Sleep Patterns and Aging

Jeannette Franks, PhD

 

It will come as no surprise to anyone over 60 that sleep changes with age and it does not change for the better. There is a reason why some people can ‘sleep like a baby’. It’s because they are babies!

According to a recent article in The American Family Physician journal, “Up to 40 percent of older adults have insomnia, with trouble falling asleep, early awakening, or feeling tired on awakening (Feb. 14, 2013 Vol 87, No 4).”

While individual sleep needs vary, we know how we feel if we don’t get enough sleep. There’s a reason why intentional sleep deprivation is considered a form of torture. Insufficient sleep affects mood, ability to think, and possibly even the immune system.

One concept that can be useful is the notion of ‘sleep hygiene’. Here are some sleep tips from the US Center for Diseases Control (CDC) as well as a few of my own recommendations:

• Go to bed at the same time each night and rise at the same time each morning.

 

• Make sure your bedroom is a quiet, dark, and relaxing environment, which is neither too hot nor too cold.
• Make sure your bed is comfortable and use it only for intimacy and sleeping, rather than other activities, such as reading, watching TV, or listening to music. Ban the laptop, TV, and smartphone from the bedroom.
• Exercise may help promote sleep, but not within a few hours of bedtime.
• Avoid large meals and alcohol before bedtime.
• Avoid caffeine after mid-day.

Sleep disruptions can be associated with dementia in the elderly. Sometimes the sleep/wake cycle is completely out of whack and the person sleeps all day and wants to wander at night. In the right environment, this is fine. As long as it doesn’t disturb others, there’s no reason why someone can’t be awake all night and asleep all day.

A recent report at the annual regional Alzheimer’s Conference found that not getting sufficient sleep (7 to 8 hours) is a predictor of dementia. It may be a chicken/egg situation, but I’ll do almost anything to get the minimum of 7 hours sleep.

Another large study reported at the April 7 day-long conference was that those who performed cardio exercise for 30 to 40 minutes 5 times a week had a lower incidence of dementia compared to a control group who were told to stretch.

Sleep medications can be harmful, especially in older people. Consult your physician and limit their use to no more than once a week, otherwise there can be a rebound effect where without the drugs, insomnia worsens.

Sleep medications can have negative effects such as problems thinking, negative interactions with other medications, and increased risk of falls and fractures. If at all possible, a long walk in the great outdoors is one of the best possible remedies.

My father’s Alzheimer’s

Facing my father’s possible legacy of dementia

Jeannette Franks, PhD

When there is dementia in the family, it strikes fear into the adult children as they age. Every time a key is misplaced or the fridge is opened with the question, “what was I looking for?” it’s terrifying to think, “Has it started? Is it happening to me?”

Fortunately there are many factors that predict Alzheimer’s and genetic heritage is one of the least indicative. One of the strongest predictors of Alzheimer’s disease is low level of education www.nytimes.com/2012/01/22/education/edlife/a-sharper-mind-middle-age-and-beyond.html. Those with a low level of education also happen to be many of the people who voted for Trump.

The other major commonality of those diagnosed with dementia is age over 90.

First, to clarify, dementia is an umbrella term for any type of brain dysfunction. It could be Parkinson’s, it could be malnutrition, it could be alcoholism or a host of other maladies. It is now thought that everyone with Parkinson’s will ultimately get Lewy Bodies, a brain malfunction that manifests itself much like Alzheimer’s but appears differently in brain imaging.

Often brain dysfunction is directly correlated with cardio-vascular health. Indeed there are recent studies that indicate that vigorous exercise 5 times a week predicts a significantly lower incidence of Alzheimer’s. Now there’s a good reason to go to the gym! Or run! Or Zumba! Or whatever can get you working hard physically and you will do it consistently.

Healthy habits, such as good nutrition, moderate use of alcohol, and not smoking all are associated with a lower risk of Alzheimer’s. Adequate sleep and mental stimulation are also important.

Being bi-lingual, singing or playing a musical instrument seriously, and life-long learning are also predicative of a lower rate of Alzheimer’s. A recent study by Lisa Feldman Barrett of Northwestern University suggests that whether the effort is physical or mental, what helps the brain is “to work hard at something.”

Let’s all get to work in the new year. This planet needs it!

 

When I first started working professionally with older people (in the early 80s) I had few, if any preconceptions. Older people are just like anyone else; they’d just lived longer. For the most part this is true.

But, horrifyingly, there is a significantly higher percentage of older people who are victims of scams and scalawags. Why? For one thing there is the rising rate of dementia as we age. Long before clear symptoms emerge, judgment and decision-making falter. Ronald Reagan is often cited as an example.

Adult children of frail parents can be the worst culprits—they know where the gold is. Often the primary asset is the home. Keep a close eye on the executor of the will, usually an adult child. It may be prudent to have the will designate a professional fiduciary as executor, rather than a son or daughter.

While older people are actually less often subject to violent crime, those who are 65 and up may be more often targeted for financial crime. Indeed According to the Bureau of Justice Statistics (BJS), the National Crime Victim Statistics (NCVS) reveals that, from 1994 to 2005, violent crime rates declined, reaching the lowest levels ever recorded. Property crimes continue to decline as well.

But that email from Nigeria that no one takes seriously. Someone is believing it and it may be your mom. I’ve seen enough evidence firsthand that increased safeguards and watchdogs may be prudent as a person ages.

What specifically can you do? Grandma has right to spend her money however she likes. But she will not like being swindled. Have a serious difficult discussion with all family, grandma included.

One suggestion is a joint bank account. Especially since we all have easy access to statements via on-line banking, if your family member agrees, you can share any account, or even just get permission to use the login and password to keep an eye on things. But don’t forget crime happens within friends and family as well as from strangers.

I knew one man who had contributed a large amount to a joint account with his father, who was in financial need. One day it was all gone and he never got it back!

Another safeguard could be a trusted financial professional such as a CPA, tax accountant, banker, fiduciary, or advisor that has access to all information and participates in a mutual agreement to watch on a regular basis for any odd withdrawals. Again, this could backfire.

Banks are hesitant to interfere and there are some ethical and legal obligations not to question clients’ decisions. I knew a woman in her 90s who gave away tens of thousands of dollars to phone scams. When her nephews found out she had squandered over $50,000 in less than a year, they initiated guardianship and put her in a nursing home, where she subsisted for almost a year of a dreadful life.

Guardianship is an expensive and humiliating process and only to be used as an absolute last resort.

But really really bad things happen and it is prudent to ponder what can best be done to prevent disaster while still respecting autonomy and choice.

                                                Sex and the Single Senior

Most of us prefer the buddy system. Whatever our age, having a partner is usually preferable to going solo, although partnering is not mandatory for a high quality of life whatever your age.

The statistical probability of one partner dying before the other is obvious. And divorce happens at any age. Therefore it is likely that an older person will at some point be in a new relationship and that may lead to a monogamous commitment.

Hazards are huge. Rather than entering into a partnership or marriage as an unencumbered 20 something, older people often have houses, adult children, grandchildren, and a host of burdens and assets.

Adult children are often aghast at the notion of mom or dad remarrying. No one can replace a parent. Of course not.

But we are all entitled to love, affection, intimacy, and relationships, whatever our age. We not talking about who gets mom’s pearls, although that can be an issue. Often the accumulations of a lifetime and the assets of a family are intricately involved in a late-life marriage.

From homes and bank accounts, to tchotchkes and teapots, get a pre-nuptial agreement.  It’s the only way that your grown-up kids might bless your marriage. Have frank discussions with your prospective spouse and your family. This might also be a good tome to review and document your end-of-life preferences.

On the topic of sex over 60, I refer you, dear reader, to famous gerontologist Robert Butler. He co-authored The New Love and Sex After Sixty with Myrna Lewis. Physical affection is a life-long human need and they have great advice to keep the home fires burning.

Also, keep in mind that STDs can also occur at any age. Sometimes older people, especially those that spent most of their adulthood in the same monogamous relationship, may not be aware of the dangers of not using condoms. They make a great insert to a birthday or Valentine’s Day card!

August 2016 Birthdays usually remind us to take our aging seriously. I just reached 68. While it is now often said that 70 is the new 50, 50 is the new 30, silver is the new blond, etc., the domina…

Source: Lying about birthdays is for sissies

August 2016

Birthdays usually remind us to take our aging seriously. I just reached 68. While it is now often said that 70 is the new 50, 50 is the new 30, silver is the new blond, etc., the dominant US culture often marginalizes people as we age, particularly women.

Ashton Applewhite, in her new book This Chair Rocks: A Manifesto Against Ageism, points out that “You look great for your age.” is an insult. Any of us can look great at any age. Rather than being mean, biased, ageist, and insulting, just say, “You look great.”

So much of what Applewhite says is so well put, that rather than quote her extensively, I urge you to get her book.

An insight that I received about aging at the beginning of my gerontological career is that there is a point in our lives where we feel like ourselves, regardless of age. Our identity stays steady over the decades. Revered gerontological social worker Wendy Lustbader wrote a poignant tale about a 90-something woman in her book, Counting on Kindness.

