The car is becoming a burden. Sometime soon the repair bill will be just too high, and I’ll give it up. But then what?

I’m not a menace on the road yet. I have to make a lifestyle choice, not a public safety one. If I don’t replace the car, how will I manage? I’ll still have lots of options for getting around. I’m lucky to live near shopping, a parking lot with ridesharing cars, a subway station and a GO train station; they’re all just a 15 to 20 minute walk away. There’s Toronto Ride to take me to medical appointments and shopping, or I can do most of my shopping online. If I’m feeling spry, I can haul a grocery cart or backpack down to the store. So it’s not independence I’ll be giving up; it’s spontaneity. Most of those alternatives require planning ahead. Will that matter?

There will be tradeoffs for sure. No more quick trips to Canadian Tire when I run out of ice melter. Things that used to be simple errands, like buying plants and fertilizer for the garden, will now become projects. And as my joints stiffen and my pace slows, what feels like an easy 20-minute walk right now could well turn into a journey to the other side of the moon. I’ll get rid of the burden of the car, but will be taking on new burdens in terms of the time and effort and foresight it will take to look after myself and manage my home.

Making adjustments, accepting new realities: it’s all part of aging. Gotta just roll with it, in the slow lane.

January 30, 2018

Why ageism won’t go away

I went to the drugstore the other day to buy a birthday card, and it made me want to head straight over to the headache remedies. Card after card full of jokes about sagging body parts, leaky plumbing, failing memories, and being over the hill. They wouldn’t dare write like this about women or ethnic groups. But here we are in 2018, and ageism still gets a free pass. It’s everywhere: media, entertainment, fashion, cosmetics, public services, workplace, medical care, long term care, and among our own nearest and dearest. In this era of political correctness and righteous indignation, why can’t we put an end to ageism?

You don’t have to be a psychologist to recognize that much of it is fear. When we’re young, we don’t want to think about our own decline and death. That’s not going to happen to me! So younger people find ways to distance themselves from us seniors. They view us through negative stereotypes, patronize us, treat us as weak and needy, a burden on society, undeserving. We get that; after all, we used to be them. But they haven’t figured out that someday they’re going to be us.

Closer to home, ageism may take a different shape. Family members, especially adult children, may wonder aloud about our ability to look after ourselves, offering help we don’t need, planning our future without asking us what we want. Obviously, some of that is driven by their real concern for our welfare. But sometimes their real concern is for their own peace of mind. They might like to see us tucked away safely in care so that they don’t have to worry about us or help us out at home. And we don’t want to cause them worry, so we might end up going into care or living in their granny flat when that’s not what we really want.

Here’s an uncomfortable fact: sometimes the stereotype is true. Aging is a tough slog. Most of us will eventually experience chronic illness and physical decline. Some of us will suffer mental decline and dementia. When young people see us standing in a crowded subway car, how can they tell which of us is on his way to a ravine hike and which of us has severe arthritis and needs to sit down? When staff see us at Home Depot, how can they tell which of us is building her own deck and which of us can’t figure out what light bulb to buy? So they decide it’s safer to assume we need help.

I don’t think we can wipe out ageism, but as seniors we do have to deal with it. If you relish a good fight, by all means call out the ageists on their most egregious behaviour. Gently but firmly stand up for yourself with your family members, letting them know that you try to exercise good judgment in your life decisions, just like they do, and will call on them when you need help. Don’t fall into the stereotypes, not even when you’re with other seniors. Don’t call yourself an old codger, don’t label a moment of forgetfulness a senior moment, don’t buy anti-aging cream. But take the seat on the subway – you’ll make that young person’s day.

December 29, 2017

My wish list for seniors

Well, Santa’s come and gone for 2017. But I figured I should submit this wish list now, because Santa’s going to need a head start to get through it. Not sure he’ll get it all done by next Christmas.

  • Enough long term care for all who need it, so we don’t have to languish in hospital beds or die on the wait list. And affordable assisted living or home support, so we can age in our own homes and stay out of institutions as long as possible.
  • Someone to please sell some decent clothes for seniors.
  • A ban on anti-aging products. Stop flogging all that snake oil, just let us age naturally.
  • Strong senior representation in neighbourhood associations, to make our local neighbourhoods senior-friendly.
  • A single umbrella group with clout that represents and advocates forcefully for seniors’ needs and interests to governments, businesses and service agencies.
  • Appropriate social and recreational programming to cater to seniors of different ages, needs and abilities.
  • Professional financial trustee services, for people who can’t manage their finances themselves anymore and don’t have anyone to do it for them. Trust companies currently make these services available only to millionaires.
  • Affordable glasses, hearing aids, dental care, wheelchairs and smart phones.
  • Enough geriatricians and gerontological nurses and social workers to meet the burgeoning demand.
  • An end to widespread public acceptance of ageism, a form of discrimination that still gets a free pass in our society.

November 30, 2017

Seniors and marijuana

In Canada, access to medical marijuana has been legal since around 2001, and access to recreational marijuana will become legal in July 2018. This is good news for seniors. I’ll tell you why, but first we need a little detour into the past.

Marijuana (also called cannabis) packs a double punch: it has medicinal properties, and it produces a high. For centuries, cultures around the world have woven it into their healing practices, customs and religious rites. But in the West, especially in the United States, the legal history of marijuana has taken a sinister turn. It has been repeatedly vilified by powerful individuals and groups in the service of political, racist and business agendas. The history of marijuana in America is sordid but fascinating. If you want to get your toes wet you can start here or here. The upshot is that the research evidence is sparse and uneven, and patients are missing out.

