Somewhere Towards The End: Book Review

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Somewhere Towards the End: A Memoir by Diana Athill is an uplifting memoir chronicling significant moments and lessons learned in this British book editor’s life. Athill writes in a reminiscent voice about important times in her life with honesty and directness. Each chapter is specific to certain events or realizations such as significant relationships, thoughts on religion, or encounters with death. The book is written from the perspective of someone who has acquired many years of life experience (89 to be exact!) and is infused with tidbits of wisdom. Her memoir is not in a chronological sequence or a typical autobiographical format. Rather, she bounces between younger life, middle age, and older adulthood, then concludes with what she discovered about herself. While I have always appreciated the elderly for the wisdom acquired naturally over the years, I was moved with admiration and respect for Diana Athill when I read her story. She writes her story simply as a way to share her experience, which she believed, correctly, to be of value. Her book would particularly appeal to the middle aged and older crowd.

            Diana Athill begins her story with a jovial anecdote that sets a light-hearted tone for her book. She first recounts her romantic life – a series of sexual relationships and affairs that are passionate and loving but that never culminate in marriage. When describing her only major heartbreak, she writes not with despair but with an uncanny ability to speak truth on the matter, such as when she states that “a broken heart mends much faster from a conclusive blow than it does from slow strangulation” (Athill, 2008 20). Next, Athill discusses her thoughts and beliefs regarding religion or lack thereof and shares her firsthand experience with death when taking care of her dying mother. Afterwards, Athill lightens the mood by telling the reader about her various hobbies or “escapes,” as she likes to call them. She describes her adventures in gardening, drawing, pottering, and reading, her favorite pastime that lead to a career in book editing, publishing, and ultimately, much to her surprise and delight, writing.

            Although Diana Athill’s escapades take up the bulk of her narrative, the heart of Somewhere Towards the End lies in the few concluding chapters. Athill relays how discovering she had an ability to write and publish written works helped her to heal in ways she did not even know she needed. First, by the public’s acceptance and enjoyment of her books, she gained a boost to her self-esteem. Also, by speaking in public events as an acknowledged author she overcame her shyness. Athill takes a whole chapter to recount her only two regrets in life, which she confesses have still never tormented her in any way. Her most poignant moments come from her musings on life, growing old, and the inevitability of death, which she views not with anxiety, but with comfortable acceptance.  

            Diana Athill attended the distinguished OxfordUniversity and is considered one of the great book editors of the twentieth century, which adds to her credibility. Athill writes with a candor that is both insightful and refreshing. Her style of writing makes the reader feel almost as if they are having a conversation with Athill about her life as opposed to reading a book about it. Although at times I disagreed with her perspective on particular subjects, it never altered my opinion of her and I found that it was precisely her openness about potentially uncomfortable subjects that made her book so engaging. One of the most enjoyable aspects, and surprising as well, was how Athill turned a relatively unremarkable life into an absolutely delightful read. She tells her story with no added frills or melodrama yet I felt absorbed from the very beginning. Despite the fact that I am less than a third of her age, I could connect to many of her experiences and there was a lot to take from her story. Even the British vernacular throughout the book could not detract from her story but rather added a distinctive flair.

            Somewhere Towards The End was truly a pleasure to read. My only qualm would probably be that I felt Athill could have wrote even more! While she does not seem to be writing for a particular audience, I would recommend this book to anyone who enjoys a good read but especially to those who like biographical non-fiction. I believe older people would really appreciate this piece as well. In her last chapter, Athill says that “one doesn’t necessarily have to end a book about being old with a whimper, but it is impossible to end it with a bang” (Athill, 2008, 182). Perhaps not, but Diana Athill concludes her book with a final resounding note that lingers in your heart. 

Athill, D. (2008). Somewhere Towards The End

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Directing A Funeral: A Solemn State of Affairs

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The funeral process is an important event that is not often thought about until the time comes when someone dear to us passes away. Some people may misconceive that they do not need assistance with planning the service and attending to the body, however once they begin the process they will soon see the preparations can be overwhelming to the untrained individual. This process can be even more difficult for someone who is in a state of bereavement (G. Swearingen, personal communication, October 26, 2013). Enter the funeral director. Funeral directors have the important job of helping people plan the perfect goodbye for their loved ones. The funeral directing career can be challenging due to the sensitive context in which it takes place and work-related stressors.

            Funeral directors have an array of duties vital to the funeral centers they work for. They are responsible for meeting with the deceased person’s family in order to determine details of the funeral service, burial, visitation or cremation (E. Lindstrand, communication, October 31, 2013). Directors may also handle paperwork, such as submitting documents to officials in order to receive the death certificate. (Bureau of Labor Statistics). The directors must also communicate with other employees, such as counselors, who are in charge of helping families choose tombstones or plaques and showing them the cemetery property (G. Swearingen, personal communication, October 26, 2013). What makes these duties all the more challenging is the emotional environment it takes place in.

            Like many careers, there is a high level of multi-tasking involved in funeral directing, but unlike others, directors work in an incredibly sensitive environment. Directors must arrange for many details simultaneously, sometimes within 24-72 hours of the death and may be working on multiple funerals at the same time (Bureau Labor of Statistics). Another demanding aspect is that many directors are also on-call twenty four hours a day (E. Lindstrand, personal communication, October 31, 2013). In addition, directors work in an environment that is often quiet, somber, and at times, melancholy (Hyland & Morse 1995). Funeral directors also have the distinctive duty of creating a sympathetic and supportive environment for their clients and forming a professional, caring relationship for a brief period of time (Hyland & Morse 1995). Funeral directors must not only work efficiently but empathically as well, which can be emotionally and professionally taxing.

            Funeral directing produces a unique set of stressors. This includes the lack of boundary between personal and professional life, depression, isolation due to profession, workaholism, and a preoccupation with death (Wilde 2012). As funeral director Caleb Wilde states: “To grasp the kind of stress surrounding a funeral, imagine planning a wedding in five days, except where there’s joy, sadness exists, and where there’s usually a bride, a body lies in state.” While Wilde further describes his career as rewarding because of the assistance he provides, he does not contest the burdens inherent in his profession. Death itself can be very stress-inducing so it is not difficult to imagine how challenging a career is that includes both the anxiety of death and the pressures of an everyday business.

             The funeral directing profession influences the perception of death and aging for those involved in this field. Constant interaction with the bereaved and being surrounded by the reality of death can engrave the adage “life is short” in a funeral director’s mind (E. Lindstrand, personal communication, October 31, 2013). As one funeral arranger (someone who performs essentially the same duties as a director without the director’s license) puts it: “We live in a culture that tries to put death out of our mind,” but when dealing with death is an everyday occurrence, it becomes natural to think about death and preparing for it (E. Lindstrand, personal communication, October 31, 2013). Regardless, bereavement is a painful process. When asked if the elderly seem to handle grief better, Lindstrand says they may be calmer during the initial preparations but still become emotional during the service and burial (personal communication, October 31, 2013). Thus it seems that even though older people have had more time to mentally prepare for it, death is no less difficult.

            Funeral directors have a career that is truly unlike many others. Due to the emotional environment and the work-related stressors unique to its field, funeral directing can be very demanding. While directors might seem fortunate to have an innate job security (there will always be people dying), the relentless necessity to deal with death, remain professional yet compassionate, and still operate within a traditional business is a task not for the faint-hearted. 

 

 

References 

Bureau of Labor Statistics (2012, March 29). Occupational Outlook Handbook: Funeral Directors. Retrieved from http://www.bls.gov/ooh/personal-care-and-service/funeral-directors.htm 

Confessions of a Funeral Director. (2012, July 16). 10 Burdens Funeral Directors Carry. Retrieved from http://www.calebwilde.com/2012/07/10-burdens-funeral-directors-carry/

Hyland, L., & Morse, J. M. (1995). Orchestrating comfort: The role of funeral directors. Death Studies19(5), 453-474. doi:10.1080/07481189508253393

Senior Stereotypes: A Problematic Predicament

From “senior citizen” to “recycled teenager” to “coffin dodger,” there are many ways to label elderly people. Some of these terms denote dignity and others display a downright disrespectfulness. For many people the word “old” is a feared word, associated with incapacity, dependence, physical deterioration, and death. For others the concept of being old is simply foreign, and like people do with other unknown entities, they make assumptions and associations that may not always be accurate. Stereotypes are a common way of processing people and things around us, without devoting too much thought to them. Stereotypes exist across many domains and although age stereotypes may not seem as prevalent as others stereotypes, they are equally pervasive. There are many stereotypes about older people, but the two main elderly stereotypes focused on here are warmth and incompetence.  Stereotyping older people as warm and incompetent can influence younger people’s behavior and can be detrimental to elderly people’s own self-perception and behavior.  

            Two primary assumptions made about older people are that they are warm yet incompetent. These two labels may seem simplistic, however they can each be viewed as umbrella terms covering several characteristics. Warmth and competence are considered to be two dimensions on which in-group members (in this case adolescents, younger adults, and middle aged people) will make stereotypes for out-group members. A perception of warmth will indicate someone is friendly, sincere and honest while perceived competence can denote intelligence and a capacity to work effectively and efficiently (de Paulo Couto, Koller 2012). Research shows that elderly folks are regarded highly on warmth traits but rated lower on competence. Consequently, this assumption leads to perception of the elderly lacking ambitiousness, responsibility, and the ability to be independent, in addition to intellectual incompetence (Cuddy, Norton, Fiske 2005). Furthermore, there seems to be a mutual dependence between the two traits, meaning that the warmer people rate the elderly, the more inept or incapable they rate them (Cuddy 2005). While the warmth stereotype does not incite a negative backlash, incompetence certainly does. This stereotype has significant ramifications on how the elderly are perceived by the younger populace.

            The connotations of being old are so ingrained that they not only can affect how younger people view the elderly but can even influence how they act, particularly after they are exposed to words with elderly connotations. Several studies have demonstrated how merely priming younger people with age-related words can affect their performance on certain tasks. For instance in one experiment with a driving simulator, one group of participants was primed with words related to aging while a control group was primed with random words. The group primed with aging words, though they were not aware of the study’s purpose, drove at a much slower pace than the control group (Branaghan & Gray 2010). Clearly the mere thought or mention of being old can slow people down, even though it is absolutely unrelated to their potential skill. It is important to recognize how this may impact the elderly population.

These stereotypes may seem harmless, but they can actually be detrimental to the physical and mental well-being of elderly folks. When older people develop a negative self-perception they can, regardless of its truth, actually create problems for themselves. For instance, one 2006 study found that “young, healthy people under 50 who held negative attitudes toward the elderly were more likely to experience a cardiovascular disorder over the next four decades than their peers who had a [sic] more positive view of the elderly” (Alexia Elejalde Ruiz 2011). Another study determined that when the elderly are exposed to negative aging stereotypes, they are more likely to perceive themselves as sicker, lonelier and have a higher tendency to engage in help-seeking behavior, underscoring a dependent nature (Coudin & Alexopoulos 2010). The sad reality is that stereotypes that seem innocuous or humorous may be more damaging than good-natured. The negative expectations people impose on themselves may be more limiting than they realize.

Certainly not everyone holds elderly people in such low esteem, however it is common enough to be considered an issue. The assumptions of warmth and incompetence in elderly folks is pervasive in American culture and not only affects their perceived place in society but can influence how they feel about themselves, whether it is true or not. Stereotypes, especially those that are negative, may start out innocently but over time can transform into prejudice and discrimination. To consider that all elderly people are a certain way is simply not realistic. Can these stereotypes be eliminated? Probably not, but with information and awareness, it may be possible to alleviate some of the negative consequences.   

 

 

 

Resources 

Branaghan, R. J., & Gray, R. (2010). Nonconscious activation of an elderly stereotype and speed of driving. Perceptual And Motor Skills110(2), 580-592. doi:10.2466/PMS.110.2.580-592

Cuddy, A. C., Norton, M. I., & Fiske, S. T. (2005). This Old Stereotype: The Pervasiveness and Persistence of the Elderly Stereotype. Journal Of Social Issues61(2), 267-285. 

Coudin, G., & Alexopoulos, T. (2010). ‘Help me! I’m old!’ how negative aging stereotypes create dependency among older adults. Aging & Mental Health14(5), 516-523. doi:10.1080/13607861003713182

de Paula Couto, M., & Koller, S. (2012). Warmth and competence: Stereotypes of the elderly among young adults and older persons in Brazil. International Perspectives In Psychology: Research, Practice, Consultation1(1), 52-62. doi:10.1037/a0027118

Elejalde-Ruiz, Alexia (2011). How Old Do You Feel Inside? Chicago Tribune.

Pipher, Mary (1999). Society Fears The Aging Process. Another Country: Navigating the Emotional Terrain of Our Elders.

 

Active While Aging: The Key to Wellness

When recalling the people I met while working the front desk at a health club, Gabby sticks out vividly in my mind. Gabby always came in with a smile, ready to take on Zumba, spinning class, weights, or the treadmill. Her multiple hour-long workouts paid off though: she was fit and strong. I knew she was older, but imagine my surprise when I looked up her age: 67! Clearly the exercise craze is not only for the young. People like Gabby are becoming less like the exception and more like the rule. It is common knowledge that consistent exercise combined with a healthy diet is conducive for one’s current general well-being, however, there is a growing plethora of information indicating it may also be beneficial for one’s future well-being. Extensive research indicates that exercise can increase longevity and enhance quality of life during the aging process by improving cognitive function, boosting overall physical health, and elevating mood.

            First, it is important to briefly discuss the components of and possibilities within the aging process. According to one group of researchers, aging is defined as a “natural and complex physiological process influenced by many factors, some of which are modifiable” (Gremeaux, Gayda, Lepers, Sosner, Juneau, & Nigam, 2012). They go on to subcategorize aging into three groups: 1) Regular or normal aging, where genes dictate the decline in physiological functions, 2) Pathological aging, which is a result of diseases and impairments such as cardiovascular disease, cancer, and dementia, and 3) Successful aging, referring to physical and mental upkeep and the ability to function without chronic illness or disease (Gremeaux et al., 2012). Most people would ideally prefer to age successfully, which includes not only living longer, but living better. Exercise can help them in several ways.

            One of the most obvious ways exercise can improve the quality of life is by improving overall physical health. As aging occurs, everything in the body naturally and inevitably slows down. By age 60 it is estimated that about 30% of the body’s functional capacity will diminish – both the heart and metabolism become slower, bones lose their density, and muscle mass and strength diminish (Deslandes, 2013). Some of these aging effects can be partially reversed or halted through a combination of cardio and strength-training exercises. One study found that a consistent moderate-intensity workout regime could help in decreasing the risk of falls while increasing mobility, strength and agility. Furthermore, research is encouraging to late starters: those who were not frequent exercisers in their youth can enjoy the full physiological and functional benefits from working out (Seguin, Heidkamp-Young, Kuder & Nelson, 2012).

            In addition to physical fitness and health, exercise has been found to improve cognitive activities such as general cerebral function and memory and reduce the risk of dementia. Due to its positive impact on the hippocampus, exercise has been shown to improve memory and executive function in the brain (Deslandes, 2013). Numerous studies have examined how exercise may help alleviate the onset of dementia. One estimate states that those who engage in higher intensity exercises can lower the risk of dementia by up to 40 percent (Howard, 2012). Another study looking at people with mild cognitive impairment examined exercise as a possible intervention against dementia during a “critical window” period. The results indicated that a consistent and long-term regime of strength and aerobic training can help improve the cognitive decline associated with acquiring dementia (Davis, Bryan, Marra, Sharma, Chan, Beattie, & Liu-Ambrose, 2013).

            Working out can also elevate mood and decrease the intensity of major depressive disorder and other mood disorders. First, the increased mobility, strength, and agility attained from working out can naturally improve mood, because seniors are able to live more independently, fulfill their daily tasks on their own, and potentially engage in new activities (Engels, Drouin, Zhu, & Kazmierski, 2000). Exercise can also benefit those who struggle with more serious maladies, such as depression. One study discovered that when depressed seniors engaged in aerobic activity and resistance training on a regular basis, symptoms of depression were moderately to significantly reduced (Babyak, Blumenthal, Herman, Khatri, Doraiswamy, Moore & Krishnan, 2000). This research has important implications for the mental health treatment elderly receive, not only because it is shown to be effective, but because it seems like it has the potential to be an inexpensive alternative to medication.

            The importance of exercise extends far beyond aesthetic reasons but rather, it serves a much greater purpose: to create a vital life through the enhancement of cognitive function, improvement of physical health, and reduction of depressive symptoms. Society often views avid proponents of exercise as being young-bodied, but this is simply not the case. Older people have as much, if not more, to gain from breaking a sweat – staying strong, staying cognizant, and staying young!

 

 

 

 

 

Resources

Babyak, M., Blumenthal, J. A., Herman, S., Khatri, P., Doraiswamy, M., Moore, K., & … Krishnan, K. (2000). Exercise treatment for major depression: Maintenance of therapeutic benefit at 10 months. Psychosomatic Medicine62(5), 633-638.

Davis, J. C., Bryan, S., Marra, C. A., Sharma, D., Chan, A., Beattie, B., & … Liu-Ambrose, T. (2013). An economic evaluation of resistance training and aerobic training versus balance and toning exercises in older adults with mild cognitive impairment. Plos ONE8(5), doi:10.1371/journal.pone.0063031

Deslandes, A. (2013). The biological clock keeps ticking, but exercise may turn it back. Arquivos De Neuro-Psiquiatria71(2), 113-118. doi:10.1590/S0004-282X2013000200011

Engels, H. J., Drouin, J. J., Zhu, W. W., & Kazmierski, J. F. (1998). Effects of low-impact, moderate-intensity exercise training with and without wrist weights on functional capacities and mood states in older adults. Gerontology44(4), 239-244. doi:10.1159/000022018

Gremeaux, V., Gayda, M., Lepers, R., Sosner, P., Juneau, M., & Nigam, A. (2012). Exercise and longevity. Maturitas73(4), 312-317. doi:10.1016/j.maturitas.2012.09.012

Howard, Beth. (February/March 2012). Age-Proof Your Brain: 10 Easy Ways to Stay Sharp Forever. AARP The Magazine, 53-54, 56.

Seguin, R. A., Heidkamp-Young, E., Kuder, J., & Nelson, M. E. (2012). Improved physical fitness among older female participants in a nationally disseminated, community-based exercise program. Health Education & Behavior39(2), 183-190. doi:10.1177/1090198111426768

Baby Boomers Behind Bars: The Health Care Concern

 

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Imagine being very old. Not only are you are nearing what appears to be the end of the road, but you are in permanent confinement. Your health is dwindling and you are at the mercy of the “system.” This situation is unfathomable for most people, however, for millions of aging men and women across the United States in correctional facilities, this is an inevitable reality. As the older demographic skyrockets in the general population, so does the number of incarcerated men and women. As these two growing trends converge, correctional facilities are faced with the daunting and unavoidable task of determining what to do regarding the increasing need of health care for older and sicker inmates.

It is no secret that the population of “graying” America is increasing steadily and swiftly. What is not so evident, but no less relevant, is the proportionate growth of inmates in American detention facilities. While in 1900, only about 4% of Americans were ages 65 and older, by 2030, it is projected that 1 in every 5 Americans will be age 65 or older (Himes, 2001). This population surge has not escaped the prison population. Texas saw an increase of 86% in the older inmate population between 1994 and 1998, while California is expected to have a 200% increase in its elderly inmate population by 2020. Futhermore, other projections state that by 2020, older inmates will represent 21%-33% of the total prison population (Rikard & Rosenberg, 2007).

            Identical to the non-incarcerated older population, elderly inmates face numerous health issues. Many times inmates’ lifestyles prior to incarceration include substance abuse and poor self-care, so unsurprisingly many face more significant health issues like chronic conditions and psychological disorders. One study found that older inmates, on average, suffered from three chronic illnesses throughout their incarceration (Rikard & Rosenberg, 2007). Older inmates are also at higher risk for age-related problems such as hearing and vision impairment, falls, cognitive impairment, and urinary incontinence (Hill, Williams, Cobe, & Lindquist, 2006).  In addition to physical illnesses, mental disorders are more prevalent amongst older inmates than younger inmates. In one Utah prison study, of the older mentally ill prisoners, 57% were diagnosed with depression, 25% with schizophrenia, and 18% with bipolar disorder (Caverley, 2006). As the elderly inmate population grows, clearly so will the need for medical and mental health services and clinics within these institutions.   

            The economic implications due to these needs are tremendous. Older inmates are three times as more costly to care for than younger inmates, a disproportionate difference. Elderly inmates require items and services such as “24-hour nursing coverage, infirmary beds, physician availability, pharmacy, laboratory, x-ray, and rehabilitative physical care resources” (Rikard & Rosenberg, 2007). In addition to medical provision, there is an emerging need for senior-specific social programs because they can be conducive for the mental well-being of incarcerated elders. However, much improvement is needed in the area of social programming. In a 2004 study of the Department of Corrections and the Federal Bureau of Prisons, it was discovered that a mere 23 states had policies and programs geared towards aging male inmates and only two for older female inmates (Williams & Rikard, 2004). To create programs such as these though would continue to add financial pressure upon detention facilities on both a statewide and federal level.

            Although there is no single clear-cut solution, there are several ideas of how to improve the health care situation within correctional institutions. First, in one report, researchers asserted that organizational strategies such as “knowledge and skills management, development of effective teams and redesigning and coordination of care processes” would benefit both the quality and cost of the health care system (Hill et al, 2006). Secondly, more emphasis could be placed on programs such as the Project for Older Prisoners (POPS), which examines nonviolent older inmates for early release and thus far has been a significant success (Rikard & Rosenberg, 2007). Third, the notion of having separate assisted living units or off-site correctional nursing homes is being considered for their benefits of reducing costs (Hill et al., 2006). It is urgent that legislators and corrections administration examine the facts and consider these alternatives in order to address the health care issue.

            The visible growth of the general aging population is already creating an awareness and urgency of the emerging need for more health services. With the inmate population in the United States increasing in proportion to their non-incarcerated elderly counterparts, the attainment of medical and mental health services in correctional institutions is one of the most exigent matters facing this specific population.