Dealing with Frailty and Death

General Observations

9/25/18 jw drive

We don’t want to think about frailty or death when, even at an advanced age, we’re feeling great, still able to do things we enjoyed in the middle and early years. Why focus on the lateness of the hour, when a bright side outlook lingers still? Why, indeed?

There is, not surprisingly, an inverse relationship discovered in the comments of our champions on this topic between levels of vitality and the extent of attention given to thoughts of frailties and/or death. Why dwell on inevitable afflictions, still early in the evening, when the setting sun is experienced with wonder and awe, not as a harbinger of reality, namely, that midnight is not long off.

While delivering An Oration at a Child’s Grave in Washington, DC on February 8, 1882, Robert Ingersoll said, We are all children of the same mother and the same fate awaits us all. Just so. But reconciling oneself to the inevitability of precipitous declines in health and the eventual onset of an eternal night is and will always be difficult. It is so for the most rational, wise and courageous among us; it’s certainly not easier for the billions who struggle with few or none of these qualities. What, then, can we offer as consolation, if not hope or  guidance, for dealing with the unknowable whence and wither realities? Here are a few possibilities:

  • Sound information, for starters.
  • Recognition of facts and basic truths.
  • Caution about existing customs, established practices that could, if overlooked, make coping more difficult.
  • Promotion of values or principles that will, if held fast, make coping more manageable and short term.

The first and foremost task is to bring to conscious awareness what you most value and wish to retain as long as possible, and what you most abhor and wish to avoid.

Here are suggested criteria along these lines. When not practical or possible, other initiatives should be found before opportunities are lost:

  • Independence, self-sufficiency or autonomy – the ability to fend for myself, supplemented by modest assists, when judged appropriate.
  • Resilience – capacity to weather change.
  • Vigilance – with respects to medications, nutrition and all the rest.
  • Welcome mat remains – loved ones and/or want you to remain where/as you are.
  • Prospects for continued life of worth – still able to sustain connections, joys and good reasons to live.
  • Maintenance of personal freedoms – maybe not triathlons but little pleasures and exertions.
  • Cognitive integrity – capable of humoring oneself or being humored, being happy now and then and having purposes for staying around.
  • Comfort and companionship – if not the equal of distant halcyon days of yore, at least good enough, all things considered.
  • Freedom from feelings of unchangeable boredom, loneliness, isolation, helplessness or captivity!

At some point near the end, palliative care is vastly superior for quality of life, peace and a modicum of remaining good life than are high-tech medical interventions (e.g., multiple chemo or radiation regimens, surgical procedures or experimental therapies). Living longer and living better are not the same. Continue only so long as the lights are on.

Absent these conditions, serious consideration might be given to a one-way holiday in Switzerland or some other suitable environment for pondering and acting upon ars moriendi (i.e., the art of dying).

The co-authors offer their respective views on these two phases of aging, starting with Don. Our perspectives are followed by participant champions whose contributions to the theme are presented in alphabetical order.

 

Don on Frailty and Death

When life seems hard and tough, largely because it is in fact becoming more and more insufferable with little relief likely, maybe it’s time to ponder a few last ditch wild and crazy possibilities.

Why not risk a bit of danger, real or imagined, at a time in life when you have so much less to lose than ever before – and at a time when there probably is not much adventure, stimulation and excitement in your life?

If giving such a suggestion seems intriguing, begin the process by brainstorming a few frailty-diversionary initiatives. Think about things you almost did in earlier times, but decided against because of time or costs involved or because they seemed reckless or unsafe, albeit good fun. Many have had such moments, times when your friends took the plunge into troubled waters – literally,  by diving or leaping off a cliff into a quarry or other off-limits swimming hole, uncertain of possible dangers, inanimate or otherwise, that might lurk below the surface. (Yes, I write this from personal experience and shudder at the memory.)

Brainstorm a range of such daring adventures, narrow the list for reasons of sensibility or practicality, select a plan of action and then, with boldness, panache and maybe humor, go for it? Of course I’m not recommending quarry dives or other high risk actions – I’m thinking more along the lines of daring amusement rides. Unlike a quarry dive, if things don’t turn out so well, your relatives can sue the operators. Kidding.