Here is the best evidence available to date. This is a nerdy list, but I want to be unbiased and thorough. First, here are the conditions that marijuana can treat.

Conclusive or substantial evidence:

  • Treatment of chronic pain in adults
  • Treatment of chemotherapy-induced nausea and vomiting
  • Improving multiple sclerosis spasticity symptoms

Moderate evidence:

  • Sleep disturbance associated with certain disorders

Limited evidence:

  • Increasing appetite and reducing weight loss associated with HIV / AIDS
  • Improving symptoms of Tourette syndrome
  • Improving anxiety symptoms
  • Improving symptoms of post-traumatic stress disorder

Here are the possible adverse effects.

Substantial evidence:

  • Statistical association between cannabis smoking and worse respiratory symptoms in respiratory disease with long-term cannabis smoking
  • Increased risk of motor vehicle crashes
  • Development of schizophrenia or other psychoses, with the highest risk among the most frequent users
  • Statistical association between increases in cannabis use frequency and progression to developing problem cannabis use

Moderate evidence:

  • No statistical association between smoking cannabis and incidence of lung cancer
  • Impairment in cognitive domains of learning, memory and attention (acute cannabis use)
  • Small increased risk for development of depressive disorders
  • Increased risk of suicide ideation and suicide attempts with a higher incidence among heavier users
  • Increased incidence of social anxiety disorder with regular cannabis use
  • Being male and smoking cigarettes are risk factors for the progression of cannabis use to developing problem cannabis use
  • Major depressive disorder is a risk factor for the development of problem cannabis use

Limited or no evidence:

  • Increased risk of acute myocardial infarction
  • Statistical association between cannabis smoking and developing chronic obstructive pulmonary disease
  • Statistical association between cannabis use and death due to cannabis overdose

Obviously there are plenty of research gaps, but with increasing public acceptance and more and more jurisdictions legalizing marijuana, hopefully the research will soon follow. Meanwhile, what stands out for me is the evidence for chronic pain, an issue of pressing concern for many seniors. It’s an obvious and very welcome alternative to opioids. So if you have chronic pain or any of the other conditions listed above as having evidence support, and you’re not satisfied with your current treatment, consider discussing marijuana with your doctor. Remember that medical marijuana comes without the kick. Just take the lowest possible dose, use in moderation, and eat it instead of smoking it.

Some doctors are uncomfortable prescribing marijuana, given the spotty knowledge base, lack of evidence for dosing levels, lack of standardized medication, and tentative, limited guidance from the College of Family Physicians of Canada. All in good time. If your doctor won’t prescribe it, then just wait until next July, have a candy and see what happens. Peace, man.

October 29, 2017

Elderfitness

Aging in place, managing in our own home for as long as we can -- that’s what most of us want. We’re in no hurry to go into care. But as we get older, it gets harder and harder to climb the stairs, do housework and yard work, shop for groceries, walk to the bus stop. Fitness is the key. We can’t stop the clock from ticking, but we can try to maintain or maybe even increase our ability to function, bearing in mind our porous bones and wonky hearts and aching, swollen joints. So how do we do it? Many senior centres run fitness programs, but they are mostly geared toward older seniors and are too gentle for seniors who are still active. So I searched through the evidence-based literature to try to come up with a formula that we could try at home, without hiring a personal trainer or buying expensive equipment. I’m no fitness guru, so do this at your own risk, and check with your doctor first. Don’t forget to warm up and cool down.

Endurance

  • 20 minutes every day of moderately intensive aerobic activity: energetic continuous movement that makes your heart beat faster and makes you feel warm.
  • Examples: low-impact aerobics, aquafitness, brisk walking, bicycling, dancing.

Interval training

  • Short bursts of intense activity, 2 days a week
  • Examples: Take a walk. For the first 10 minutes, walk at an easy pace. For the next 15 minutes, do a hard walk for 1 minute, then a medium walk for 1 minute, then an easy walk for 1 minute. Repeat 4 more times. Finish with a 5-minute easy walk. Or, if you have an exercise bike: warm up at an easy pace for 5 minutes, then cycle for 20 seconds at high intensity, cycle slowly for 90 seconds, repeat 4 – 6 times, cool down with 2 minutes of light cycling and 2 minutes of walking.

Muscle strengthening

  • 2 days a week, exercises that strengthen all the major muscle groups, upper and lower body.
  • 8 to 12 repetitions per activity, or until it would be hard to do another repetition. If they get easy, do another set.
  • Examples: squats, one-arm row with hand weights, bicep curls with hand weights, using resistance bands, wall pushups.

Balance

  • A few minutes a day.
  • Examples: walking backward or sideways, heel walking, toe walking, standing from a sitting position, standing on one foot.

Flexibility

  • A few minutes a day.
  • Examples: arm and leg stretches, yoga.

This is all very sketchy and you need to fill in the details by finding examples and routines on the internet. YouTube is full of great free workouts; you can exercise in front of your computer. Use keywords like “20 minute” and “low impact”. Keep searching until you have a nice collection of varied workouts so you’re not doing the same ones every day. Check out some pregnancy workouts; they work well for seniors because they’re safe, and careful about balance.

If you would like to read up on guidelines or get some background information, go to: