Attitudes to older people | The Good Funeral Guide

Category Archives: Attitudes to older people

The race grows sweeter

Tuesday, 12 February 2013

Posted by Vale

Here on the blog we often rail against society’s thoughtless pursuit of longevity. Rightly so – it is cowardice not kindness that endorses the suffering that medicine – seemingly without reflection or conscience – prolongs.

But it’s important to remind ourselves that it isn’t always so; that old age can bring wisdom and unlooked for joys as well.

In the New York Times recently, in piece called The Race Grows Sweeter Near Its Final Lap, Eve Pell tells the story of the love she found. She writes:

Old love is different. In our 70s and 80s, we had been through enough of life’s ups and downs to know who we were, and we had learned to compromise. We knew something about death because we had seen loved ones die. The finish line was drawing closer. Why not have one last blossoming of the heart?

I was no longer so pretty, but I was not so neurotic either. I had survived loss and mistakes and ill-considered decisions; if this relationship failed, I’d survive that too. And unlike other men I’d been with, Sam was a grown-up, unafraid of intimacy, who joyfully explored what life had to offer. We followed our hearts and gambled, and for a few years we had a bit of heaven on earth.

Not only was I happy during my short years with Sam, I knew I was happy. I had one of the most precious blessings available to human beings — real love. I went for it and found it.

It’s a moving story of love and age and I defy you read to the end without a tear in your eye. Read it here

The biggest social issue coming down the pipe

Thursday, 31 January 2013

From an article in last Sunday’s Sunday Times:

You may not be part of Britain’s 6.4m-strong army of carers yet, but if your parents are still alive, the dilemmas surrounding how to look after them as they get older will surely come.

Future Identities, a government report published last week, drew attention to what one expert calls the biggest issue we face as a society. Because women are giving birth later in life, the baby-boomers’ time-poor children are increasingly being hit with a double whammy: they are having to care for their own offspring and their elderly parents simultaneously.

Christopher Lambert’s story is typical of this so-called Sandwich Generation. “My son was five, I was 58 and my dad was 87. I’d divorced my wife and was living back with Dad as his main carer,” he says. “My son would come at weekends, which was supposed to be our ‘special time’. It was bedlam. Dad would be screaming, ‘Breakfast! Breakfast!’ My son would be yelling, ‘Dad, Dad, you said you’d . . .’

“I felt trapped in the middle, the only grown-up. I remember being out in the garden and Dad collapsing on the ground and my son wanting to play football and me saying, ‘Let’s play looking after Grandpa,’ and he’d say, ‘No, that’s boring and he’s smelly.’ I was at my wits’ end.”

The feelings of conflicted loyalties, divided between the parents who raised you and the children who need you to raise them, are so common that more than 4 in 10 Sandwich Generation carers are struggling to cope or at breaking point, according to a recent survey by Carers UK.

The problem will only intensify as the postwar baby-boomers enter their seventies — by 2022 there will be a 20% rise in over-75s (up from 5.1m to 6.6m). “People live longer now with severe disabilities who would have died years ago,” says Helena Herklots, chief executive of Carers UK. “A revolution is required in family care akin to the new understanding we have around working parents, as in the future so many of us will be juggling work around elder care and children.”

The forecast is also for the number of children aged under 16 to increase from 11.8m now to 13.2m in 2022, exacerbating the Sandwich Generation squeeze.

Source (£)

The unintended consequence of promoting longevity

Tuesday, 8 January 2013

Michael Wolff describes caring for his eldery, dementing mother in New York magazine. It’s a long piece and it will concentrate your mind. You’ll brood on it. Warning: once you start, you won’t be able to put it down.

…what I feel most intensely when I sit by my mother’s bed is a crushing sense of guilt for keeping her alive. Who can accept such suffering—who can so conscientiously facilitate it?

“Why do we want to cure cancer? Why do we want everybody to stop smoking? For this?” wailed a friend of mine with two long-ailing and yet tenacious in-laws.

Age is one of the great modern adventures, a technological marvel—we’re given several more youthful-ish decades if we take care of ourselves. Almost nobody, at least openly, sees this for its ultimate, dismaying, unintended consequence: By promoting longevity and technologically inhibiting death, we have created a new biological status held by an ever-growing part of the nation, a no-exit state that persists longer and longer, one that is nearly as remote from life as death, but which, unlike death, requires vast service, indentured servitude really, and resources.

This is not anomalous; this is the norm.

The traditional exits, of a sudden heart attack, of dying in one’s sleep, of unreasonably dropping dead in the street, of even a terminal illness, are now exotic ways of going. The longer you live the longer it will take to die. The better you have lived the worse you may die. The healthier you are—through careful diet, diligent exercise, and attentive medical scrutiny—the harder it is to die. Part of the advance in life expectancy is that we have technologically inhibited the ultimate event. We have fought natural causes to almost a draw. If you eliminate smokers, drinkers, other substance abusers, the obese, and the fatally ill, you are left with a rapidly growing demographic segment peculiarly resistant to death’s appointment—though far, far, far from healthy.

Read it all here.

Oldies in frocks

Tuesday, 20 November 2012

72-year-old Liu Xianping modelling the new range for his granddaughter, Chinese fashion designer Lyu Ting. She says, “He picked up one piece and tried to give some advice on how to mix and match. We thought it was fun so we started shooting.”

Liu says: “Modeling for the store is helping my granddaughter and I have nothing to lose. I’m very old and all that I care about is to be happy.”

More pics of Liu here.

Oldies in Need

Friday, 16 November 2012

Image

The British are some of the most charitable people on Earth — if you measure their charitableness according to how much money they fork out for good causes.

Today marks BBC Children in Need Day. There will be the customary telethon, razzmatazz, fevered fundraising, spinning figures and, if all goes to carefully-laid plan, ta-da, a record sum of money amassed.

Children in Need is the perfect good cause. It has all the attributes. Brits are sentimental — they can’t resist a tug at the heartstrings. They’re suckers for sensation (expect lots of oohs and aahs). They succumb to celebrity endorsement. They are bedazzled by glamour. It’s actually not all that difficult to whip up a lot of heightened emotion where sick children are concerned. Who could possibly doubt that this is an excellent cause?

Fundraising is a highly professionalised business. But fundraisers can only work their magic if a cause has all the magic ingredients: sentiment, sensation, celebrity and star quality. Compassion has its no-go areas. Where cancer is concerned, boobs will always trump balls.

What price, then, Oldies in Need Day?

Hinterlands between the living and the dead

Monday, 5 November 2012

We didn’t cover the Dia de los Muertos, the Day of the Dead celebrations on 1 & 2 November. Perhaps that was an oversight. It’s a colourful and intriguing festival of great interest to Westerners. Those from cultures influenced by Protestantism tend to be a bit tongue-tied in their relationships with their dead.

The Dia de los Muertos is much envied by those who feel that their own culture has forgotten how to commemorate the departed. But is it culturally informative, or is it no more than a cultural curiosity?

Held to coincide with the Feast of All Souls, the Dia de los Muertos is the result of the incomplete colonising of a pagan festival by militant Catholics. Its origins are Aztec and it possesses a quality of incoherence which seems not to bother anyone very much. In its original Aztec incarnation the Dia expressed the belief that the living and the dead co-exist. Christian teaching, on the contrary, tells us that our dead go far, far away.

Our own Hallowe’en is, of course, the product of another such marriage of incompatibles, in this case between Christian All Souls and the pagan Samhain, held at that time of the year when the door to the Otherworld opens wide enough to allow the souls of the dead to return for a brief time. Again, not at all Christian.

In an increasingly secular society, where the spectrum of spiritual beliefs is very great, it is useful to have the examples of other cultures to plagiarise and adapt – repurpose, to use the modern idiom. We can probably expect to see a growth in the variety of commemorative observances as people increasingly find the courage to do whatever it is they feel they need to do no matter what anyone else might think.

Maurice Saatchi, for example, breakfasts every day with his dead wife, Josephine Hart, at her grave. He’s not a fan of the moving-on/closure school of grieving. He says, “In my view, to move on is a monstrous act of betrayal and to come to terms with — I think I’d call that an act of selfishness.”

Saatchi’s wifes’s death has even enabled him to redefine his own identity: “The reality of it is that she is me, I am her, we are one . . . I am Josephine Hart, I can put it no stronger than that. It is no different now from what it has always been; we have always been one person.”

The on-trend hinterland between the living and the dead is currently that occupied by zombies. Of ancient African origin, contemporary portrayals of zombies are derived from the slave culture of Haiti, where, according the Amy Willentz, ‘the only escape from the sugar plantations was death, which was seen as a return to Africa, or lan guinée (literally Guinea, or West Africa) … The zombie is a dead person who cannot get across to lan guinea,’ and is thereby condemned to an eternity of backbreaking toil in the sugar plantations under the rule of cruel overseers.

Wilentz goes on: ‘There are many reasons the zombie, sprung from the colonial slave economy, is returning now to haunt us. Of course, the zombie is scary in a primordial way, but in a modern way, too. He’s the living dead, but he’s also the inanimate animated, the robot of industrial dystopias.’

Leaving aside industrial dystopias (together with ghosts and angels), let’s finish by considering the living dead – those kept alive by modern medicine; those who inspire all the debates we’re having these days about assisted dying.

The Liverpool Care Pathway has come under fire in recent months. Doctors have been prescribing it without consulting some families. Hospitals have been incentivised to apply it to living dead people in order to effect economies in healthcare.

The Liverpool Women’s NHS Foundation Trust received £1.03m for doing just that in the last financial year.

Time’s up, take yourself out

Monday, 16 July 2012

A theme that we like to explore on this blog is the way in which longevity has reconfigured the landscape of dying. The blessing of long life has its downside: protracted decline. We are likely to linger longer, much longer, than our forebears. There’s a physical cost in chronic illness and possibly, also, mental enfeeblement. There’s the emotional cost to the elderly and their families. And then there’s the financial cost, which the government has wrestled with and now kicked deftly into the long grass.

In the Sunday Times Minette Marrin wrestled with it, too. I’ll have to quote a lot of it because the ST website is paywalled. She suggests some interesting solutions:

Last Thursday the Office for Budget Responsibility (OBR) announced in a chilling report that the escalating costs of an ageing population will mean yet more national austerity. Pointing out that the proportion of people over 65, who now make up 17% of the population, will rise to 26% by 2061, it estimates many increased costs, in care of the elderly, health and pensions, amounting to an added £80 billion a year in today’s money.

In the next 20 years, the number of people over 70 is set to rise by 50%, reaching nearly 10m, according to the Office for National Statistics.

The OBR states that Britain’s public spending will be “clearly unsustainable” over the next 50 years, despite the spending cuts. So, far from care for the elderly rising above today’s inadequate standards, it is almost certain to fall further below them. There’s no money now and in future there’s going to be even less.

Universal bus passes (which cost £1 billion a year), winter fuel allowances (£2 billion) and free television licences must go.

Everyone must accept that their savings, including their homes, may have to be spent on paying for care in old age. There’s no universal right to leave one’s property to one’s children.

Taxes of all kinds must rise hugely, or else there will have to be a large hypothecated tax upon people reaching old age. Services to old people must be reduced … Health service care must be rationed for the very old. Palliative care of every kind should be available, but not ambitious treatments.

There should be fewer old people. I’ve often felt the best thing one can do for one’s children is to die before real infirmity sets in. The taboo against deliberately shuffling off this mortal coil, as people did in other cultures in the interests of younger people, is wrong. Most people say they never want to be a burden to others in old age; it would be good if more of us felt able to prove we mean it, by taking a timely and pleasant walk up the snowy mountain. Especially since there’s no money left. [Our bold]

Source

Dead wrong

Thursday, 5 April 2012

It was the nineteenth-century Liberal politician and prime minister Willim Ewart Gladstone who famously said ”Show me the manner in which a nation or community cares for its dead, and I will measure with mathematical exactness the tender sympathies of its peoples, their respect for the laws of the land and their loyalty to high ideals.” His words are largely forgotten in the UK but they are often quoted by American undertakers seeking to big up their role and get inside their clients’ wallets. Care = spend.

Were Gladstone living today he would probably have broadened his message to take in the elderly and exclude US undertakers.

The Oldie magazine recently received an appeal from Ward 23, a care of the elderly ward at Bristol Royal Infirmary. The writer, Sue Nicholls, Ward Clerk, asked for money to buy basic toiletry items. She said, “Even the smallest of items such as a bar of soap would benefit our patients … we get single sachets of shower gel and shampoo, but they are unscented and don’t lather. Vile stuff.” Ward 23 hopes also to raise enough money to buy special chairs and footstools for the patients.

Vile treatment of the elderly is normal in our country. Punitive legislation has altered attitudes to black and minority ethnic people and all sorts of other people, but no one has thought it worthwhile to extend attitude-altering legislation to include old people. Nor are there any current plans for an Old People In Need telly-jamboree fundraising festival.

The manner in which a nation or community cares for its elderly is a measure of its attitude to its dead. We shan’t get death right until we change the way we treat our elders.

If you are inclined to send a donation or a little parcel to Ward 23, the address is: Ward 23, Uppwer Maudlin Street, Bristol BS2 8HW

Four things oldies need to keep bouncing back

Tuesday, 13 March 2012

In a useful and instructive blog post, Bobbi Emel discusses what oldies need if they are to be able to adapt to the falling-to-bits process. Continue reading →

Is Fear Killing Compassion for Older People?

Wednesday, 7 March 2012

Posted by Jon Underwood, founder of the Death Café project

“In this case, ignorance is not bliss. With death, ignorance is fear.”

Caitlin Doughty – The Order of the Good Death

The UK Commission on Improving Dignity in Care chose the 29^th of February to drop their bombshell in the form of a draft report on how to improve care for the elderly. Their recommendations were dry and sensible but the Commission used their moment in the spotlight to prod at a shadowy part of our national psyche. When splashed across the media nuance was lost to the big message – we’re not compassionate enough, we need to care more. Their implication was clearly that we don’t care enough.

Though it was NHS staff that were labelled as lacking compassion there were a lot of us who felt, deep down, that we might not care enough too. If we did how would we allow incidents like those that set this Commission in motion continue to occur. Some of these were documented by the Health Ombudsman in a migraine inducing report, the kind that you have to steel yourself to open.

And when you do you learn of Mr. D whose family arrived at hospital on the day he was due to be go home and found he had been waiting for several hours. He was in pain, desperately needed the loo and couldn’t ask for help because, he was so dehydrated. His daughter said that ‘his tongue was like a piece of dried leather’. The emergency button had been placed beyond his reach, his drip had been removed and the bag of fluid had fallen and had leaked all over the floor making his feet wet. When the family asked for help to put Mr D on the commode they reported that he had ‘squealed like a piglet’ with pain. Truly a horrific experience for any family. His daughter said that ‘From the moment cancer was diagnosed my dad was completely ignored. It was as if he didn’t exist – he was an old man and was dying.’

The report continues in a totally dreadful way. You read about Mrs. H who was transferred from hospital to a care home. When she arrived the Manager found she had numerous injuries, was soaked with urine and was dressed in clothing that did not belong to her and which was held up with large paper clips. Or you read about how staff at Ealing Hospital left Mr. J forgotten in a waiting room, waiting to be told he could come in now, while his wife died in the ward nearby. Or about how staff at Oxford Radcliffe Hospital turned off Mr C’s life support despite his family’s request that they wait until they got there.

Can you imagine equivalently painful situations would be allowed to occur and reoccur if they concerned children rather than older people? Its convenient to blame medical staff but there is evidence of a much more pervasive problem. According to the European Social Survey Britain has one of the worst records in Europe on age discrimination. Age UK, our loudest voice on behalf of older people, says “Undignified care of older people does not happen in a vacuum; it is rooted in the discrimination and neglect evident towards older people in British society. Age discrimination is the most common form of discrimination in the UK.”

Abuse and neglect is a crime. Horrible incidents like the ones described above are much more likely to happen to older people. These things together, I firmly believe, constitute hate crime. In the face of them it’s hard not to feel we have some questions to answer, like why these things happen and what can we do about it.

The explosive reaction following the publication of the Dignity in Care commission report was unsurprising because they almost dared to point the finger of blame at the general public. The tone of this debate is shrill and pervaded with unease. Commentators seem happy to skip the bit about what the problem actually is and focus on what should be done about it, and about this there is almost a complete lack of clarity and agreement.

Some suggest banning the use of the word ‘dear’ to describe older people. Many say that nurses pay and conditions do not allow them mental space to be compassionate and when they are improved standards will improve too. Others suggest that NHS privatisation will only make things worse (a view one suspects they had before the report was published). Esther Rantzen is proposing Silverline, a 24-hour phone service where older people or their families can blow the whistle on cruelty or neglect. Virtually no one suggests that the Commission’s own mild and unthrilling recommendations will amount to much more than a cursory step in the right direction.

The most entertaining commentary I’ve seen was a teeth-grindingly awful piece by Allison Pearson in the Telegraph called ‘Listen darling you can’t legislate for compassion.’ Pearson thinks that “Caring is a vocation, empathy a gift”, conveniently letting herself off from ever having to develop any compassion herself. She continues “Hospitals used to know as much, back when girls with big hearts and a small clutch of CSEs were recruited to do what they did instinctively: fetch a flannel and basin to give someone a nice wash, stroke a shaking, ancient hand, share a joke over a bedpan.” Ah! The harking for the mythical past! So comforting to invoke because it didn’t exist so there is no chance of us ever getting back to it.

Pearson is wrong on so many levels but the idea that things were better then is just bollocks. This is because the issue here isn’t about reintroducing matron or even about older people. It’s about death. The people profiled by the Health Omdudman were dying. 9 out of 10 of them didn’t live to see the report get published. Things can often go to shit when people are dying and this is where so many problems lie. Key fact: 54% of the complaints that the Healthcare Commission receives are ‘bereavement related’.

It makes sense because many of us don’t do dying very well. We don’t even like to talk about it. And when we see people who are dying we can freak out, a bit or a lot, and sometimes not do the best things. It doesn’t take anything else to cause incidents like Mr. D’s.

So the flipside of this, is that someone who is more OK about death (and all that is all associated with it) should be better at looking after a dying person than someone that who is scared. This makes sense and there is a surprising amount of evidence of this point. Its not just nurses that are afraid of death – count me in and probably you too – but they are the ones who’ve mainly been studied as far as I can tell. G. G. Eakes studied the relationship between death anxiety and attitudes towards the elderly amongst 159 nursing staff. The conclusion was clear: “Nursing staff with high levels of death anxiety had significantly more negative attitudes toward the elderly than nursing staff with low levels.” Vickio and Cavanaugh found that the results of their study of 133 nurses “indicate that a connection between old age and death may underlie the relationship between death anxiety and attitudes toward elderly adults.” DePaola, Neimeyer, Lupfer and Fiedler’s comparison of 145 nurses with a control group found similarly that “increasing levels of death concern were associated with greater anxiety toward ageing, especially in the nursing home sample, and nursing personnel displayed significantly fewer positive attitudes toward the elderly than did controls.”

If our problem is fear of death then what should we do about it? The good news is that in many areas we’ve never been better at it – another reason that Allison Pearson from the Telegraph is wrong to yearn for the good old days of matron. For example, the modern Hospice movement is a magnificent British gift to the world through the pioneering work of Dame Cicely Saunders. It is noteworthy that the word ‘hospice’ is completely absent from the Health Ombudman’s report. Britain is also a world leader in natural burial thanks in large part to two decades of effort by the Natural Death Centre. There is always compelling off-centre debate on this blog. The GFG has the courage to fire sharp barbs at the big funeral chains and is clever enough to lead on big tasks like redefining ritual for non-religious funerals. There are many fantastic undertakers and celebrants and lots of great stuff is happening, like my personal project Death Café and the brilliant Order of the Good Death

Saying that this is a debate about how we care for the elderly makes nurses, care homes and hospitals the things we need to change. No one would deny that changes to date haven’t been entirely successful. Saying this is a debate about how we die would bring the focus back to where it needs to be – on the dying person and their family with nurses, care homes and hospitals there to provide compassionate support.

[Death Café works with anyone who wants to talk about death. This includes those who are dying, those that support them and everyone else. Please do get in touch if you’re minded to.]