In all seriousness, here are a few examples you might consider. A likely goal for doing one of these or other glorious stunts might simply be momentary relief from whatever it is you might be enduring:

  • Ride the Skyjump at the Stratosphere in Las Vegas, or the roller coaster Desperado in the nearby town of Primm. The former gives you the thrill of walking off a building and suffering not so much as a scratch (heart attacks are optional); the latter provides a beautiful view going up – before you plummet the other way at 90 mph.
  • Take a cruise along the Amazon rainforest.
  • Do a bungee jump (much safer than leaping off a rock into a lake or river).
  • Go on a safari in Kenya.

Other, more serene but equally valuable and worthy options might include:

Walking or having someone guide you across a few of America’s most famous or historic bridges, particularly the Golden Gate and Brooklyn spans. Or, if you have so far missed one or more of our amazing national treasures, visit the memorials and museums in Washington, DC (all free, by the way) and/or our national parks, particularly Yosemite, Yellowstone, Grand Canyon and Glacier) – or others you might have heard about but have not so far found time to experience.

As for death, well, like so much else during the splendid play of life, the best way to deal with the final act, assuming you get to have any options at all, depends. It depends on your circumstances, whether death is immanent or predictable, your beliefs and support system and much else. No one kind and manner of exit can be recommended – it is not always or even often a personal choice. Throughout human history, most have not had much choice as to how or when to die, thanks to infectious diseases (e.g., pneumonia and influenza, tuberculosis, gastrointestinal infections and diphtheria), wars, starvation, accidents, natural calamities, wildlife and, in recent times, chronic diseases.

Bottom line in question form: If you have a choice in your manner of death, why not carpe diem, that is, seize the (final) day?

Jack On Frailty and Death

Deal with mortality – your own, head on. Keep the idea of death present in your consciousness. Use the reality of your eventual demise as motivation to render each day special, as another gift to be enjoyed. Among the possibilities within your control are the following:

*  To evaluate options. Do so while the opportunity exists. Recognize that if you delay, physical and/or mental declines may close off alternatives.

*  To insist, ensure and otherwise communicate to one and all that you are the one who calls the shots.

  • To take into account the feelings and wishes of your loved ones.
  • To resolve not to be a burden.

I plan to control my fate, to the extent possible. Doing so has not often been the case. Earth has hosted about 100 billion homo sapiens on this planet over the course of about 200,000 or so years, even more if you add guesstimates of earlier homo species numbers. Few had much choice about final exits.

My wife and I are on a list for continuous care, though neither of us has given any thought to organizing our things and packing our suitcase anytime soon. That will be a judgment call hopefully still some time to come. In any case, we plan to stay a few steps ahead of Mr. (Grim) Reaper and his cousin, Mr. Whereinhellami.

Participant Champions Reflect on Frailty and Death

Jon Adamson – Jon reported that frailty and death are not topics he likes to think about while still healthy and active. Not unlike most people, he said, I unconsciously assume things will go on more or less as in the present. Of course, consciously and intellectually, I know better. 

One reason older folks adopt this perspective is an assumption, often true, that not much that can be done about eventual, unwelcome changes. Jon described a recent visit to a senior living establishment newly opened near his home and immediately discovered he had nothing in common with the program on offer – and left hoping never to return there, or to a place like it.

Yet, Jon has taken relevant action, namely, creating a well thought-out estate plan. With good evidence, he thinks his lifestyle extends the eventuality of frailty and death as far as possible, yet still recognizes that, the most ideal of lifestyles will cease to hold declines at bay. Asked,  what then, Jon replied, with gallows humor, I’ll let my spouse or kids deal with the situation. But then, he added, maybe I’ll change my mind – maybe I’ll do more, particularly when something comes along to motivate more attention to such matters. For now, however, the status quo feels just fine.

