Senior Toronto blog

September 29, 2018

Loneliness in old age

This won’t be news to you: loneliness in old age is rampant. It’s a disease, an epidemic, a tsunami. Just ask Google.

It doesn’t behave like other diseases, though. We don’t go to the doctor and have tests done to get diagnosed. We’re the ones who decide if we’re lonely. We might say we’re lonely if we feel that we’re not connected meaningfully to other people, to the world, to life; that we don’t belong anywhere. We might feel this way even when we’re surrounded by people, if the relationships are not satisfying. And we might not feel this way even when we’re alone; we might be perfectly content with solitude.

The research literature offers some surprises. It turns out that there are two stages in life when loneliness peaks. One is in young adulthood (teens and twenties), the time of life when we’re trying to figure out who we are and what role we will play in the world. That’s a lot of responsibility at a time when we don’t yet have life experience and resilience skills to help us through. The other peak is in old-old age (80+). That’s a time when our social world may be shrinking. We may have lost a spouse or close friends, and health issues may be keeping us at home.

I think there’s a special poignancy to loneliness among seniors. We need all the resilience we’ve built up over the years to deal with those painful losses and our own physical and maybe mental decline. Not everyone has the social skills or the will to make new friends at this point. Those who have had difficulties with relationships all their lives may now need to accept that this is how it will always be. And we may feel shame about our loneliness. We may not want to admit our feelings to others, and risk falling into the stereotype of the lonely old person, and becoming an object of pity.

I’m no therapist, and don’t want to serve up clichés. So I’ll just say that I think we need to become good, honest friends with ourselves in old age. That might involve figuring out just how much interaction we really want now, and what kind. Do we want high social involvement? Then we might look for activities like social clubs, book clubs, or group dining. Maybe we want high involvement, but where the main focus is not social. Then we might choose activities like choirs, fitness classes, sports, or card games. Maybe we want activities that don’t need to involve us very much, like lifelong learning classes. Or maybe we’d like high involvement solo activities, like reading, computer games, hobbies, or crafts. Maybe we don’t want to do any soul-searching, we just want to keep busy. No shame in that. Many seniors are very involved with family or religious activities or volunteer work. It’s pretty easy to fill up our calendar; there are hundreds of options right here at Senior Toronto.

On the wall in my computer room I have a print of Vermeer’s painting, The Lacemaker. A young woman sits bent over her work, bobbins and pins in hand. Her expression is intense, rapt, totally involved, mind, body and soul. The light shines on her face and hands. Behind her there’s just a grey wash, no hint of a background at all. There’s no need; her world is complete as she plies her craft. I love that state of mind and try to seek it out. For me it comes when I’m learning something interesting and feel myself grow in understanding, like when I’m preparing a blogpost or learning a new piece of music. Then I’m fully alive, and it gives me such pleasure, it’s impossible to feel lonely.

August 30, 2018

Carebots

Robots in eldercare: looks like it’s a question of when, not if. Our population is aging rapidly, as we baby boomers reach retirement age. We’re living longer too. There are more seniors in Canada now than younger people, so who will look after us all? The home care and long term care industries, always strapped for resources, are eager to find new ways to cut costs. Much robot technology has already been developed and is being deployed in Japan, where the population is aging even faster than ours, and where the use of robots in eldercare is now supported and promoted by government policy. So there’s probably a robot or two in our future. I hope that it’s not just presented to us as a fait accompli, but that first we have a thoughtful discussion about what the risks and benefits are, and who the robots should serve. How will carebots affect our lives?

Carebots can perform many chores now done by personal support workers in home care and long term care. They can bathe us, feed us, lift us into and out of wheelchairs, mop the floor, do the laundry, fetch and carry objects, dispense pills and more. So they could enable us to stay independent longer in our own homes. In long term care, robots would relieve care staff of some repetitive chores. We might even prefer a robot to a human caregiver for intimate tasks like bathing and dressing. But then we will lose the social interaction with human caregivers. Will we miss it? Interaction with human caregivers is not always positive. Who would you rather have change your diaper, a carebot or a resentful, burnt-out daughter? Who will control what the robots do? Will we seniors be empowered to start and stop the tasks? How would carebots be controlled if we have dementia? If the carebot drops you on the floor, who would be liable?

Carebots can be used as health and safety monitors. They could remind us to take our pills, detect falls, take our vital signs and relay them to medical staff, let staff know when we leave our beds, follow us around the house, and enable virtual visits by healthcare professionals or family members controlling the robot remotely. If family members can visit you virtually from the comfort of their own homes, or assure themselves that the carebot is looking after your safety, will they visit you less in person? What privacy do you have when your every move is being monitored, recorded and reported? Who should have access to all that information? What if carebots, in the interests of our safety and well-being, restrain us from doing what we want to do, like going out for a walk or binging on ice cream?

Finally, carebots can be programmed to provide companionship. They can respond to questions, show facial expressions, play games with us, use spoken words and gestures, and suggest activities. There are fuzzy, cuddly robot animals that wag their tails when they’re petted. If family members know the senior is kept busy and entertained with a carebot, will that give them guilt-free permission to visit less often? Is it deceptive and exploitive to encourage seniors to form relationships with machines? Seniors may be well aware that companion robots are not people, but may not mind if they enjoy the interaction anyway.

Policy about the use of robots in eldercare will ultimately be made by politicians, with heavy lobbying by industry players. I hope they seek input from seniors and seniors’ advocates too. Carebots should serve the needs of seniors first and foremost, not caregivers and investors.

July 29, 2018

Elder wisdom

I’m 72 now, and as my stamina wanes and health issues take their toll, I find myself turning more and more often to nonfiction for guidance. Old age really feels like life on a different planet; you can’t imagine what it’s like until you get here. So I don’t usually pay much attention to what younger people write about old age. That’s mostly about financing your retirement, getting your aging parents safely into care when they get frail, and worrying about seniors bankrupting the healthcare system. Or they fall back on tired old stereotypes: 90-year-old marathon runners, miserable curmudgeons, ditzy old ladies falling for scams. I want guidance from wise, articulate seniors who are travelling this road with me, or younger writers who are listening carefully to them and learning from what they hear. Here are a few books that have helped me. These are not feel-good advice books, and they don’t trade on clichés. They’re honest and hard-hitting, and full of surprises too.

  • Being mortal, by Atul Gawande. A surgeon discusses how to live our last days, what’s important, and what doctors could do better. Doctors need to go beyond the medical facts, listen to the patient’s wishes and guide decisions to meet the patient’s goals. Ask the patient: What do you understand of what is happening to you? What are your fears and hopes? What are your goals if your condition worsens? What trade-offs are you willing to make and not willing to make? Which choice best responds to this? Touching, provocative, and personal.
  • Dancing fish and ammonites, by Penelope Lively. This award-winning British novelist writes a personal memoir at age 80, exploring old age, history, memory, reading and writing, and six items of import in her life. The mind expands while the body declines. For this author, reading is a meaningful part of lived experience. Rich, eloquent, and reflective.
  • Happiness is a choice you make: lessons from a year among the oldest old, by John Leland. This New York Times journalist spent a year interviewing six seniors aged 85 and over, probing how they live and think. Most of them have disabilities and pain, but they don’t define themselves by those things. Freed up from having to build a future, they focus on the present, and make their lives out of what they have to work with now. Written with depth, empathy, and understanding. The experience changed the author’s life.

June 29, 2018

Snake oil

We seniors are major users of natural health products: vitamins, minerals, herbal teas, glucosamine, sleep aids, you name it. On every package, you’ll see an eight-digit Natural Product Number (NPN), which means that the product has been authorized and approved for sale by Health Canada’s Natural and Non-prescription Health Products Directorate. So it’s safe and effective, right?

One of my relatives has chronic lymphocytic leukemia. So he was very interested in some recent clinical trials run at the Mayo Clinic (Phase I and Phase II), which showed promising results using high doses of EGCG, an ingredient found in green tea. He contacted the chief investigator, who told him how to run his own trial. He asked a naturopath to recommend a good brand of green tea capsules, bought some at a local health food store, and started taking them. When blood tests showed no significant effect after a few months, he wanted to make sure he was getting enough EGCG. So he took the capsules to a lab. The label on the bottle claims there are 315 mg of EGCG in each capsule. The lab found 39.8 mg of EGCG per capsule – not even 13% of what they claim on the label, and far too little to have any therapeutic effect.

This is no blip. There is virtually no enforcement of quality control for the manufacture and labelling of natural health products in Canada. Furthermore, Health Canada accepts a very weak level of evidence to qualify a natural health product for approval in the first place. For homeopathic products, for example, anecdotal information will do. A few years ago, the CBC TV show, Marketplace, demonstrated just how low the evidence bar is when they created a fake product, called it Nighton (an anagram of Nothing), said it was meant to treat fevers in children, and submitted their application with a few pages photocopied from a 1903 homeopathy text. Yup, it got approved. When Marketplace presented their findings to Health Canada, Health Canada didn’t even apologize; they claimed they were offering consumers choice. What sort of choice do we have when manufacturers can lie on the label? How can we trust any natural health product, when the industry is free to sell snake oil with Health Canada’s blessing?

