Thursday, August 30, 2018

An Emotional Playbook for Couples in Retirement

Credit: Adobe Stock
6 tips to navigate a time of life that brings so many changes

By
Joan Fischer

We’d only been retired for a few weeks when the questions started coming.

“How’re you doing with so much time together?” we heard from friends, both the still-working and the long-retired alike, their voices knit with concern.

I was a little puzzled. My husband and I had been married for nearly 35 years and got along just fine. What mysteries could possibly await us?

Yet apparently we’d stumbled onto new ground in Elder Country, where each couple must blaze their own trail. We met one pair who can’t get enough of each other, traversing the country in the close quarters of an RV and spending months at a time volunteering at national parks, often living in remote sites with no TV, cell or Wi-Fi.

And on the other end of the spectrum, we met a couple who’d agreed to more or less ignore each other until 5 p.m. on weekdays, mimicking the schedule they’d kept during their working lives. This was not done with any hostility; it was simply a pattern of interaction that worked for them.

Where would we fit in?

As time went on, I realized that our concerned friends had a point: Retired couples do need to hash things out.

The stakes are high. While nearly 80 million boomers are retiring at a rate of some 10,000 per day, according to the
Social Security Administration and other sources — the divorce rate of older Americans is also rising. Among people ages 65 and older, divorces have roughly tripled since 1990. At least some of that discontent is caused by problems that surface in retirement.

Couples in Retirement: Preparing for the Next Stage

“Due to our heightened expectations of marriage and also to our healthier life spans, most people are no longer willing to stay in a boring marriage ‘until death do us part,’” noted sociologist Stephanie Coontz, director of research at the Austin, Texas-based Council on Contemporary Families.

But even if divorce is not on the menu, couples need to prepare — beyond finances and health care — for a life stage that brings so many changes. Most of us don’t blithely stumble into marriage or childbirth, perhaps because those transitions carry so many obvious red flags. Retirement, on the other hand, seems like 100 percent ease, a hard-earned gift of time. In spite of that, couples need an “emotional playbook,” said Miriam Goodman, author of
Too Much Togetherness: Surviving Retirement as a Couple.

Navigating the Challenges, Enjoying the Experience

Luckily for all of us, a number of sociologists and other experts have weighed in on marital harmony in retirement. Here are six key pieces of advice:

Communicate clearly “It’s not you, it’s me.” If one of you needs more alone time, make sure your partner understands it’s a part of your nature, rather than a rejection of his or her company. Presumably, your spouse knows a bit about your temperament after so many years together, but a whopping 40 hours a week of newly freed time can be a wake-up call to each partner’s needs and plans. A need for “more space” can be addressed quite literally by designating separate rooms for each partner as mostly his or hers, if possible.

Cultivate separate hobbies and friendships “Couples should focus on building their individual social lives to avoid becoming too dependent on each other or spending too much time together,” advised sociologist Rob Pascale, co-author (with Louis H. Primavera and Rip Roach) of
The Retirement Maze: What You Should Know Before and After You Retire. “In addition to maintaining and strengthening existing friendships, retirees can consider joining clubs and organizations so they have opportunities for developing new independent relationships.”

Spend time with others as a couple “People report the happiest feelings when they socialize with their partner and other adults, not just with the partner,” said Coontz. “And a whole lot of studies show that having friends beyond your family or spouse as you age is an extremely important contribution to people’s mental and physical well-being. It’s a protective factor on the same order as keeping physically fit and not smoking.”

Understand that retirement brings different challenges for men and women By most accounts, men have the tougher time. Many women have moved in and out of the workforce while raising children, and, culturally, have been encouraged to place a higher value on close friendships. They’ve also been assigned more of the day-to-day domestic activities that await the retiree.

The emphasis of men’s role as providers first and foremost, spending less time cultivating friendships and managing the home, leaves many men more at a loss when the workweek vanishes. That, in turn, can become a problem for women who find their husbands suddenly underfoot.

Couples can kill two birds with one stone by: a) agreeing that each partner will pursue new activities and friendships and b) negotiating an equal division of domestic chores, even if the woman had done the lion’s share while both partners worked.

Partners who both work should retire at the same time, if possible “Researchers have found that when spouses retire together, the marriage is seldom affected by their joint decision; good marriages will stay good and bad marriages bad. But problems can occur when only half of a two-income couple retires,” said Pascale.

By retiring together, partners avoid such issues as changes in the dynamics of the relationship —only one person “bringing home the bacon,” for example, can cause problems — or interference with the retired partner’s ability to participate in certain types of activities or social events. Retiring together also provides each partner with some emotional support as they try to adjust to their new living arrangements, Pascale noted.

Allow yourselves time to adjust “Be patient with each other,” said Goodman. It takes time and experimentation to find a groove. Maybe one partner will decide to take a part-time job or a significant volunteering commitment that feels like a job, while the other is happy with less structure.