Winston Allen – Winston has given more attention to these looming realities than most. While he reported not yet experiencing frailties that inspire doubts about his joie de vivre levels, he has prepared for these eventualities. A short while ago, he moved to an attractive continuing care facility in Saint Augustine, FL. This has been an altogether positive move for Winston – it relieved his children from worries and responsibilities and, at the same time, enriched his remaining days or, better still, years if not decades!

Winston, as contrasted with the reaction by Jon Adamson noted above, perceives the facility he found to not in any way look, feel or be experienced like a stereotypical old age home. It has varied communities offering a neighborhood-like ambiance. There are ordinary homes, apartments and, most consequentially, a wellness/fitness center. The move enables, on an as needed basis, skilled nursing resources and even memory care for assisted living. Winston is particularly attracted to the 25-yard heated lap pool, the fully equipped exercise room and the safe, low traffic bike and run routes. He also appreciates the healthful dining services, the wide range of social activities and the presence of interesting, successful people from all walks of life.

When the time comes when he can no longer compete in triathlons or other sports, Winston will have plenty of other interests. Like other triathletes he’s known over the years whom he considers overachievers with plenty going on in their lives, Winston seems confident that he’ll know how to manage the culminating challenge of life. When he reaches a stage when unable to rise, or get to a bathroom or feed himself, he intends to stop cooperating with misery, to cease doing what prolongs unceasing discomforts or worse. At that time, he will facilitate a welcome encounter with the architect of his existence. To this, he added, I’ve had a wonderful life!

David Arst

On March 6 I crashed my bike and broke my neck. I suffered a concussion and was in a neck brace for ten weeks. My helmet saved my life. While the break did not require surgery, recovery has been slow. My back is very bad, which effects my legs so I can hardly run and sometimes even walking is difficult. I continue to exercise almost every day, but it doesn’t take much to wear me out.

David described these limitations as being very depressing, noting that a lot of old people are depressed and that it’s no wonder why. In positive NDY fashion, however, he lists a few little steps that can help one to to stay positive, day to day, despite it all:

Taking time to relax, keeping your mind active, trying to be creative, getting into a routine, getting a good night’s sleep, if possible, trying not to be alone a lot, maybe getting a pet and trying to do something for someone else. Probably an antidepressant would help although I’m not much into medication if I can avoid it. Finally, of course, is some strenuous exercise, if possible. These things have helped me. 

On the matter of mortality, David added: Don’t worry about the eventuality of death. If you dwell on it, you might need help from a counselor. 

Roger Brockenbrough – Roger declared that there are five things he knows about frailty:

  1.  I‘ll give up driving before I give up my bike.
  2.  If I forget where I parked my car, I’ll just leave it there.
  3.  If I forget just one more name, I’ll at least have a frail, if feeble excuse.
  4.  Frail is definitely better than feeble!
  5. The way to manage frailty is to just keep on keeping on, the best you can.

Roger also knows five things about death, as follows:

  1. I will NOT be late for my funeral.
  2.  I do NOT want to be buried with my bike.
  3.  I will not come back to haunt you.
  4.  I will procrastinate on this part of my journey as long as I can.
  5.  I might take a page from the funeral customs of the indigenous Canadians – I’ll leave instructions noting that when the curtain drops, send me off on a  floating ice patch!

 

Elizabeth Brackett – Elizabeth said she had a very Protestant attitude toward frailty and death, something that became apparent after marrying her second husband, a Catholic, lapsed, but still a Catholic. Catholics approach death, at least the ones I know, with a much more realistic attitude than Protestants.  The caskets are open, the wakes go on for hours and the funerals are celebrations of life. Now with Protestants, the casket is never open, if there is one. The funerals are lovely but a lot shorter and, in my family, followed by a cocktail gatherings at home. Sometimes it’s hard to remember that someone died! In other words, denial plays a big part in the way Protestants deal with death. When my husband started telling me that I might actually die someday, I told him the topic was not up for discussion. He rolled his eyes.

