Are We Ready?

Are We Ready?

Ok, so I am 3 years from being 30, and all I can think about is “In 3 years my body, without any of my control, will began to automatically decrease in function”.  When I think of aging I view it as a gift.  It seems as if my generation is beginning to die earlier and earlier; some are barely making it to see the age of 30.  My thoughts about aging are both exciting and nervous about many things.  I was sitting here thinking how I smoked for a couple of years and how that will affect my future.  How many problems smoking will cause me in the future?  From the outside looking in I feel that the biggest impact on how we age is based on the individual. 

Environment



As a child we have no control over what kind of environment we are raised in (i.e. poverty, wealth); but when we come of age to make our own decisions, we can choose to be in an environment that is less stressful.  Sometimes our environment affects our cognitive, emotional, physical, and behavioral well-being.  Sometimes our environment will cause us to make decisions we would not make if we had other options available to us. Interviewing someone close to my family I seen the difference and freedom that she had vs. some of the individuals in a SNF.  She is living on her own, but she could not help to say how it was nothing like having your own and not having to depend on anyone for anything.  She needs help with some things but for the most part she enjoys trying to get things accomplished herself.  In her words “I enjoy taking care of what belongs to me”.  In my opinion, her living on her own gives her that feeling of accomplishment and pride, nothing taken from her, she is able to enjoy the “fruits of her labor”!

"Age is an issue of mind over matter. If you don't mind, it doesn't matter."

-- Mark Twain

Normal Aging

This is inevitable.  There is nothing that we can do in preventing this.  Some people have trouble accepting that aging comes with factors that cannot be prevented.  Sagging skin, decrease in melanin, loss of moisture, changes in texture and color, changes in visual and auditory acuity, slowed mobility, and decline in strength (Occupational Therapy with Elders). But in my opinion, “You are what you eat”. Foods that are consumed can have a great impact on your body and how you may feel. Talking with my grandmother, her only wish is to die with dignity and to be loved just as much as she loved.  She feels that aging is part of life.  We are all on a timeline and within that timeline you are given, you must complete all that you set out to achieve, and then age to sit and ponder what you have done.

 "Those who think they have no time for bodily exercise will sooner or later have to find time for illness." Edward Stanley (1826-1893)

At the end of the day, we will all have to face this gift.  What will matter the most is if you will be prepared to handle it?  My aging process is being decided now even before I hit 30 because all decisions made in my life impacts my aging process.

We cannot direct the wind, but we can adjust the sails.

One of my idols once said, "If you don't like the road you're walking, start paving another one!"

"Find out who you are and do it on purpose."
~Dolly Parton

All my life I've heard that once you turn 30 it's all a downhill slide until you die. I never believed that, especially since after I turned 30 I still felt like a 23 year old. Our text book, Occupational Therapy with Elders, confirmed what people have been saying, and states, " ...it is estimated that organ systems gradually lose function and efficiency at a rate of 1% per year after age 30." So turning is the kiss of death right? Nah!!!! Knowing that things start to decline at age 30 means that as we age we have to learn how to age healthfully. That means that if you don't like the road you're walking, you start paving another one!

According to researchers at Tulane University, some of aging healthfully is in our genes, but most comes from the proper balance of diet, exercise, social activity, and productive pursuits. I've really come to believe this through my observations at various fieldwork sites. The healthiest aging adults that I see are active and social, despite any physical or medical limitations they face. Unfortunately, I also see adults who are perfectly capable of physical and social activities who limit themselves to their rooms all day. Those are the people that seem to age the quickest. With that said, I hope that during my time as an OTA and beyond I can help educate people on how to obtain that balance in life and age healthfully. Afterall, "We cannot direct the wind (genes), but we can adjust the sails (diet, exercise, etc)."

I Already Wear Purple...

I have enjoyed greatly the second blooming...suddenly you find-at the age of 50 , say-that a whole new life has opened before you. ~ Agatha Christie

 When I am an old woman I shall wear purple
With a red hat that doesn't go, and doesn't suit me,
And I shall spend my pension
on brandy and summer gloves
And satin sandals,
and say we've no money for butter.
I shall sit down on the pavement when I am tired,
And gobble up samples in shops and press alarm bells,
And run my stick along the public railings,
And make up for the sobriety of my youth.
I shall go out in my slippers in the rain
And pick the flowers in other people's gardens,
And learn to spit.
You can wear terrible shirts and grow more fat,
And eat three pounds of sausages at a go,
Or only bread and pickle for a week,
And hoard pens and pencils and beer mats
and things in boxes.
But now we must have clothes that keep us dry,
And pay our rent and not swear in the street,
And set a good example for the children.
We will have friends to dinner and read the papers.
But maybe I ought to practise a little now?
So people who know me
are not too shocked and surprised,
When suddenly I am old
and start to wear purple!