As for my relative, now he gets his green tea capsules directly from the scientist in Japan who supplied them to the Mayo Clinic. It’s too early to tell whether green tea will help him, but at least he gets to find out.

May 30, 2018

Elder orphans

Are you an elder orphan? This is what it means:

An elder orphan is a senior who lives alone and has no children or family member or friend who can or is willing to act on his or her behalf in handling health, legal and financial issues.

More and more people are living alone these days. For many of us, it’s a lifestyle choice that we’re comfortable with. But as we age, we come up against healthcare, financial and legal systems that were not designed for us. You’re scheduled for day surgery, and the surgeon tells you someone has to pick you up and stay with you overnight. You break your arm and can’t go home right after surgery because you won’t be able to wash yourself or cook your meals. What if you have a stroke or develop dementia? Who can you appoint to have power of attorney over your care and your financial affairs?

There are no easy answers, but you can at least track down all the services available to you, and use them. Find out which agencies offer senior services in your area. You want one, or maybe more than one, that can provide some social and healthcare support: services like telephone reassurance, escort to medical appointments, case management. This is a messy search. To start with, find your LHIN. Click Seniors and then Seniors’ intervention and assistance services. If you don’t find enough there, try Community support services or Seniors’ centres or Advocacy and social action for seniors. Become a client; get to know the intake people. If you find yourself in hospital unexpectedly and can’t look after yourself while you recuperate, remember that Ontario offers a convalescent care program for those who qualify. You get a short-term stay bed in a long-term care facility. If you think you need this, ask to speak to a social worker at the hospital. Details about this program are remarkably hard to find online. Here’s a brochure from a jurisdiction outside Toronto.

As for powers of attorney, things get even murkier. You used to be able to arrange with a trust company for them to assume power of attorney for your finances, but now the trust companies will do this only for clients whose assets are worth a million dollars or more. There’s no regulated agency you can just call up and hire a professional to be your power of attorney for care or finance. You have to flounder around looking for someone on your own. You’re probably thinking that this field is ripe for exploitation, and you’d be right.

Obviously I have more questions than answers about the issues faced by elder orphans. If anyone reading this has some useful suggestions, please share them with everyone in the comments section. This can’t be the end of the story.

April 29, 2018

City of Toronto’s new website dishonours seniors

In December 2017, the City of Toronto proudly unveiled their revitalized website, designed to be service-focused and citizen-centric, visually appealing, action-oriented and easy to navigate. What a great opportunity to showcase the age-friendly city that Toronto is trying to become! So I was eager to check out the section on Seniors. I was in for a shock.

Feel free to follow me along on the tour. The new homepage, https://www.toronto.ca, has a link called Community & People. That sounds like the place to find Seniors, so let’s click on Community & People. We get a drop-down menu with a grab bag of topics including, among others, Children, Youth & Parenting; Animals & Pets; Health & Wellness; Housing & Shelter; but no Seniors. It took me a little while, but I eventually I found it, tucked away under Housing & Shelter. See it for yourself; it’s all about finding housing, long term care, or home help. One of the Housing links, called Seniors & Disabled, mentions seniors in the title, so let’s take a look at it. More about home support, with just two additional senior-relevant items under Related Information: a falls prevention program that caregivers can sign up for, and a link to the Toronto Seniors’ Forum. Other than that, the City of Toronto sees us as nothing but a housing issue.

It’s hard to believe that this is a city that took the trouble to create a Seniors’ Strategy back in 2013. Using the framework provided by the World Health Organization’s Guide to Global Age-Friendly Cities, they proclaimed some lofty goals, based on equity, inclusion, respect and quality of life. The report covered health, housing, transportation, recreation and community programs, safety and security, accessibility and civic engagement. So where are the links to resources for seniors in these areas? Even the Strategy itself is hidden away under the Toronto Seniors’ Forum. And if you’re lucky enough to stumble on it and click on the Toronto Seniors’ Strategy link, all you get is the decision to adopt the strategy in 2013. What’s happened to it since? Well, there have been progress reports, but there’s no sign of them here. And there are efforts underway to create a new strategy, but there’s no mention of that anywhere either. In any case, regardless of what the Seniors' Strategy may say, it's obvious that word has not gotten out.

It’s pretty discouraging to see the City of Toronto present this narrow, reductive view of seniors to the world in 2018. Many other cities have adopted a much more welcoming, holistic approach on their websites. To see how it’s done, just check out Hamilton or Vancouver or Ottawa or Edmonton or Mississauga or Laval.

I can’t imagine what the Toronto Seniors’ Forum members have been doing with their time, but they might as well stay home. Judging from their website, an age-friendly Toronto couldn’t be farther from anyone’s mind at City Hall.