But, I eventually became more realistic about my eventual demise. We purchased long-term care insurance and discussed the possibility of downsizing.  We live in a big place with lots of stairs – and we enjoy using them. At some point, they’ll be too daunting but until that happens, we’re staying where we are.

I occasionally lift the layers of denial and peer into the future at a time when my body will let me down, a time when swimming, biking, running and maybe even walking will no longer be possible. I don’t know what would be worse – losing my physical abilities and having the mental capacity to know it, or losing my mind while my body remains strong. Given my years of training, it’s likely to be the latter.

Of course, neither sounds very appealing. I fear that my resting heart rate of 46 BPM will keep my body going when I no longer know what a heart rate is. Contemplating these unpleasant endings sends me back to my standby coping mechanism – denial.

So far, it’s working just fine.

Margaret Bomberg – Margaret mentioned two kinds of frailties that come to mind when asked about frailty and death – 1) those that arise suddenly, unexpectedly and that are temporary, and 2) those that are usually gradual, inevitable and permanent. I’ll mention two of the first kind, then address the latter – those brought on by the passage of time and the loss of vitality with aging.

The sudden kind seemed no different in recent years than than when I started training in my early 60’s. I broke several significant bones, including a collarbone (clavicle) because I did not stop running in time and I suffered a broken neck when I fell off my bike and descended 25 feet down a road during a century ride. In both cases, recovery was swift and there were no lingering injuries.

I do acknowledge the gradual kind – it’s likely there will be frail days ahead, but this physical status does not seem seem immanent. My mother lived to 95. All things considered, including the fact that my siblings are also bike riders, frailty seems long enough away that the three of us will soon be off for ten days of riding in Southern France.

Susan Bradley-Cox – Susan stated that every adult with any sense at all knows that frailties and eventual death are associated with old age, even though most probably manage not to think too much about such things in order to keep worry and stress at bay. Active athletes are probably more conscious of these realities, at least the frailties part. We all have to adjust our activities as we age…but I continue to believe that there is still so much out there that I haven’t done and want to try doing before it’s too late. Experiencing new adventures and enjoying just being active are important to me.

A frailties strategy I gained from my dad when he was in later life was to be sure to have lots of young friends. I’m fortunate in this respect – I work with young people and interact socially with friends of all ages who keep me focused on staying alive, staying alive in a sort of Bee Gees Stayin’ Alive (1977) sense.

Although death is deniable in that it can be (sort of) put out of mind, for a while, it remains inevitable, natural, universal and a fact for all life forms. My view is that when quality of life is gone, why exist? I do not want to be a burden on my family. When that time comes, my intentions have been made clear – pull the plug!

I’d like to end my reflections on this topic on a sweet note, just as I’d my wonderful life to end in such a fashion. How better than to remind loved ones and others to love, as so well described in a few excerpts from the poem, The Paradoxical Commandments, by Kent M. Keith:

  • People are illogical, unreasonable and self-centered. Love them anyway.
  • If you do good, people will accuse you of selfish ulterior motives. Do good anyway.
  • The good you do today will be forgotten tomorrow. Do good anyway.
  • Honesty and frankness make you vulnerable. Be honest and frank anyway.
  • What you spend years building may be destroyed overnight. Build anyway.

Ken Fleischhacker – Ken said frailty and death, though inevitable, are difficult to grasp and almost impossible to manage successfully. One reason is that there are no universal standards of success in managing either. Cultures vary in these matters, as do religions, personal preferences and opportunities. We’re on our own to try as we might to make the best of each when the time comes.

In an analogous way, I look at frailty and death somewhat as I view athletic training. I never schedule a day of rest, because I know that along the way there will be days when training will be put on hold, due to unexpected situations.

When young, I was fortunate in that rest days were far and few between. Now, as I get older and frailer, more unexpected diversion days seem to occur. Regardless, I still schedule athletic and personal plans as in the past, moderated only by what the aging process throws at me.

When I eventually find that my training days all become rest days, I’ll reluctantly sell my home, my athletic toys and all the rest in order to take advantage of my long-term insurance policy.