When the woman agreed to let Wendy visit and be her social worker, the woman held up a photograph, perhaps a prom picture, of a lovely young woman in a gorgeous red dress. She said something like “I want you to remember that this is who I am.” The next time Wendy visited, she looked deeply at the woman and remembered her in the red dress. The woman sensed it immediately and said, “You know who I am.” I am paraphrasing, but the scenario has stayed with me over the years.

Often staff in health care settings, retirement communities, and especially nursing homes see a frail, compromised elderly person who may have trouble communicating. It can be so hard to learn who the person really is. Staff are often rushed and it can be emotionally exhausting to recognize every single person for who he or she is. But it’s crucial to good care and good relationships. In fact many experts posit that good relationships are the key to good care.

Some gems from another of Lustbaders’ books, What’s Worth Knowing:

• “A good listener is someone who’s not talking.” Harold Jones, age 76.
• “Retirement is a ridiculous idea.” Ben Rail, age 92.
• “When in doubt, try the truth.” Martha Eastman, age 80.
• “Don’t hide your age.” Henry Horton, age 90.
• “All that matters in the end is that you are loved.” Edna Whitman Chittick, age 101.
• “Doing good gets you out of bed in the morning.” Grace Stanchfield, age 96. I had the great fortune to get to know Grace well. She lived in an assisted living community where I took a group of UW Medical School graduate students every year. She was always ready to help, to interact with students, or to do any kindness.

While I prefer to support independent booksellers, I also endorse every type of brick and mortar bookstore. It’s important to me to buy a real book in a real store. Even though I do have stock in Amazon. It’s generous of a big chain to carry a small local book, so please do stop in the Silverdale Barnes and Noble. Also, request Ashton Appleton’s new book: This Chair Rocks. She’s awesome!

    How can a community best support aging in place and why should we? The why is easy: few people want to spend the last year of their life in a nursing home. Not only that, but as the boomers age, the economy won’t be able to support a huge increase in the long-term care population, whether publicly funded or private pay. The costs are gigantic.

   According to the 2010 US Census, those in the age group of 85 to 94 are the fastest growing age group in the US. That age group is the most likely to need long-term care.

   Several concepts can maximize options for aging in place. One is the village concept. Check out http://www.vtvnetwork.org . If you are on or near Bainbridge Island, you might want to look at http://bivillage.org . Portland, Oregon has 9 villages; Seattle has 3.

   Another aspect of aging well and aging in place is understanding ageism. Don’t miss Ashton Applewhite in Seattle Sept. 18. 2016, at Cornish Playhouse in Seattle. I can hardly wait to get my copy of This Chair Rocks: A Manifesto Against Ageism. ashton@thischairrocks.com

   Negative attitudes and stereotypes about aging and older people are a huge barrier. Even older people themselves sometimes assume that they will decline dramatically both physically and mentally. While we do experience challenges in old age, exercise, engagement, and education can mitigate the changes. Don’t let negative assumptions become self-fulfilling prophecies!

 

NY Times today covered a new retirement community specifically for those of Indian-American origin (as in from India).

Culturally-specific and age-segregated communities have been around for decades, although this appears to be the first for Indian-Americans. These communities can be a nice fit for those who prefer them and can afford the price.

On Loc in San Francisco in the 60s was one of the first programs. Young activists were horrified to see the single men who had come west without families, to build the railways and the shipping industries, being forced into nursing homes. Through grassroots organizing they created the first comprehensive eldercare community, and while not always as culturally specific, there are similar models nationwide.

I spoke recently at Nikkei Horizons in Seattle, predominantly Japanese, but inclusive of many ethnicities. The food was outstanding!

Seattle also has a Norse Home, a German Home, a predominantly African American home, a kosher/orthodox retirement community, a Spanish-speaking nursing home and health care organization, and one that is Chinese. California has some highly regarded retirement communities for musicians, actors, and those in the film industry. And of course there are those that are specifically GLBT.

My county, Kitsap, has a Continuing Care Retirement Community (CCRC) that is clearly white, rich, and Christian. They don’t even allow wine at meals!

I advocate ‘finding your best fit’, which for my partner and me is clearly age-integrated, multi-ethnic, and at least somewhat affordable. The important criteria for us is to be in an accessible home where we can walk to the store, clinic, dentist, restaurants, pub, and 3 museums. Plus we are close to health care, friends, and family.

My community is currently organizing BI Village, where I hope services such as home care can be negotiated with great economy of scale and reliability. If you want to come to a living room talk, call me at 206-755-8461.

Bainbridge Island Library, March 26, 3 pm, “7 Actions to Take to Stay out of a Nursing Home”

“End-of-life Issues”, BI Senior and Community Center, Sat. April 16, call 842-1616 for more information

Bremerton at “The Pearl” April 2 10 am, “7 Actions to Take to Stay out of a Nursing Home”

my email is jfranks1@comcast.net