Senior Toronto blog

October 30, 2022

Immunocompromised should take action

Back in March, I wrote a blogpost about the precarious situation of immunocompromised people in Ontario and elsewhere. Many of them are seniors with aging immune systems. Now they’re in even more danger, with the protection mandates nearly all stripped away, COVID hospitalizations climbing and new variants looming. The unstated policy is simply that people should go back to business as usual, and the immunocompromised should get out of the way.

The onus is on this high-risk, vulnerable population to protect themselves: wear masks, stay away from crowds, curtail their social activities, and muddle through on their own. Why is it up to the victims to come up with the solutions and make all the sacrifices? Government policies are restricting their freedom of action and endangering their health. Yet Canada has a Charter of Rights and Freedoms, and equality rights are at the core of it. They are intended to ensure that everyone is treated with the same respect, dignity and consideration, regardless of personal characteristics such as race, national or ethnic origin, colour, religion, sex, age, mental or physical disability, sexual orientation, residency, marital status or citizenship. Immunocompromised people are entitled to the same respect, dignity and consideration as everyone else.

Immunocompromised people are a small minority group, and a diverse one. Maybe it’s time to make them harder to ignore. Here are some concrete actions they could take or lobby for:

  • Create an advocacy group, to speak with one voice. Then people with lupus and multiple sclerosis and leukemia and transplants don’t have to fight separately for the same protections.
  • Lobby for mask mandates in all healthcare facilities. Immunocompromised people have to go to these places, and should not be put at risk when they do.
  • Mask mandates should be strictly enforced wherever they are in place. If a patient enters the doctor’s waiting room holding a Kleenex over his face, or wearing a mask under his chin – both of which I’ve seen in my own doctor’s waiting room – he should be handed a proper mask and told to put it on immediately and keep it on. If he refuses, his appointment should be cancelled and he should be sent out of the waiting room.
  • In healthcare facilities, HEPA filters should be running in all the patient areas, including the waiting rooms.
  • Social distancing should be maintained in waiting rooms; bookings should be carefully arranged to accommodate this.
  • Immunocompromised patients should have access to free antibody testing, so they can find out if they’re getting any benefit from vaccines.
  • Authentic, approved N95 and KN95 masks should be readily available at low cost to all immunocompromised patients. They should be classified as an assistive device, since they enable mobility, and they should qualify under existing programs like Ontario’s Assistive Devices Program, or the one operated by the March of Dimes. Alternatively, they should be made available on prescription.
  • Evusheld provides ready-made antibodies to immunocompromised people on a short-term basis. Ontario guidelines are still following the original FDA guidelines for 150 mg of tixagevimab and 150 mg of cilgavimab. But back in February, the FDA found evidence that this dosage was insufficient, and doubled it to 300 mg of each drug. Ontario still has not upgraded the dosage and should do so immediately. Further, the FDA now recommends that Evusheld should be administered every 6 months. Ontario needs to upgrade its guidelines to accommodate the new evidence.
  • Evusheld should be made available to all leukemia patients, not just patients in active treatment. The action of the disease itself makes leukemia patients just as vulnerable as those in active treatment.
  • Cancer centres and other facilities treating immunocompromised patients should be proactively advising their patients what they need to do, when, and where to get the treatments they need. Patients should not have to call around to find a source for Paxlovid, a medication to treat immunocompromised patients with COVID symptoms; it has to be administered in the first few days after symptoms appear.
  • If new variants emerge which evade Paxlovid and Evusheld, and replacement medications are developed, Health Canada should act promptly to approve them. Health Canada does not run tests on these medications; they just review the existing evidence, usually the same evidence that the FDA has reviewed. Vulnerable immunocompromised patients should not have to wait for months for Health Canada to approve what the FDA has already approved.
  • Try a Charter challenge. It’s a matter of social justice.

September 30, 2022

No funeral

A friend of mine lost her brother recently. I knew the family and wanted to read the obituary, but I couldn’t find one. My friend told me that her brother’s children decided to have no funeral and no obituary; they just posted a message to their Facebook friends. Funerals and obituaries, they explained, are going out of style. It took me a little while to get used to the idea of funerals and obituaries being a matter of styles and trends. I still see plenty of obituaries and notices of funerals you can even watch on Zoom. But this all got me wondering: what’s a funeral for? Do you want one?

It’s easy enough to understand why many people would want a funeral. If you have a religious affiliation, it’s an important rite. It supports and formalizes the mourning process. It’s also a way to maintain and strengthen the fabric of your family and community, and an opportunity to celebrate a life and say goodbye. Funerals tend to be highly ritualized and rife with platitudes. Every mean-spirited sourpuss suddenly becomes a beloved family member and a pillar of the community. All the mourners tell the survivors that they are sorry for their loss, and want them to find comfort knowing that the deceased has gone to a better place. So funerals can be a mixed bag, but family members and friends still often feel a strong religious, social or cultural motivation to attend.

But times have changed. Many of us live far from where we grew up and away from family and old friends. Now that people live longer, we often outlive our friends and relatives. These days lots of seniors stay single all their lives, and have no children. We may not have a religious affiliation, and don’t want an expensive ritual that we consider meaningless. Some seniors might be loners who have had a bumpy ride through life, with few good relationships, and just don’t want to give those so-and-sos one last chance to sneer at them.

It’s a kind of balancing act, between our last wishes and our survivors’ current ones. Of course, whatever we decide, we have to make sure our survivors know what we want. But in the end, if they don’t follow our wishes, well, we won’t be there to complain.

August 30, 2022

The inner lives of seniors

You don’t need me to tell you: aging is a challenge. Most of us have our work cut out for us, trying to stay fit and maintain a healthy diet, dealing with loss of strength and energy, chronic disorders, pain, memory loss, new changes to adjust to all the time. And then, every so often, memories, images and thoughts bubble up, some with strong, uncomfortable feelings in tow: unfinished business.

