The shape of memory changes for many people in later life. If our typical old person has one real complaint about his own mental functioning, it is likely to concern his memory for recent events. A word, a name or a fact, just doesn’t come to mind when he wants it. What happened in the distant past is likely to be clear and precise in his mind. He can accurately recall events that occurred 60 or 70 years ago, but may draw a blank for what happened a week ago last Monday.

The picture is even more complex than this. The research shows that another type of memory also must be distinguished (i.e. recall for immediate events). The old person in good health does not appear to suffer any particular problems in this regard. He can remember what has just happened, can remember very well what happened decades ago, but has difficulty with the time in between long ago and a moment ago.

No single principle of mental health can guarantee that a person will pass through the challenges and perils of a long life without experiencing distress, loss, suffering, and human error that are part of most lives. However, it is within our abilities to reduce the depth and frequency of suffering and to help each other when our own resources are temporarily overrun.

In old age, distress can be more acute since immediate problems bring to mind earlier difficulties. The old person may be haunted by memories of stressful events and relationships as far back as early childhood. Tormented by both past and present, they may feel helpless. At the same time, there may be fewer resources available to cope with problems in the immediate situation, fewer people to share experiences with, less physical and financial control over the environment and so on.

Life review is an examination of one’s total life experiences as we enter that period we tend to call old age. It’s a time to set what is known as “our house in order.”

The outcome of an older person’s life review is by no means guaranteed. Like all of the other ways of using the past, it can have either favorable or unfavorable consequences. If the elderly person is hard on himself, he views his life as a string of failures and missed opportunities. He may dwell on his shortcomings as a child, a spouse, or a parent and perhaps brand himself guilty of some obscure transgression that has not been forgiven. At the same time he may feel powerless to make amends and face the prospect ahead with trepidation and dread.

There is another common change in us as we grow older: we slow down. This change is probably most obvious in our physical activity. But it is part of our mental life as well. Psychomotor speed, as psychologists often call it, is required by many activities. This is the pace at which we carry out all steps of an action, from sizing up the situation, figuring out what we want to do about it, and finally doing it.

Activities and tests that place a premium upon speed often show the old person at a marked disadvantage. He does however perform as well as younger people. But does performance in those circumstances reflect intelligence? When activities or mental tests are designed so that speed is not a significant factor, then the difference between old and young becomes much slighter. The old person reveals his ability to learn, think, remember and solve problems when not being rushed and when allowed to proceed at his own pace.

Do you often ask yourself what gives your skilled nursing facility its identity or what makes it stand out amongst competitors? If your patients, residents, and staff come to mind, you’re on the right track. But, now what?

Your facility is a story unfolding across all customer touch points.

In spite of language losses suffered by an individual with Alzheimer’s, many skills that support communication are remarkably preserved and remain for a long time. When working with the AD individual, the caregiver should keep in mind six abilities that are nearly always preserved.

1) The Use of Procedural Memories
Individuals with AD begin to lose memory for words, information and events quite rapidly, but procedural memory, or the knowledge of how to perform familiar tasks remain relatively intact until the later stages of dementia. The research suggests that this is because procedural memory is the most elemental of human memory systems and is the only memory system capable of operating independently. This system can sustain some very complex human activity such as walking, washing hands, or even driving a car. Procedural memory is like a computer program whereas other types of memory are like data stored in the computer. Alzheimer patients begin to lose data rapidly but still function. They may forget where they are going, but they still know how to walk. They may forget what they are saying, but they still know how to talk.

• The look on the face of the five-year-old as he boards a school bus for the first time and the look of apprehension on the face of his mother.
• The last lingering touches of two lovers who cannot bear to let each other go.
• The moment when one must board that jet and fly off to a new life elsewhere.
• The apprehension that this could be the last time they shall see each other and that chill of final separation.

The following is an excerpt of a discussion I had several years ago with the daughter of a man (her father) who had recently passed away.

“The last time I saw my father I guess I knew it might be the last time. We talked a little about this and that…nothing important. It was as if we both had agreed to keep it that way because we both knew, and we knew that we knew.

Definition: Perspective “a view of things (as events) in their true relationship or relative importance” (The Merriam Webster Dictionary)

Some years ago I had a conversation with a resident in a facility where I was the head of the Nursing department. She was close to her 100th birthday. I asked her what she made of her life in general. She promptly replied: “Can’t tell yet! I am still making my life!”

A person who appears demented may be tormented by grief and anxiety. His demented behavior may have been brought about by emotional pain. A grieving person at any age is less able to pay close attention to everything that happens around him. He takes less care in grooming and dress. He has less emotional energy to welcome new opportunities or to respond to challenges. He feels uncomfortable with his body. His mind may be constantly uneasy or tortured.

Loss and grief are common in old age as death removes loved ones. An old person may have suffered other significant losses, of occupation, residence, physical mobility, belonging, or usefulness – all of which produce a grief response.

Without question, working in long term care is demanding and stressful. In addition to the intrinsic stressors staff must face daily in nursing homes, often they must also struggle with managers who add to the stress. It takes only one thoughtless supervisor to create a work environment that goes from bad to worse in an instant.

Unfortunately, there are managers and supervisors in long term care who may lack self-awareness or the desire to evolve into better leaders. They may intentionally create “power distances” between themselves and their employees. This distance may also signal that they may be unapproachable.

