Impairments = Missed Opportunities

Reduced mobility creates hardships for seniors interacting with the world around them. When one experiences falls, broken hips, broken wrists, lower back pain and or a reduction in or cessation of driving, opportunities for interpersonal communications diminish.

My grandfather developed severe back pain brought on by a crushed disc in his lower back earlier this year. Lower back pain in the elderly is common, as a recent national survey proved that in “patients aged 75 and older…back pain is the third most frequently reported symptom” (Bressler, et. al., 1999). His back pain caused him trouble walking and difficulties rising from chairs, walking up stairs, walking to the phone, and getting in and out of vehicles. Additionally, just a few months prior, he suffered a fall that resulted in a broken wrist. The broken wrist reduced his ability to write and in combination with the loss of mobility from the lower back pain, he experienced a lack of communications with family and friends.

While the impairments in the ability to walk and write do not initially sound related to traditional communication barriers like hearing or vision losses, they have affected my grandfather’s ability to do many things related to interpersonal communication. He is no longer able to walk to the phone fast enough to answer it. When he finally does receive a phone call, he seldom holds the phone for long because of the pain in his wrist. When someone comes to his front door, he seldom makes his way across the house to open the door quickly enough. He no longer writes letters or sends birthday cards to friends and family. These impairments have led him to hire a caregiver to run errands for him, drive him and write out checks for him, though the caregiver’s assistance does not improve his communications with outside family, friends or society.

Further compounding the lack of communication that my grandfather experiences with avoiding calls and not writing, is the fact that he has ceased driving due to the lower back pain. Now that he must rely on the caregiver’s schedule for transportation, it has lessened his opportunities for outings and social interactions. “The older person who reduces or ceases driving bears the brunt of the changes that occur in terms of monetary, social, psychological, and emotional costs” (Burkhart, 2007). Knopp (2009) notes, that “isolation and loneliness experienced by nondriving seniors can result in deteriorated physical and mental health.” Plus, older drivers who generally drive on six outings per week usually reduce outings down to two per week when they become reliant on receiving rides from others (Burkhart, 2007). Hence by discontinuing driving, my grandfather has lost additional opportunities to engage socially with others outside his home.

Sadly, the number of seniors who do not drive is not as uncommon as one might think. “SCOPE, the community planning group, cites national research indicating that about 21 percent of Americans age 65 or older don't drive and that, on any given day, 50 percent are home-bound due to lack of transportation options” (Knopp, 2009).

Falls in the elderly are also not uncommon. Warshaw (2006) reports that “after age 85, over half of women will suffer a fall” while “31 percent in the 80- to 84-year age group” of men experience falls. The complications from falls include fractures of the hip, and forearm [or wrist] (Warshaw, 2006). Earlier this month, the Pope at age 82, fractured his wrist when he fell (B92.net, 2009). A good friend, Marie, who was in her mid-70’s when she fell on pavement broke both her wrist and hip. “Because bones become brittle with age, fractures are common among the elderly” (Joseph, 2008). Interestingly, Warsaw (2006) also points out that “after a few falls, some people become so frightened and anxious that they will not attempt to stand even when there is adequate help and support.” As people become afraid to stand or walk after falls, they are not likely to return to outings that require walking or standing which also decreases their opportunities for interpersonal communications with friends, family and society.

When Marie experienced the impairments of a fractured wrist and broken hip, I witnessed a loss in her interpersonal communications. Like my grandfather’s experience, Marie’s reduced mobility in walking and writing, resulted in her not taking telephone calls, seldom answering the door and the end of her writing to friends and family. Additionally, Marie had been a very social person before her accident and had engaged in many senior group tours overseas and spent much of her time out with friends shopping and dining out. Her reduced mobility led to the end of her overseas vacations as well as her social outings with friends.

When looking at the losses of mobility from back pain, falls, broken wrists and broken hips, compounded with the cessation of driving, it becomes clear that seniors and the elderly lose opportunities for social engagement as mobility is reduced and they become increasingly homebound. Thus, even impairments unrelated to hearing and sight can equal losses in interpersonal communications for seniors and the elderly.

References
Bressler, H., et. al. (1999, Sep., 1). The Prevalence of Low Back Pain in the Elderly: A Systematic Review of the Literature. Lippincott Williams & Wilkins, Inc. Retrieved from: http://journals.lww.com/spinejournal/pages/articleviewer.aspx?year=1999&issue=09010&article=00011&type=abstract

Burkhart, J. (2007, Jan. 30). Mobility Changes: Their Nature, Effects, and Meaning for Elders Who Reduce or Cease Driving. Ecosometrics Incorporated. Retrieved from: http://trb.metapress.com/content/dlk6vw1r15245554/

Joseph, T. (2008, July 28). Colles’ Wrist Fracture. Medicine Plus. Retrieved from: http://www.nlm.nih.gov/medlineplus/ency/article/000002.htm


Knopp, T. (2009, July 12). Nonprofit service helps seniors retain mobility. Herald Tribune. Retrieved from: http://www.heraldtribune.com/article/20090712/COLUMNIST/907121023/2080/OPINION?Title=Nonprofit-service-helps-seniors-retain-mobility.

Pope Falls and Suffers Broken Wrist. (2009, July 17). B92.net. Retrieved from: http://www.b92.net/eng/news/world-article.php?yyyy=2009&mm=07&dd=17&nav_id=60560

Warshaw, G. (2006, Apr. 10). Falls and the Elderly. University of Cincinnati. Netwellnes.org. Retrieved from: http://www.netwellness.org/healthtopics/aging/faq9.cfm

All content © Village Memorial. 2009-2010.

Transitions: Retirement

Retirement is a difficult transition for seniors to adjust to. It is a stage of life in which most aspects of an individual’s life change. Income, social networks, social status, time management and sense of utility or purpose all change (Donovan, 2008). Thus, the transition into retirement requires personal adjustments on multiple levels.

According to retirement coach, Donovan (2008), the five main benefits one obtains through full time work: the paycheck, time management, sense of utility or purpose, status, socialization, are essential to recreate after retirement. “Part of the planning for a vital retirement involves finding replacements for each of these five benefits” (Donovan, 2008). Also affecting the adjustment into retirement life are “activities with friends and family, feelings about rest and tranquility, and activities that fill up free time” (Nussbaum, et. al., 2000, p. 123).

The unique part about retirement as a stage of life is that it lacks the vital elements and expectations that provide fulfillment during the other stages of life. According to Walker (1999):

Youth, adulthood, and old age fit us for the school, the workplace and retirement...But retirement, unlike school and workplace is not a place. It is not an activity like education or work, nor a role defined by the development of skills or exercise of competence, like that of a student or worker. Retirement is defined instead as the cessation of the adult role of worker (p.104).

Retirement is not a destination nor is it an achievement on its own. The cessation of expectations for growing, learning and working into later life can have negative effects on individuals.

As Bartky (1999) explains, “I have seen the effects of professional obsolescence on older men in my profession” (p. 63). When her dissertation adviser retired she says, “he died shortly after” (Bartky, 1999, p. 63).

As seniors transition into retirement, one must consider the “importance of an individual’s social network” (Nussbaum, et. al., 2000, p. 117). The people whom the individual feels close to or comfortable around during his working years are the same people he will wish to spend time with during retirement and this can be a problem “for elderly people, whose close social network may no longer be living” (Nussbaum, et. al., 2000, p. 118). Equally disrupting to the adjustment to retirement is the loss of one’s social network through a post-retirement move. Seniors often choose move to locations that provide a warmer climate, although “the adjustment to retirement is often made easier by the support of families and friends” (Nussbaum, et. al., 2000, p. 123). When one moves to a new community, one loses vital support networks and must build new friendship networks or face isolation (Nussbaum, et. al., 2000, p. 123). As individuals lose friends or acquaintances through retirement, relocation, or death, there is a risk of social isolation if the individual does not find new opportunities to meet people.

For couples, the transition into retirement is additionally complicated. Bloir (2007) describes how the adjustment of retired couples takes time. They will first experience a short honeymoon phase with things running smoothly. However, when reality sets in, the excitement will wane and as Bloir (2007) explains it, “many [couples] find they’re not quite as excited about the prospect of being a senior citizen or ‘stuck’ with each other.” Spouses might feel the other is getting in the way. Such issues are compounded when the retirement was not taken voluntarily. However, as couples take on new tasks, hobbies, and interests, Bloir (2007) insists that “communication is essential.” Bloir (2007) suggests that couples remain open and honest in a loving way, about “ideas, opinions, likes, and dislikes” because, “a few minutes of heated discussion is better than weeks of repressed anger and resentment.” Couples can survive the adjustment into retirement with considerate communication and by engaging in both common and separate interests that help generate a new sense of purpose and meaning.

Activities of leisure can open up new possibilities for interpersonal communication among retired seniors, hence assisting the adjustment to retirement life. Nussbaum, et. al. (2000) explores three activities of leisure that can be completely enriching interpersonal experiences: “television, playing poker, and learning about computers” (p. 119). Television provides individuals with current events to discuss. Poker provides a group environment in which the players can have ample opportunity to interact. “The entire context of the poker environment is social” (Nussbaum, et. al., 2000, p. 119). Computer courses allow additional opportunities for communication as individuals share information and help one another. Computer courses also give individuals a chance to discuss information with others outside their class. As Nussbaum, et. al. (2000) explains, their familiarity with computers gives them “practical skills and conversational skills…[that] can lead to intergenerational relationships” (p. 119). Plus, the improvement of seniors’ abilities in computer literacy can improve social status, allow seniors to “remain connected with their larger social development and to develop new relationships with those who have similar interests” (Nussbaum, et. al., 2000, p. 120). Thus, through activities that on the surface appear quite casual, seniors can find abundant opportunities to improve communications and find fulfillment during their post-working years.

Bartky, S. L. (1999). Unplanned Obsolescence: Some Reflections on Aging. In M. U. Walker (Ed.), Mother Time. Women, Aging, and Ethics. (pp. 61-74). Lanham: Rowman & Littlefield Publishers, Inc.

Bloir, K. (2007, October 8). "Honey, I'm Home!" - For Good: The Transition to Retirement. Ohio State University. Retrieved July 9, 2009, from http://ohioline.osu.edu/hyg-fact/5000/5159.html

Donovan, J. H. (2008, October 3). Coaching: Transition into retirement. Keys to success in the next part of your journey. BizTimes.com. Retrieved July 10, 2009 from: http://www.biztimes.com/news/2008/10/3/coaching-transition-into-retirement

Nussbaum, J. F., Pecchioni, L. L., Robinson, J. D., & Thompson T. L.. (2000). Communication and Aging. (2nd ed.). London: Lawrence Erlbaum Associates Publishers.

Walker, M. U. (1999). Getting Out of Line: Alternatives to Life As a Career. In M. U. Walker (Ed.), Mother Time. Women, Aging, and Ethics. (pp. 97-111). Lanham: Rowman & Littlefield Publishers, Inc.

All content © Village Memorial. 2009-2010.

Sight & Hearing Loss = Social Isolation

A relative, Mr. P., refuses to buy his wife a hearing aid. He and Mrs. P., never really had what one would describe as a good relationship, and now that Mrs. P., cannot hear much of what he says or what others say when they visit, it appears to suit Mr. P. just fine. Mrs. P., with her hearing loss cannot keep up with the conversation, and frequently falls asleep when at the table where conversation is occurring. Mrs. P. therefore suffers from social isolation due to her hearing loss.

With an elderly property manager, Dale, who suffered hearing loss, I had to adopt a “louder and slower conversational style” (p. 236) to ensure he heard and understood me. If I did not use this style of speaking, he would inevitably ask me what I had said. His hearing loss led to “increased requests for information to be repeated in conversation” (p. 236). Dale’s hearing loss led me to keep in person conversations brief and send him emails if I had a lot to explain or more complicated information. Fortunately, Dale used email.

Some facts about hearing loss associated with aging (Presbycusis):
* Increases after age 45
* Causes difficulty in the ability to discriminate between higher frequency consonants like F, G, S, T and Z (p. 236).
* Elderly may tend to “fill in the gaps” and guess what they have missed in the conversation or resort to “lip reading”
* Can affect one’s speech “as people rely on their ability to hear as feedback for monitoring speech” (p. 238).

Some facts about age related Sight Loss (Presoyopia):
* A thickening of the crystalline lenses of the eye.
* Begins at age 40. (p. 234)
* By age 70, “fewer than 30% of elderly people have 20/20 eyesight” and most do not achieve “normal eyesight even with correction” (p. 234)

Conversational Issue with combined Hearing/Sight loss:
* To “compensate for reduced ability to see or hear” people often end up “standing closer to the information source” (p. 237) thereby infringing on the others personal space. This “can be considered inappropriate, making conversation unpleasant” (p. 238).

A favorite elderly neighbor of mine, Alice, who was in her 80’s when I knew her, experienced both sight and hearing loss. On the back of her front door she had taped a sheet of paper that read: “Don’t Forget - Glasses, Hearing Aid, Dentures, Keys, Purse.” Perhaps this was the key to her success. She never left home without her "essentials" and she was able to live a very active life.

Reference:
Nussbaum, J. F., Pecchioni, L. L., Robinson, J. D., & Thompson T. L.. (2000). Communication and Aging. (2nd ed.). London: Lawrence Erlbaum Associates Publishers.

All content © Village Memorial. 2009-2010.