I’ve elected to pass on life-support, should that option present itself. I don’t want to be a burden. I prefer a simple funeral, with maybe a rendition of Bach’s Air on a G String.

Pat Fossum – I’m well aware of frailty; I deal with it by working out and giving close attention to diet, especially taking care to include enough calcium. As for death, I’ve completed all necessary legal documents (power of attorney, etc.) and made sure everything is current and in a known location.

Bruce Hildreth – I had no medical history of note until I reached 65. My health had been perfect. Then it started – nearly every year, one thing after another. Back surgery, blood clots, double vision, leg neuropathy and exercise asthma. I’ve been competitive all my life but this changed my perspective. Even though I could make the podium in most local races because of the few entrants in my age group, I just didn’t feel like competing, as my times increased significantly. I’ve had a great competitive life but now I participate for the social and health aspects. Fortunately, I have many other interests and hobbies to keep me occupied. I know others faced with declining health continue to train hard and maintain that competitive spirit. Good for them. I’ll support them at races. I can still enjoy the memories.

This philosophy of acceptance has progressed to my mortality. It’s coming. I know it. I can actually feel it. I’ve had a great life and I’m OK with this ending. But I’ll enjoy every moment until it happens.

Roger Little – At 78 years of age, I can’t ignore the prospect of death. Since my lifestyle, so far, has kept me feeling well and fatal diseases at bay, I don’t consider death imminent. I think of it as possibly ten years or so from now, so it’s sufficiently far into the future that I don’t dwell on it.

But when I do think about it, like now, I ask myself: What I can expect and how my lifetime of training and triathlon competition might help. Here are some considerations that came to mind related to longevity, health, fears and hope.

  • Longevity. While all I’ve learned along the way suggests lifestyle contributes positively to years of life, I definitely do not live as I do for the purpose of life extension. It is, however, a beneficial side effect.
  • Health. Being healthy and feeling well as long as life lasts are vitally important factors that make all the training hours well worthwhile.
  • Fears. We all can accept dying eventually, but no one wants to die after lingering in a hospice, semi-conscious or in pain, worrying family and friends for months.
  • Hope.  I hope that somehow all of my training and competing will result in a clean, quick death. I want to sprint across the finish line, not crawl down Ali’i Drive to the finish.

Sharon Roggenbuck – So far my body continues to function as it should, just a lot slower. I don’t have physical problems or frailties keeping me from exercising and competing, but I know the day will come when I have to change the way I do things and adjust to a different mode.

I hope that day is still a long way off. As for death, the final stage, I used to say I wanted to live to 100. Now I’m not so sure. I spend a fair amount of time visiting a friend in a memory care unit. Seeing what life can be like, so different from what I’ve known and experienced, has changed my thinking about the desirability of lasting to the century mark. Fortunately, my religion relieves me of responsibility in the matter. My hope is that I will have my mind intact while retaining the ability to function until God calls me.

I hold no grudges, have no enemies, no regrets.

Bill Ziering – I have had many experiences lately that feel like I’ve been wrestling with the Grim Reaper. Closing in on my 90’s, I’m now the USAT poster boy for injuries. Everything hurts, particularly what’s left of my pride. In every event, I wait in vain for the endorphins to kick in but, I suspect, these chemicals retired many yesterdays ago.

Still, until recently, I continued to train, head forward, not daring to look back. Gone was the spring to my step. My posture more resembled the Leaning Tower of Pisa than the standup athlete I was just a short while ago. Biking hills is how I used to separate myself from the competition; nowadays the slowest of the slow wave as they zip on by. Only open water swimming is not handicapping – the fifteen additional pounds housed in my paunch grant provide a welcome compensatory buoyancy.

With the inevitable end in sight, I’m becoming more reconciled to whispering nada mas. After all, this is not my first retirement. I must confess while the triathlon ride has been unbelievably joyful and thrilling, the practice of medicine was my primary career and that might be my ticket to heaven.

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No contributions from

Lockett Wood

Elaine Croissant

Dwight Lundell