It is sobering to recognize that retirement represents our last years of life, our time to finally do whatever we wish — health and resources permitting. That freedom is a tremendous gift; one that, with good communication and understanding, couples can make the most of together.

Thursday, August 23, 2018

9 Signs You Should Fire Your Doctor

By Hilary Thompson



Credit: Adobe Stock

Your doctors help with so much more than just your health. They impact your pain management, your health care experience, your quality of life and even how long you are able to live it. Because they are such a powerful force in your life, it is crucial that you hold them to a high standard.

And physicians like Dr. Neel Anand, professor of orthopedic surgery and director of spine trauma at Cedars-Sinai Medical Center in Los Angeles, couldn’t agree more.

“When you keep expectations high, you find better providers and you also more often hold yourself accountable to following their prescribed treatments because you inherently trust in them,” he says. That’s a win-win for you and the doctor.

Here are nine warning signs that it might be time to find a new doctor:

1. You don’t feel heard. Your doctor should listen — really listen — to all of your concerns. If you want to discuss your heart disease risks and your family’s cancer history and all your doctor wants to talk about is your hearing, there is a major disconnect that may not be bridgeable.

Anand says: “If you’ve waited a long time to see this person and they provide you five minutes of time, most of which is spent staring at the chart… it’s best to go with the doctor who puts down the chart and actively listens to what’s going on with you. You’ll both be better for it.” Dr. Edward Hallowella New York City psychiatrist, adds that if a doctor cuts you off or frequently prevents you from sharing the whole story, it’s time to find a new one.

2. You have a serious personality conflict. How do you trust a doctor who you can’t bring yourself to like? Dr. Peter LePort, bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, Calif., says personality is pretty important.

“I’m not talking about the [doctor’s] qualifications or outcomes. Those are very important factors, but what I’m talking about has to do with how you feel about the [doctor] you are considering,” he says. Concerns about the physician’s dedication to you as a patient, your ability to trust him or her, he says, may be on the warm and fuzzy side, but it’s equally important as the doctor’s skills and outcomes.

Would you want someone you can’t stand operating on you or making major medical decisions for you, despite the fact this person may be talented? For some, this is a deal-breaker.

3. Your doctor is too stretched to serve you. He or she may be the best doctor in the world, but if you can’t get in for an appointment within a reasonable time or the physician has way too many patients to make you a priority, you may need to seek someone who is more conscious of your needs.

Of course, much of this depends on how populated your area is and how many doctors there are. A recent report can tell you what the practitioner-to-patient ratio is in your state. For instance, Hawaii has a nurse shortage and Idaho has a physician shortage. If you live in a state with shortages, you might look for a new medical practice in your area with a shorter list of patients who won’t be overbooked yet.

4. Your doctor’s approach is not healing you. Sometimes you need a second opinion if treatment doesn’t seem to be working. But research shows that you should venture outside your doctor’s practice to get an unbiased opinion. You may want to do so for no other reason than to give you the confidence that you’re going in the right direction.

5. Your doctor doesn’t educate you. These days, some medical answers are one Google search query away. But there are disadvantages to getting your information this way, including the potential for poor-quality or biased sources. Hopefully your doctor is a reliable source for all the information you need, so you don’t feel compelled to seek more information elsewhere. You should be educated completely about your medications, conditions and treatment options.

6. You can’t be honest with your doctor. Your doctor needs all the information you can possibly provide to make decisions about your care. LePort notes, “When you know you can talk to your doctor, you’re more likely to keep your appointments, follow his or her advice and implement suggestions for making adjustments that are right for you.”

Hallowell agrees and underscores the importance of trusting your doctor. He says you should be able to tell your physician things you wouldn’t even tell your best friend. If you are unable to, he says it “may be cause for ending the relationship.”

7. Your doctor is too aggressive. Be careful how quickly your doctor moves to extreme treatment options. Anand says that, in medicine, you should seek a doctor who is both conservative and a little aggressive. For instance, if you go to see a doctor about your back pain and he or she immediately wants to schedule surgery, that should be a huge red flag.

“What you really want is someone who will assess your condition over some period of time, trying the least invasive and disruptive approaches to managing your back pain first. But you also want him or her to stay on top of it, too. That’s where the aggressive part comes in,” he said. That being said, Anand maintains that your doctor needs to make adjustments quickly if things are not working.

8. Your doctor refuses to coordinate with your other specialists. Care coordination is crucial, especially with your primary care physician (PCP). But all your doctors should be communicating at some level. Most often, a PCP acts as the “hub” of information, especially in complicated cases. A study done of patients in 11 different countries found that roughly 5 percent of patients reported their care coordination as “poor.” If your doctor won’t communicate with your other doctors about your care, it might be time to find a new one, especially if this physician is  your PCP.

9. You feel bullied. If your doctor is pressuring you to undergo a treatment or take a medication you’re not comfortable with, or isn’t open to second opinions, this is not a good sign. There are usually at least a couple of treatment options your doctor should be discussing with you. According to the Patient Advocate Foundation, “Statistics show that over one-third of adults in the United States will never seek a second opinion and almost one-tenth of newly diagnosed patients rarely or never understand their diagnosis.”

Hallowell says a doctor who doesn’t answer all your questions, doesn’t return phone calls, speaks condescendingly or keeps you in the dark is not well-suited to you.

 

© Next Avenue - 2018. All rights reserved.

Thursday, August 16, 2018

Try Tai Chi for Balance and Fall Prevention

Villa Gardens Residents Practice Tai Chi
By Debbie L. Miller

Patricia Bethke Bing, 75, a retired community organizer in Knoxville, Tenn., has been practicing Tai chi for approximately 20 years. She practices three days a week, for 40 minutes, with a group of people around her age.

“I decided to do Tai chi for the health benefits, both mental and physical. I have no specific health issues, but I was looking to keep my good health and improve my leg strength,” said Bing. “Tai chi practice helps me to maintain my good balance, strength, and flexibility.”

Tai chi, also known as Tai chi chuan, is a Chinese martial art performed with slow, controlled postures and movements. Enthusiasts practice it for defense or health, or both.

Tai Chi Is Helpful for Balance

Recently, several studies have addressed the benefits of Tai chi for older adults. A 2014 analysis of research on Tai chi and balance, “Improvement of balance control and flexibility in the elderly Tai Chi Chuan (TCC) practitioners” in the Archives of Gerontology and Geriatrics concluded that “TCC practice was beneficial to improve the balance control ability and flexibility of older adults, which may be the reason for preventing falls.”

Peter M. Wayne, associate professor of medicine, Harvard Medical School, and director of research at the Osher Center for Integrative Medicine at Brigham and Women’s Hospital and Harvard Medical School, has been studying the health effects of Tai chi for 18 years and practicing it for 40.


“Across multiple studies, Tai chi appears to reduce risk of falling by 20 to 45 percent and is considered one of the best exercises available for ambulatory older adults with balance concerns,” Wayne explained.

Falling: A Serious Risk for Older Adults

Falls are the leading cause of accidental death among people age 65 and older. “In an effort to find ways to prevent falls among older adults, researchers have been investigating specific exercises, like Tai chi, that target both the physical and cognitive fundamentals of mobility,” said Brad Manor, director of Mobility and Brain Function Lab at the Institute for Aging Research at Hebrew Senior Life and assistant professor of medicine at Harvard Medical School.


Credit: Michael Miller
“We and others have shown that regular Tai chi practice aids the muscular system, movement coordination, balance, and even higher-level cognitive skills such as complex reaction time and problem solving,” Manor said, “which together enable us to move throughout our environment and complete our daily activities safely without falling.”

Many factors work together to prevent falling, including balance and stability. “Unfortunately, even falls that don’t result in injury or death often have a very real and significant negative impact on quality of life,” Manor said. The result? A cycle of fear and risk of future falls. “These falls often lead to fear of falling, reduced physical activity, depression and lack of social engagement — all of which, in turn, increase the risk of suffering another fall.”

Biomechanics (how we measure and control our movement, how it changes with age and how movement relates to balance) is an important factor in the balance/fall equation.

“Our balance control system is incredibly complex and, with aging, there is a decline in sensory and muscle function,” Manor said. Tai chi helps with the ability to maintain balance, especially when we’re doing more than one thing at the same time (dual tasking), a skill which also decreases as we age.

Research Confirms the Benefits of Tai Chi

The National Center for Complementary and Integrative Health (NCCIH), part of the government’s National Institutes of Health, summarized the benefits of Tai chi and concluded that “Practicing tai chi may help to improve balance and stability in older people.”

At Beacon Hill, a residential living community in Lombard, Ill., one of the residents leads an hour-long Tai chi class two days a week. “During the class, residents, who are between 62 and 93 years of age, sit or stand, depending on what feels most comfortable,” said Marc H. Raben, director of lifestyle at Beacon Hill.

Tai chi’s benefits go beyond the physical. “It is highly spiritual and also helps with focusing and calming the mind, as well as with balance,” Raben added. Several studies have shown tai chi to be helpful for those suffering from depression, hypertension, arthritis and fibromyalgia.

“Tai chi helps me mentally, as one must concentrate on the moves and the sequence in order to get the full benefit,” Bing explained. “I find the practice calming and centering, and it helps me emotionally. Tai chi is a pause from daily stresses and a safe comfortable place to be quiet.”


© Next Avenue - 2018. All rights reserved.

Wednesday, August 8, 2018

Can age be “just a number?” I’d say no.

by Ashton Applewhite, reposted with permission from ThisChairRocks 
 

The phrase has always made me uneasy, partly because it’s usually accompanied by a picture of an older person doing something considered “age-inappropriate,” like wearing a wacky outfit or doing something acrobatic. The bigger issue is that it trivializes something important. Age is indeed “only a number,” as long as that number reflects how many times we’ve circled the sun. Age is real. Age differences can’t be wished away, nor should they be.

Needless to say, it’s complicated, just like the discourse around telling people how old you are. It’s important to claim your age, and just as important to push back: to ask what difference the number makes in the questioner’s mind, and why? The longer we live, after all, the more different from one another we become. That makes chronological age an ever-less-reliable indicator of what a person is capable of or interested in, so it makes a certain sense to decline to identify with it. That’s one reason so many octogenarians maintain, truthfully, that they still feel fifty, forty, or even thirty inside—that “age is just a number.”

The other reason they feel that way is internalized ageism: the belief that younger = better and that their older selves have less value than their younger selves. That’s why fudging or disavowing our age is so problematic. It gives the number more power than it deserves. It distances us from our peers. And it reinforces ageist thinking, by implying that our years are something to be ashamed rather than proud of, and suggesting that capacities might erode or relationships founder if the number came to light.

People can be far apart in years and have plenty in common, as we realize the minute we bust out of age silos. That’s why I loved an article by Gina Pell called
Meet the Perennials—her witty proposal for what those of us who refuse to be constrained by generational moats start calling ourselves. “It’s time we chose our own category based on shared values and passions and break out of the faux constructs behind an age-based system of classification,” she writes. “We are ever-blooming, relevant people of all ages who live in the present time, know what’s happening in the world, stay current with technology, and have friends of all ages.” My people!

So what’s not to like? The article’s tired tagline: “age ain’t nothing but a number.” (This may well have been an editor’s handiwork, not Pell’s.) It’s the age-based version of “post-racial.” It’s happy talk, papering over the very real differences between being younger and older. It’s important to acknowledge those differences because it’s part of what makes relationships authentic. Because the differences are interesting. Because the exchange of skills and stories across generations is the natural order of things.

Those differences aren’t what stand between us and age equity. The obstacle is ageism—the age segregation that cuts us off from most of humanity and the prejudice that justifies it. As Pell writes, “Tolerance feels unattainable when there are hard lines drawn between decades, and terms like Boomers, GenX, and GenY keep us separate and at odds.”

 If we’re going to dismantle ageism, we’re going to have to collaborate across those artificial “generation gaps.” Gerontologist Jenny Sasser, whose
Gero-punk Manifesto ought to be required reading for all Perennials, describes this beautifully:

The revolution around dismantling ageism can’t happen unless we can create cross-generational coalitions, which can’t happen if we can’t meet each other in the middle across age difference and become friends. Not despite age differences, but across them—because we are both similar and different, because we are all traveling through the life course at the same time but are at different phases of the journey. We need to ask better questions about when age and generation differences matter, and when they don’t. And help each other develop a keener critical capacity for seeing through the socially constructed ideas and structures that keep us in conflict rather than in cooperation. 

Hold this in our heads and it’s far easier to reject young vs. old ways of thinking, to make friends of all ages, and to find common cause. Pitting the generations against each other is one of the major tactics used by the wealthy and powerful to divide those who might otherwise unite against them in pursuit of a fairer world for all. It’s like pitting groups of low-wage workers against each other, or the interests of stay-at-home moms against women in the paid workforce. The underlying issue is a living wage for all, and redress requires collective action. When issues are instead framed as zero-sum—more for “them” means less for “us”—it’s harder to see that the public good is at stake and the issue affects everyone. The objective, in the words of historian David Hackett Fischer, is to create a world “in which the deep eternal differences between age and youth are recognized and respected without being organized into a system of social inequality.” That social order has to work for all ages, and we Perennials and Gero-punks need to roll up our sleeves and help shape it.


Author and activist Ashton Applewhite is the author of This Chair Rocks: A Manifesto Against Ageism. In 2016, she joined PBS site Next Avenue’s annual list of 50 Influencers in Aging as their Influencer of the Year. She has been recognized by the New York Times, National Public Radio, and the American Society on Aging as an expert on ageism. Ashton blogs at This Chair Rocks and is the voice of Yo, Is This Ageist? She has written for Harper’s, Playboy, the New York Times, and many other publications, and speaks widely, at venues that have ranged from universities and community centers to the TED mainstage and the United Nations. Ageism is emerging as a pressing human rights and social justice issue, and Ashton has become a leading spokesperson for a movement to mobilize against it.