Not many of us have the skills, tools and insights for dealing with unfinished business. But I’ve come across an extraordinary book to help us along the journey. Written by Dr Connie Zweig, a Jungian-oriented psychotherapist, The Inner Work of Age explores the unconscious inner obstacles that block our capacity to fulfill the extraordinary possibilities of late life, and offers the tools – shadow work, spiritual practices from many traditions – to overcome those obstacles. She presents a broad range of ideas, interviews and practices pointing to the inner work that we need to undertake for ourselves, our families and our communities. Zweig advocates for a combination of inner work and social justice work to resolve critical issues of our time as well, including global population aging, family caregiving, service and legacy, the cancer epidemic, climate change and political activism. She calls upon us to renew ourselves emotionally and spiritually, to live fully as elders filled with vitality and purpose.

The path is not quick or easy. This is not a how-to book dashed off by some get-rich-quickster. It takes courage, honesty and sustained effort. For those of us who have not spent much time exploring our emotional or spiritual sides, it may feel strange at first. But what a gift awaits us: freeing ourselves of lifelong obstacles, and finally developing into our authentic selves, by doing the inner work of old age.

July 29, 2022

Journaling

When we were young, journaling used to be called keeping a diary. Did you have one? Mine was a five-year diary, bound in fake leather, with a lock and key to keep it away from prying eyes. I poured everything into that diary: family life, school, friends, and all the bumps and scrapes along the path to growing up. Who would have guessed that now, more than sixty years later, journaling has been rediscovered as a powerful tool for our aging brains?

Journaling can just be a fun pastime, but it can also offer real benefits to seniors. For example:

  • Improving memory. You can use your journal to record and preserve events and activities, and refer back to them later.
  • Providing stress relief. Writing about your thoughts and feelings can help you sort them out.
  • Creating a routine. Journaling is a pleasant, relaxing activity you can enjoy on a regular basis.
  • Strengthening cognitive skills. You can use journaling to research topics of interest to you, build and synthesize evidence, and articulate what you’ve learned and decided.

Should you use pen and paper, or word processing software? Lots of seniors are comfortable with the pleasant, slower rhythm of handwriting, and a notebook they can carry anywhere. If you have trouble using your hands, you might find keyboarding easier. If you are using journaling to record memories, you might prefer to use word processing software, because then everything is easily searchable. Word processing software might also work better if you’re using journaling to strengthen cognitive skills, because it’s easier to edit and reorganize your content. Choose what’s right for you. There really aren’t many rules for journaling. I would suggest just one: keep it private. You don’t want to have to consider what anyone else would think about what you write. This is strictly for you.

June 29, 2022

Middle old age

Everyone ages differently, so I’m only speaking for myself here. I’m 76 now, and all those creeping age-related changes seem to have joined forces and given me a different self and a different life. I think and act very differently than I did even just a few years ago. It feels as if I’ve entered a new stage in aging: middle old age.

My late sixties were really the glory years. Retired on a pension, in pretty good health, I finally felt free to do just as I pleased and enjoy myself. It was a marvellous time of life. What I didn’t realize is that it’s a stage, young old age, and that it lasts for only a few short years.

But then, bit by bit, or sometimes suddenly, health issues begin to crowd in. I keep trying to compensate with more fitness, a healthier diet, good preventive care, and those things all help. But I can’t get over how much work it is, how much energy it takes to look after myself now. Chronic pain and chronic fatigue rule my life. They tell me how long I can sit, stand and walk, and are unforgiving if I don’t obey, so now I’m mostly housebound. It’s frustrating having to pay so much attention to my body; I’d certainly rather think about other things, and try my best to do so. But middle old age imposes limitations that cannot be denied.

My friends are going through middle old age too, and it’s a different path for each of them. Of course we all want to support one another, but figuring out how best to do it is a minefield. Health issues loom large in all our lives now, so we need to talk about them, but we don’t want to give in to endless whining. None of us are doctors, so although we would like the comfort of knowing that others share our experience, it’s not especially helpful to assume that your aches and pains are just like mine, so here are the exercises and herbal supplements that worked for me, why don’t you try them? Neither is it helpful to view this situation as a contest, the winner being the poor sod with the worst health. Some people reverse this ploy: one so-called friend keeps reminding me triumphantly that I’m worse off than she is.

I think one of the hardest challenges is managing a friendship with someone who is suffering from worsening memory loss. There’s still a warm connection, and we keep our conversation light, but so many of our shared memories and experiences have simply been wiped out.

I struggled for a while to come up with something upbeat to end this post. But then I decided that in this new stage of life, aging has become a formidable force and deserves more than cheery platitudes. So I’ll just say that middle old age is what it is. It’s my new life now, and I have to play the cards I’ve been dealt.

May 29, 2022

Seniors in Adland

Have you ever looked closely at pictures of seniors in ads? They look a lot like us regular human seniors, but actually they’re a different species, living on a different planet, called Adland. Here’s how to identify this species:

  • The men all have a full head of hair
  • Almost nobody wears glasses
  • Their skin is marvellously smooth, with just a few decorative wrinkles around the eyes and neck, and no age spots
  • They all come in couples
  • They’re slim and trim, with no batwing arms or pot bellies
  • Nobody uses a cane or walker
  • They live in modern, spacious homes, with sunlight pouring in through the windows
  • They use their notebook computers while curled up on the couch, and their tough, pain-free backs don’t mind a bit
  • They wear stylish casual clothes in mostly pale colours: white, beige or pastels
  • They like to hike and jog and ride bikes
  • They hold hands a lot
  • They hang out in multiethnic groups

Wouldn’t you like to live in Adland? You’d never get old!