Jenny Joseph

                                                                                 Forgive me for borrowing so many wonderful words from two very wise women, but I am merely 40 and still wondering what to do with getting old. The above poem sounds about right. Even though I do wear purple on occasion, I am never tempted to wear an accessory that does not match. This, I think, is a good suggestion. Can I accept the fact that what other people think of me is none of my business? Or will I have the privilege of growing old enough to realize that no one is thinking about me in the first place? How liberating to purposely clash.
Personally I am excited to live a long life, mostly in part because I am such a late bloomer.  Great things are ahead I just know it--the real good stuff is yet to come! I am guessing this based not on my intentions of living an extraordinary life from here on out, but on the hope given to me by my parents and others in their generation whose paths I have crossed. It seems to me that it is their attitudes about life--how they think and feel about themselves, what they think and feel about others--that stave off what could otherwise be a mighty bleak existence.
Perhaps this sounds preposterous, as if someone could hold back age-related diseases with positive thinking! There are certain things in life we are just powerless over, right? From what I'm being told, growing old is impacted by many different factors--that not one can be the most influential. If I had to choose though, I would say that it is psychological factors which play the biggest part in how a person ages--at least in as much as they can control their thought processes. People who have an honest desire to live in the solution instead of in the problem--yes that means optimistic people--have a head start I think when it comes to good self-care and having the ability to take right action. Does that mean those cup half empty folks are doomed to a lonely, painful time of aging? No--because anyone can change--have an awakening--turn over a new leaf. But make haste people! If life is a process and we run ourselves into a corner, how long do we have to make things right? If I sprint into the jungle for 20 years can I expect to turn around and walk out in four?
I think how we feel about ourselves and whether we cherish life in general plays the biggest part in our aging process because yes...bad things do happen. The road throws twist and turns our way--and our attitude helps determine how we handle that--to a certain extent. The rest of it is we are powerless over anyway.
So remember...practice makes perfect. I guess I'd better start mix-matching my clothes now, so no one will later be surprised that my socks and hat clash so loudly, that I've kept my expectations low and my acceptance high, and that I'm happy to be too old to drive properly.   

Earthsuit Care Instructions

You’ve probably already heard this philosophy on life.

"Life should NOT be a journey to the grave
with the intention of arriving safely in an attractive
and well preserved body, but rather to skid in sideways,
chocolate in one hand, martini in the other, body thoroughly used up, totally worn out and screaming WOO HOO what a ride!"

I couldn’t find the name of the author of the above philosophy, but he/she makes me laugh.  They talk about enjoying life instead of preserving the “earthsuit” where earthsuit is a euphemism for the human body.  (BTW, I couldn’t find the originator of the word “earthsuit” either, but I’m making a mental note to use the term more frequently because I think it’s funny, and I believe that a person is more than the sum total of their exterior appearance.)

At age 50 my thoughts on my aging are simple: it’s happening to me whether I like it or not, and the only alternative that I know of is death.  Every day there’s another wrinkle or gray hair.  Our youth-oriented culture tells me that it’s not good, and that I ought to send my “earthsuit” to the cleaners.  (Thus the first picture to this blog.)

It seems easy to respond to this blog by saying that people who take care of their earthsuit, i.e., eat right, exercise, avoid excess alcohol and nicotine, are going to age more slowly.  Isn’t that a given?  Doesn’t everybody know this by now?  Do we still need to blog about it? 

But then I take a look at the 2010 National Vital Statistic Report from the CDC http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf , and I see the same old story.  The leading causes of death are heart disease, malignant neoplasms, chronic lower respiratory diseases, CVA, accidents, Alzheimers, Diabetes and Nephritis.  Most of the diseases just mentioned (and the premature aging that accompanies them) are preventable. 

I found a good article called The State of Aging in America on the CDC website, see  http://www.cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf .  It talks about 15 indicators that determine whether or not a person can expect to “grow old gracefully,” i.e., to experience “healthy” aging.  The following are indicators the CDC has determined to be factors of unhealthy aging:

1.    The number of sick days taken per month

2.    the amount of mental distress experienced

3.    tooth loss

4.    the limitation of activity due to a disability

5.    a decrease in physical activity

6.    insufficient intake of fruits and vegetables

7.    obesity

8.    smoking

9.    lack of flu vaccine

10. lack of pneumonia vaccine

11. irregular/nonexistent mammograms

12. irregular/nonexistent colon cancer screening

13. lack of utilization of all available preventative screening

14. lack of cholesterol screening

15. having a hip fracture

If the rate of aging is dependent on lifestyle choices, why aren’t we as a nation doing something about it?  Did the patients that I see now, totally “blow off” the Surgeon General’s initiatives? 

See http://www.surgeongeneral.gov/initiatives/index.html

In my opinion the patients that we see now, have heard of, and believe, the Surgeon General’s recommendations for improved health.  Why, then, don’t they follow these recommendations?  I suspect that these lifestyle changes, while simple in theory, are very difficult to implement.  These changes require modifications to a person’s habits/routines and that’s easier said than done.

While aging can’t be halted, it can be slowed.  Our patients, with OTA encouragement and instruction, can take measures to slow the aging process.  They can maintain a physically active lifestyle.  They can extend the life of their earthsuit AND enjoy the ride.

How we Age

I think that there are many factors that impact how we age. But I feel that lifestyle choices are one of the main factors.  There are many people who eat bad, drink, smoke, have high blood pressure, and high cholesterol. But there are also people that take care of their bodies and are in the best shape of their lives, even in their 70’s... According to the CDC, “About 60 million adults, or 30% of the adult population, are now obese.”(Centers for Disease Control). I realize that this is easier for some than others but if we just all tried to eat better and exercise more I feel that it would affect how we age. We would feel younger and be much, much healthier. 

I now introduce Dr. Life. Dr Jeffrey Life is a physician who decided to change his life around the age of 60. He is now in his 70’s and looks like a body building 20 year old. To read more about Dr. Life and his story please click here

I also would like to introduce Ernestine Shepherd. She is a 75 year old personal trainer, model, and body builder who holds a Guinness Book world record for the oldest performing female body builder. To read more about Ernestine please click here

My point in showing these 2 amazing people is that most of us are able to make lifestyle changes that can have enormous positive affects on how we age. I would love to be in the shape that Dr. Life is in when I am in my 70's. So...I guess that I'll start by laying off the Twinkies.




Source:

Centers for Disease Control. (n.d.). Facts about obesity in the United States. Retrieved from http://www.cdc.gov/pdf/facts_about_obesity_in_the_united_states.pdf

No More Anxiety

NO MORE ANXIETY

Anxiety……. I was anxious going in because you just never know what to expect.  You get the chart and you see all these diagnosis and the only thing you think is “What am I going to do?”  You want to say it will be just fine, but reality of the situation is even if you know the diagnosis, each patient is completely different.  Actually seeing the patient in person vs. reading a chart was the most interesting part of the day.  I was expecting a patient far more worse than what I read in the chart.  I think that my session with my patient was interesting, because it tested my flexibility and how well I do with being able to upgrade and downgrade activities.  I was very comfortable with introducing myself and building a rapport with the patient. I feel as though my visual and verbal reinforcement took time but I could see the results that repetition creates. What I struggle with is the confidence in knowing that I am making the right decisions and being client centered during therapy.  My favorite part of the day was actually seeing my client eventually being able to perform 1-2 step instructions without needing reinforcement.  Today I have learned that I have more patience than I give myself credit for. After staying up all night trying to plan an activity, I meet my client and realize that everything that I planned was useless.  I took me just taking simple things in the environment to meet the expectations of my session, which was to follow 1-2 step instructions in order to perform basic ADL’s. So my expectations may have not been met based on his chart alone, but it was certainly met, based on the person he was this particular day. I take from this experience that each day is a new day, that being flexible will get you a long way in this career.





Reflection

This week was a good week. It was nice getting to know my pt even though she is not going to be the same one that I will see next week b/c she is at a lower level. I felt that I approached my pt in a professional and respectful way. I introduced myself and asked her if I could sit down and talk to her for a little bit. She accepted my offer and it was interesting to get to chat with her and establish rapport. I really enjoyed talking to her and learning so many interesting things about her. We talked about her kids, grand-kids, and great grand-kids, how she liked to bake, where she was from, and much more. During our conversation I noticed that her call button was hanging down off the bed so I asked her what she would do if she needed help. She responded that she would push the button. I placed the call button at her side and had her demonstrate how she would do it for me.

One thing that I learned about myself and something that I clinically need to work on is my observation skills. I need to do a better job of looking through my OT goggles and really observing my pt’s and what they are doing. I felt that when it came time to do my documentation that there were a few things that could have been documented that I didn’t document because I didn’t think about them at the time. This is something that I will definitely be working on.

My favorite part of the session was just getting to know my client. It’s amazing what can be learned just my sitting down and chatting with someone. I feel like I could sit down and make a long list of things that I learned just by talking to this pt for a mere 20 minutes. This population loves to tell stories!!

If someone were to read this particular clients chart they probably would have a relatively good understanding of how she would be. The way I pictured her physically, after reading her chart, was pretty much how she actually was, but her cognition seemed to be intact. She answered my questions and was able to elaborate on her answers. This was a pleasant surprise and hopefully she enjoyed talking to me as much as I enjoyed talking to her!!

It's all in the approach!

As we already know,  treatment sessions may not go as planned.  Somewhere in between the high traffic of  the CNA, OT and OTS,  I was able to get to know my client a little better.  I learned a lot about her interest and current goals.  When I walked into DB's room she was asleep.  I was very nervous to wake her up, but I had to use my assertiveness.  She actually woke up and was willing to talk to me,  I guess because I was a new face.  I need to continue working on my assertiveness and also my confidence in my OT knowledge, to become more at ease and comfortable.  

My favorite part of the day's session was how well I got along with DB.  The chart doesn't describe DB accurately.  Also, the OT and PT informed me that she had behaviors and was often unwilling to participate in therapy.  May be because the activity we did wasn't very physically demanding but DB had no problem with participating. She was actually laughing and telling jokes.  Go figure!  It must be true when Ms. Marcus said "It's all in the approach".  I was pleasantly surprised by her personality and I look forward to working with her. I would also like to think that she looks forward to working with me because before I left she made sure I wrote my name down on her calender for next Tuesday and Thursday.

My expectations weren't met (thankfully!)

This week, while on fieldwork, I needed to reach into my OTAS bag of tricks.  (Luckily, the bag wasn’t empty.)  The professional skill that I pulled out of the bag (and the skill that I think I used best) was establishing a therapeutic rapport.  I quickly connected with my client and discovered the number of children she had, the number of great-grandchildren, what her diagnoses were, etc.  Although I had an extensive list of questions I wanted to ask, I let her set the tone and speed of the conversation.  When she said that she would soon be moving to an Assisted Living Facility I asked her “How do you feel about that?” instead of “That’s great!”  or “That’s terrible.”  Asking her for her feelings is something I learned to do in OTA-180.  

While reaching into my bag, I didn’t look for assertion, and I should have.  That skill would have come in handy when I asked my client whether she wanted to go play trivial pursuit in the Cabana Room.  The game started at 2, and I asked her at 1:53.  She and I were having a good time getting to know one another, and she didn’t want to leave.  Miss Marcus stopped by at 1:55 to see whether my client was going.  I told her “No.”  Miss Marcus then asked my client “Why don’t you go to trivial pursuit?  It’ll be good for you to get out of your room.”  The client then changed her mind.  Maybe, my client needed to be asked twice or maybe the request had to come from a supervisor as opposed to a student.  Either way, when Miss Marcus asked, the client complied.  I believe I need to be more assertive (maybe adopt the “manner of speech” or “tone of voice” that Miss Marcus used) when I ask the client to do something.

On the way to the Cabana Room my client saw 2 of her friends and the receptionist.  She spoke to all of them.  Plus, once in the room, she saw another friend of hers, and they talked a bit.  Socially speaking, my client hit the “mother load” on the way to the game and getting out of her room was a great way to prevent depression and boredom.  This incident helped me to learn that I readily take the client’s first response as the answer to my requests.  Perhaps, sometimes, I need to ask the question more than once and more assertively the second time.  This might increase my client’s compliance rates and improve their overall mental health.

My favorite part of the fieldwork was getting to know my client.  That was my favorite part about fieldwork last semester, too.  I like discovering things about their lives:  where they are from, how many children they had, what kind of work they used to do.  I especially like listening to their medical history to see whether I’ve heard of their diagnoses before and, if they bring up any surgeries or medications, I like to know see whether I’ve heard of them before.

Thinking back on the turn of events, I also like the fact that she got so much social interaction on the way to the activity room.  This further supported last semester’s claim that group activities were good for a client’s mental health. 

When I think about the image in my mind of my future client and the actual image I had after meeting my client, there was a bit of a discrepancy.  I had read in the chart about my client needing Mod A to sit up in bed.  That made me think that she was very weak and frail, and I was a little bit intimidated.  I didn’t want to break any bones in the transfers!  But when I actually met my client she was much “hardier” looking than my mental image.  I was pleasantly surprised.  She was able to stay balanced and seated in her w/c and her limbs did not look frail.  I worried that she would have a foley that I’d have to carry and was relieved when I didn’t see one.  I am pretty sure that I could have dealt with it, but it was nice to know that I didn’t have to hold onto it and push the w/c at the same time.

Overall, meeting and interacting with my client was much easier than I had anticipated.  I hope that future interactions go as smoothly.  I just have to remember to not take "no" for an answer when it comes to social activities.  :-)

Don't Judge A Patient By Their Chart

     The morning of our first fieldwork treatment session I was surprised to realize that I was a lot more excited than nervous.  After all--this is what I WANT to DO with myself. What a sense of purpose going to this week's  session gave me! Once I arrived and actually met my patient, I felt invigorated. It was amazing. I felt as though I'd lucked out too for she truly was a pleasant person to work with. This particular patient was very willing to try all of the activities I had planned for the session--even when she struggled a bit--she still gave it her all. I really appreciated and admired that about her.
     This session gave me the opportunity to use some clinical skills when I needed to modify a crayon so it could be held by the patient, whose wrist was in a cast. I used PVC pipe, cloth, and tape to make it more like a large marker which was a bit easier to work with. Professionally I presented myself well but had some blank spots where I was thinking of what to do next. I'm not comfortable with the silence this can cause and I think I need to work on the flow of the session more.One thing I learned was that I CAN do this! It was a definite confidence booster for me and I'm grateful to have gotten off to a good start. My favorite part of the session was when I told my patient that I had seen her room and that it was lovely. She smiled so big and looked at me as if she were really happy--it was at this moment that we connected and that felt fantastic.                                                       
      Before I met her, my patient was just words on a page as we were allowed to each do a chart review on our patients in preparation for seeing them. Before I even met her, I had made some presumptions about my patient based on her diagnosis. I did this I think so I would feel prepared for anything but I won't make this mistake again. During the 35 minutes I spent with her, my patient behaved in the opposite manner I would have expected. I was quick to realize this and it was a great lesson in assumption prior to investigation.

Great expectations....

On previous Fieldwork sites OT supervisors have told me to formulate a Plan A and a Plan B before working with a client, and then when you walk into their room, throw those plans out the window. This week absolutely personified that belief when I worked with my client (D.W.) for the first time! After reading through his chart, and all his ailments, I was expecting D.W. to be much more sickly than he actually was.

I had prepared for the day by making a "bag of tricks" that I filled with arts and crafts supplies and card games. I knocked on D.W.'s door and introduced myself, he invited me to pull up his wheelchair, and then we chatted for a while about his family, time in the Army, career, and interests. The chat was comfortable and like talking with a family member that I hadn't seen in a while. 

 

I then brought out my bag of tricks and offered D.W. the option to play some of the games I had brought.......not interested. Then I brought out some of the art supplies I had, and offered him the option to make a card for his wife, or other family members that he hadn't seen in a while.......not interested.  I then explained to D.W. that I would be working with him twice a week and helping him meet his goals for O.T. and asked him if there was something he was interested in doing that he's not able to do while he's at Rose Manor. Nope. This conversation continued for quite a while, until I realized that the extent of the day's session was going to be limited to learning about D.W. and his history.

 

I then broke out the SET Test and explained to D.W. that I was going to be asking some questions. He answered the questions as best he could, and but also told me that he hadn't slept well the previous night because his roommate played his t.v. all night long. His charted stated that he was "likely demented" so it was important to me that I assess this during our session. I then assured D.W. that it was alright if we didn't do anything this week, and I understood that he was tired, but I also told him  beginning next week we WOULD be working to meet his therapy goals.    

 

So while I didn't get D.W. into an activity I feel good about my flexibility, listening skills, and my empathy skills. I also feel like I was persistent, but I need to work on forced choice or, for lack of better words, eliminating choice. Perhaps if I would told D.W. "I'm going to take you to the therapy room" or something like that, I would have been more successful.  I think I was afraid of ruining any chance of building rapport if I was too forceful. However, when I broke out the SET Test and told him that I wanted him to answer the questions, he complied. This was probably my favorite part of the session because I felt that I made progress, and it showed me that if I eliminate the option to decline, the client is more apt to comply.

I have a game plan set for Tuesday....here's hoping I don't have to throw it out the window.