Def: Muse - to become absorbed in thought - Merriam Webster Dict.

For more than fifty years I’ve cared for countless sick elderly and disabled individuals in my capacity as a Registered Professional Nurse.

“You’re looking pretty tonight.” Her eyes warm to the compliment. Automatically she checks her hair, newly washed and cut. Even after all these years she is still slightly nervous. But a date is still a date even when you are seventy-and-more. For his part, any tentative feelings are covered with pride and pleasure at being seen out with such a fine woman – much as he felt fifty years and more ago.

“Shall we go?”

Far too often, labeling a person as ‘senile’ is a thoughtless expression steeped in prejudice. ‘Diagnosing’ a person as ‘senile’ is accurate only when we mean there is a continuing pattern of progressively deteriorating thought and behavior coupled with a medically proven diagnosis of an irreversible brain disease. Careless use of this single word (senile/senility) suggests that we think we know what is wrong and there is nothing more to understand or to be done. This attitude is not justified even when the person is, in fact, suffering some form of a progressive cerebral change. But the attitude is particularly destructive when the individual is troubled, yet far from ‘senile’.

Even professionals are capable of making such errors. International mental health teams and researchers in the field of gerontology who have been studying this problem have discovered that many elderly persons who were labeled with the term senile/dementia have come to realize that the problem is, in fact, functional in nature. If this can happen, then people without professional or scientific training may be even more prone to error. Any sign of confusion or mental lapse in an elderly person may be erroneously taken as ‘proof’ of senility.

Definition: keen-minded – “mentally alert” – (Merriam-Webster Dictionary)

Why are some elderly people more keen-minded than others? In youth and middle age some people are more mentally alert and vigorous than others. Keen-mindedness tends to be habit forming: a combination of fortunate genetic endowment and a lifestyle that keeps the intellect well honed.

Despite the obstacles, love can triumph for the old as well as for the young. The importance of a sustained love relationship in old age is hard to overestimate. Sex brings more than direct physical gratification, although this by itself is not to be slighted. It also reaffirms each partner’s identity as a person who can offer something worthwhile, and who can be someone worthwhile to another person. The body is still a means of giving and receiving pleasure.

But there is another important function of sexual intimacy in old age. The old person is all too often ‘typecast’ to the outside world. He is the secondary character, belonging on the fringe of the real action.
We tend to remain at an emotional distance from him. Every day we walk past, almost through old people on the street, without clearly registering their existence as individuals.

Several decades ago two prominent psychologists wondered whether giving institutionalized elderly people a tiny amount of control over something in their lives would have a positive influence on their personalities.

What they did was to give a house plant to each resident in a nursing home. Half of the residents were told that the plants would be cared for by the nursing staff. The other half were told that they were responsible for the care of the plants. They were to decide when to water the plant and how much sun it should have. At the beginning of the study, the two groups were similar in physical and mental vigor. Three weeks later, there was no difference in the health of the plants, but there was a lot of difference in the psychological adjustment of the residents who were put in charge of caring for their plants. The group given personal responsibility rated themselves as more alert, active and vigorous.

A grim choice confronts some people when they face problems associated with advancing age.  Do they have to accept insecurity and deprivation? Must they surrender much of their independence and integrity in order to be helped?

Elderly men and women may prefer to go it alone instead of taking advantage of available resources to which they may appear as stubborn and unrealistic.  But they many feel life would no longer be worthwhile if they were to become too dependent on others for their needs.

Our society will continue to insist on using chronological age for many purposes. We can live with this practice if we recognize that to set up a chronological checkpoint for calling a person ‘old’ is simply a matter of administrative or statistical convenience. It is an unfortunate usage but difficult to avoid. We can, as a society, minimize the negative impact of this practice by making a clear distinction in our own minds between chronological age and the individual’s actual physical, mental and social situation. We can also refuse to be swept along by the implicit relationship between chronological age and human value. ‘Ten years older’ does not mean ‘ten years worse’ or ‘ten years less valuable.’

            Age-grading emphasizes society’s interest; functional age emphasizes the direct facts about the individual.

Lately, I’ve been giving a lot of thought to our profession, post-acute and aging services, and began to wonder if anything we do matters.

With all the challenges from regulators, attorneys, payers, and the press, why do we do it? Not WHAT we do, or even HOW we do it, but WHY? Simon Sinek wrote an entire book on the topic, entitled, Start with Why, and spoke on it in a widely viewed TED Talk several years ago (use this link to view the original “Start with WHY” talk https://www.youtube.com/watch?v=IPYeCltXpxw).

“I feel like a mushroom.  They keep me in the dark, so I keep them in the dark.”

A key member of a leadership team muttered these powerful words when we conducted an organizational assessment for his company.  This is what happens when organizations fail to create a culture that embraces open communication.

Consider how damaging it is when an influential member of your leadership team withholds information.  From you. From staff. From residents. The negative impact is tremendous.

Creating culture candor.

Organizations that have a strong culture that focuses on communication will outperform those left “in the dark.”  Transparency allows organizations to run more efficiently and effectively.

It starts with sharing information.  Anytime you have an important message to communicate, we suggest doing so in at least five ways.  Some ideas include: