Talking With Peg Gordon: How It Feels to Be Old
What does 85 really feel like? What's it like to recover from a stroke, go for a walk with diminished sight and hearing, or lose your senses of taste and touch?
Xtreme Aging, an innovative "sensitivity training" program at the Macklin Intergenerational Institute in Findlay, Ohio, aims to let baby boomers and others find out for themselves. The program gives participants a number of devices to simulate common maladies of old age -- dried corn kernels to put in their shoes, oversized latex gloves, tape over the lenses of glasses to replicate the effects of cataracts -- and then asks them to complete some simple tasks. Impaired in this way, the participants discover that it can take Herculean efforts to button a shirt, find a name in the phone book, or take a walk. And those are the easy maneuvers -- next, participants write their names on a card with their nonwriting hand, with their legs crossed, while rotating one foot, to experience stroke recovery.
Peg Gordon, a Macklin trainer and consultant, says that programs like Xtreme Aging are catching on with healthcare professionals and others who work with the elderly because American society is increasingly segregated by age and ignorant of the needs of elders. Another Macklin program integrates the daily activities of children in its daycare center with those of the elderly residents of Birchhaven, an assisted-living and nursing facility at the Institute. Shared activities range from wheelchair races to having residents with dementia and Alzheimer's rock babies.
Gordon, who joined the Institute three years ago, believes that the lives of children are enriched and that isolation among the elderly decreases when generations interact and understand each other. An early study done by the Institute showed that the personal and social skills of the intergenerational preschool children were about six months ahead of those of their peers in same-age-only programs. A later study done in 2005 showed that the children in the intergenerational program were about a year ahead in these developmental areas, Gordon says.
So far, no studies have been done to determine what benefits the elderly Birchhaven residents derive from mixed-generational activities. But Gordon -- who witnessed the deterioration of her husband's grandmother and her own, both in nursing homes that neglected their emotional, cognitive, and social needs -- believes that the benefits are clear.
Q. How do intergenerational activities help older people?
A. We're hoping to show that elders in our program have better social and personal skills, and that they feel less bored, lonely, and helpless. I remember hearing a doctor say that that old people in institutions are dying from those things more than from physical problems, and I agree.
Q. What specific benefits have you seen?
A. One of our little boys was late learning to walk, and one of our elders taught him to walk with her walker. Another woman was incapacitated by a stroke. She was very depressed and hadn't spoken for months. Our preschoolers make their own lotions and massage the hands of the old people with them. She didn't seem to be responding when they massaged her hands -- but then she said "good-bye" as they left one day. Gradually, she began to talk more. Often people will do things for kids that they wouldn't otherwise do.
Q. You're not only an Xtreme Aging trainer, you went through the program yourself. Did it help you understand what your grandmother was going through in her nursing home?
A. Xtreme Aging training takes the participants through the social, physical, emotional, cognitive, and spiritual aspects of aging. It really tries to let people experience on a very small scale what it is to be diminishing; how aging affects all of the domains.
The emotional and spiritual parts really hit home for me. I could look back and say, "That's what she must have been going through." I began to understand and, on a very miniscule level, to feel what she must have felt upon entering and living in a nursing home. I saw how she must have been grieving her for independence, her way of life, her personal belongings, the family she had left behind, and all the privileges a healthy person has. I began to see how her spirit must have been crushed. I think the biggest thing I learned was to appreciate a person for where they are in life, and to understand what they need.
Q. Was there a particular exercise that helped you realize these things?
A. We were asked to write on slips of paper some of the most prized possessions, important people, and appreciated privileges in our lives. Then, throughout the training, the leader removed the possessions, people, and privileges one by one. By the end of the exercise, you're left with maybe one or two things. Surprisingly, it's very difficult to see those things taken away from you, even on paper. In the debriefing, the group talked about how a person moving into a long-term care facility is in that very same position. It's a pretty simple exercise and yet it really helped me put my granny's experience into a frame of reference. That's when I began to understand the injustices of typical nursing homes.
Q. What was your grandmother's nursing facility like?
A. It was a state-run nursing facility outside of Cincinnati. It's what you think of when you think of a nursing home: a very medical model designed for the convenience of staff, not necessarily for the best interest of the patient. There was a set time when you're going to eat, and a set meal you're going to eat; too bad if it's inconvenient for you. There were no individually designed activities to challenge her cognitive skills or allow her to socialize on a level that she was comfortable with. My granny was not one to play bingo, but if that was the activity of the day, you got wheeled out and you had to sit there.
There was no counseling or emotional support -- although antidepressants were discussed from time to time. There was no comfortable place for her to visit and relax with her family. Truthfully, I don't believe any staff took the time to really know or care about my granny as a person. She was simply someone's job.
Q. Was that also the main problem with the facility your husband's grandmother was in?
A. For both of them, so much emphasis was put on their physical needs: "We really need to get them better." And at some point, you realize they're not going to get better. But you still focus on what's happening to them physically.
My granny was well and active until the very end, when her lungs started failing and she got pneumonia. It was old age. She was 98. Her body was tired and giving out. But it was a sickness, so we focused on that, on the pneumonia. And you get so focused on that, sometimes you forget that this is a process for the dying person as well. And you look back and think, "Did I address her emotional needs? Did I address her spirit?"
Q. How did the nursing home staff interact with you and your family?
A. Initially, my granny was suffering from sundown syndrome , and I had never witnessed that. To see her go into this state of confusion and terror was heartbreaking. My sister and I wanted to know what was going on; we were upset by it. And when we got a little demanding, we were told, "You know what? Maybe you're the ones with the issue." We were trying to address an emotional need and we were told we had a problem.
I didn't officially start hearing about what sundown syndrome was until about two years later, when my husband's grandmother was in the hospital with cancer and she started suffering from it. Then someone explained it to us and we did a little research, and that's when we knew that was what our granny had.
Q. Did you ever break through to the staff?
A. Not until the very, very end, within hours of her death. We got really pushy. They would say things like, "Yeah, you're going to hear the rattle in her chest -- that's natural," and just brush us off. Of course, you don't want to hear that when it's someone you love. You want someone to talk to you about it. I understand that this was routine for them, but it wasn't for us. They didn't or wouldn't understand our needs, and we didn't understand our needs or our granny's needs.
Later, when my husband's grandmother was very ill, there were times when we wouldn't let the doctor out of the room until we found out what we felt we needed to know. I think it's hard for a doctor to say, "This is it, this person is dying. This is what to expect." But I remember times standing in the doorway and saying, "I need answers before you leave this room."
Q. Did you ever feel that you were able to address your grandmother's needs?
A. Hospice came in at the very end for just a short time, but they quickly assessed things. There was a chaplain with them. By addressing our needs, he allowed us to be there and address hers. I remember him saying, "You need to hold her hands and look at them. There are no other hands like those. And appreciate everything they've touched and done in a lifetime." It was so moving, and it allowed us to touch her -- to stop worrying about what the physical body was doing and be with her.
We always laughed about my granny being a hillbilly from Appalachia, and I remember at the very end my sister and I sitting quietly and holding her hand and singing some of those old songs she would sing to us. Family was on every side, every corner of her bed. She was not lucid, but I believe that touch and love and those sorts of things transcend that.
Q. Did the hospice people help you open up to that?
A. Yes, I think so. They asked a lot of questions: "How many grandchildren did she have? How many great-grandchildren? Tell us about that." And that allowed us to start opening up.
Q. Whose idea was it to call hospice?
A. At first, the nursing home staff said that there were no instructions to have them come in my grandmother's papers, or that it was not the wish of her grandchildren who had power of attorney. But we pushed and a nurse took pity on us and called hospice. It was one kind person.
Q. Did these experiences inspire you to join Macklin Institute?
A. I think they had a huge impact. After the experiences with the two grandmothers, I walked into this facility and thought, "I will never again do it differently than it's done here."
Q. Looking back, what would you have done differently then?
A. I'm not even sure that there were the options in nursing homes then that there are now. First, I would have tried to keep her in her own home as long as possible, although that wasn't within my realm of control. Then, when she needed to go to a facility, I would have really tried to find one that made her independent and active for as long as possible.
A really good facility is focused on the individual. The hubbub of real life is around them. For example, are there children around in childcare or kindergarten classes? Are there gift shops, beauty parlors, churches, and libraries in a centralized location for the residents to use? Are there gardens to tend to? A good facility should have a resident council that gives all residents a voice. A good facility lets people eat when they're hungry and not just when it's convenient for staff. A good facility is a real community.
A very lovely and helpful article. Obviously, hospice should be called as soon as possible for terminally ill patients of any age, but especially the elderly. Also, I really do hope I can put off entering assisted living as long as possible, and never have to enter a nursing home. All of my female ancestors passed away at age 96 or older. All of them lived at home untill the end, and were in their right minds with good sight and hearing to the end. They had a maid to come daily to help them, and lived fairly happily untill dying of heart failure with no extended suffering or need for nursing home or hospice. Apparently, such nice endings to life are rare. I am 79. in great health, and dreading becoming like the old people you describe. Bobbie Sena
Peg, I am so impressed with your sensitivity to the elderly and dying. Having just lost my daughter to alcoholism and watching her die in a loving hospice made all the difference in the world. The love you had for "Granny" and the field you chose to make a difference makes me proud. Now I know why Jennifer is so strong. She comes from a family of strong women. Keep up the good work. I especially love the work with children and the elderly. You have planted a seed. Mauryne
They have raised the future generation. They should be treated with the utmost love and respect.
What Peg is saying is true. I am a CNA. Have worked in nursing homes for 20 years. No one seems to care about the person themseves. We all have feelings and needs. Wheather old or young. The elger are our past generation.