December 14, 2010

how old are you, really?

yesterday we visited "nursing homes" as part of our current study of medicine for the geriatric population. I went to possibly the nicest version of a retirement/nursing home that has ever been created. In order to move into this community, you have to basically prove (via medical screen, interviews, history) that you'll be able to live completely independently for at least 2 years. Most people move into to condos that surround a central restaurant/pool/gym/community center area. The residents who live here are involved in the greater community, some work part time, many volunteer, and lots are involved in the running of the community itself.

But, if at any point the residents need more assistance, they transition smoothly into (what I think should be called level 2, but they call:) Residential Living, where you move in to your own room in a big lodge-like building. But the rooms are still individual, you can still access any part of the entire campus, but there's a closer restaurant/gym/pool in case you don't want to leave the building daily. The hallways are full of open doors with a sign with the person's name, umbrella stands, small tables and chairs, photographs, bookshelves - altogether, much more cosy than any hotel or college dorm.

If you have a stroke or your health deteriorates in any other way where you need even more assistance (incontinence, decreased unassisted mobility, trouble eating independently) - you can move to (what I'm calling level 3, but they call:) Skilled Nursing Floor. Which still looks like hallways of rooms in a lodge that are more individualized, except that the beds are all the same and adjustable, so that the nursing staff can easily move people. This is usually the final move for most people and the people there looked very settled, but there is a fourth level (3.5?) called Long-Term Care, which is specifically designed for people with dementia. This area has been designed to be easily navigable (e.g. circular hallways, so no one can get stuck in a corner).

I went to one of the condos in the Independent Living section that looked a lot like the condos my grandparents live in (near the tennis courts and pool, where they play almost every day) - and how I imagine many sections of Florida might look: nice, clean condos all filled with people over the age of 65 hanging out and enjoying each others company. Except all the people know that they're going to live there until they die.

or maybe that's not so different at all.

I spoke with a wonderful man named Henry who was 75 and had returned from a tennis match with a friend a few hours earlier and was headed to a board meeting for an organization downtown later that evening. He had moved into the community three years ago because he slipped and fell off a roof in his more remote home and realized he didn't feel completely competent living so far from help. He also saw his father move through (the levels of) the community and how his autonomy was preserved as much as humanly possible. He was certainly not someone I would have suspected would live in a "nursing home" community, but he was so happy with his choice.

We talked a lot about the concept of internal perceived age versus external physical age. Henry told me that his assignment for me for the next few weeks was that whenever I was sitting around a table with a group of people to ask them all about their internal age. He said, "you'll be surprised - some people your age will say they feel older, and people my age will often say much younger than you think". I asked him about his internal age - and he said (without hesitation) - 36. When I asked him about why and also, "why not younger, like, 25" (which we're learning is the peak fertility, peak physical shape, etc). He said, "oh no. 25 is crazy".

yup. wiiiiise man.

what's your internal age?

From my tea this morning, yet again:

"to me, old age is always 15 years older than I am"
-Bernard M. Baruch

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