Geriatric Care: Finding Meaning in Caring for Elders

An older woman does yoga on a lawn.I work part-time in a geri-psychiatric ward where my title is recreational therapist. What that means is that when elders are committed to this hospital ward, usually involuntarily, within anywhere from 72 hours to one month they are termed “gravely disabled and in dire harm to themselves and/or others.” Along with individuals that are in a psychotic phase of their schizophrenia and those suffering from bipolar episodes, a large percentage of those admitted to our facility have dementia. When the people with dementia are admitted to the facility, they usually arrive in a stupor of confusion. The confusion is often exasperated because they have not been eating or have been unable to sleep for days. It is tragic to see elders, who I imagine once had interesting lives, be incapacitated in a society that does not have the ability to handle, heal, or fully understand them.

The procedure, after they have been admitted to our facility, is a psychiatrist’s assessment on their disability and prescribed medications to help to calm and reorient them. While they are adjusting to medication, they often feel nauseous, dizzy, and/or confused. Many sleep for a few days to regain some equilibrium. Further disorienting, is that their senses are impaired. Few arrive with their glasses, and thus can’t see well, many also have hearing loss and have lost their hearing aids in the transition. A majority of them are in a wheelchair or can only move with the help of a walker.

I have only worked here a short time. As a marriage and family therapist and registered art therapist, I have a strong background working with elders. I co-wrote a chapter about using art therapy, when working with people with Alzheimer’s, in a book entitled Art Therapy and Clinical Neuroscience. Even with my experience, I was not prepared for the intensity of this environment. For the first few weeks I was overwhelmed by the heavy energy I felt witnessing the suffering of these people. It affected me to such an extent that I experienced many sleepless nights until I was able to adjust to the environment and understand my part in the healing process. I felt such sorrow at seeing people’s terror and witnessing their limited cognitive ability. I felt some relief when I observed them calmed with the aid of psychotropic medicine.

That is just one component of healing, though. I feel totally confused about what the ultimate solution to their suffering. In bygone years, we had extended families who took responsibility for their elders’ care, as it became necessary. Now, oftentimes, families do not have the capacity to take care of their loved ones and so they live in nursing homes and assisted living facilities. When they become out of control (hitting, not eating, not sleeping, depressed, etc.), they are sent to us to be re-regulated. Many are lonely and unable to care for themselves. You often hear the women making statements with great urgency like, “I have to go home now to take care of my husband,” or “I need to get home now to take care of my children.” These statements persevere for hours.

I am confused about this system that, when it comes to the old and infirmed, I feel is broken. However, I don’t know what the solution is in making it better. I feel a large component to the healing in our facility is in the job I do with them as a recreational therapist, coupled with the care the nurses, social workers, and doctors provide. As a team, we all try our best in offering our compassion, patience, and understanding. I feel my job as a therapist is to help care for their souls.

Once these elders come out of the stupor of drugs, and medical problems are treated (from thyroid imbalances, urinary tract infects, body sores, etc.), they spend a few hours a day with me in a small group. I also work with some on an individual basis. When I work with people, I try to stimulate brain activity through creativity, activate long-term memories, and, in short, stimulate neural connections.

Erik Erikson called the last phase of life, for those over 65 years of age, Integrity vs. Despair:

“As we grow older and become senior citizens, we tend to slow down our productivity and explore life as a retired person. It is during this time that we contemplate our accomplishments and are able to develop integrity if we see ourselves as leading a successful life. If we see our life as unproductive, feel bad about our past, or feel that we did not accomplish our life goals, we become dissatisfied with life and develop despair, often leading to depression and hopelessness.”

I find that reminiscing is a wonderful, healing activity for elders. Reminiscing promotes individuals taking pride in their well-led lives. People with memory loss lose their long-term memories last, so when coaxed to talk about their youth, families, adventures, interests, and careers, they brighten up as the memories flood their minds. I am always trying to stimulate their brains and endorphins by introducing topics that they can embellish with stories of their lives. These memories bring back feelings of pride because rich memories reinforce meaning in their lives; they remember what was interesting, loving, and fulfilling.

Almost daily, I do some type of art with them, utilizing paints, colored pencils, markers, or pastels to create simple abstract marks on paper. I also have them create collages, manipulate clay, or create stories with miniature toys (my adaptation of sand tray work). Some elders are able to be more sophisticated than others. Seldom are they able to create a figurative statement in the work. They enjoy the act of just moving their hands across the paper, often with my help. Many are able to admire their final product. Sometimes we talk about feelings that are generated from making the art. I often place the finished works on a bulletin board so they can be admired by staff and clients alike. It gives them great pride to see their work displayed.

Other activities I do include stretching (influenced from my yoga teacher training), simple visualizations, and body awareness exercises. I always play music, which is can be calming and healing. Sometimes we play percussion instruments to a CD playing in the background. For those able to stand, we dance, and for those who are chair-bound, we move our limbs to the beat of the music. Music played is eclectic: staples from the 1940s, 1950s, and 1960s, world music, classical sounds, and easy listening contemporary sounds.

All of these techniques work. Most people leave the room after our session with a smile, feeling less anxiety and confusion and, I hope, a small sense of intellectual connection. Many of them thank me for the “great time” they had. Often when I return the next day, I find the elders are sitting in the recreational room waiting for me to begin the activities.

Last Monday when I arrived, I noticed a new patient, Lydia (not her real name), sitting on a chair in the hallway where patients are often placed so nurses can monitor them. She was a small woman, shrunken by age with osteoporosis curving her spine. Her eyes were closed and she was unresponsive to my attempt to say hello. I read her chart; she was 85, a Hungarian immigrant who had been dropped off the night before by her nephew because of her depression and advanced state of dementia.

After a few days, when she was again able to walk and respond to me, I escorted her into the recreational room. Reading her chart, I learned that she once knew nine languages. As we began conversing I realized she had difficulty creating full sentences in English. I wondered if she had had a stroke that caused aphasia, or as dementia patients often demonstrate with the progression of the disease, had lost the ability to speak in her second language(s). To stimulate our work together, we began creating a cooperative drawing, where I would make marks then encourage her to do the same. She took the paint brush in her hand and, at first with my help, she was able to move it across the paper. Soon the painting became self-generating. Once we had made a connection her story began to unfold. When words didn’t come, she made hand signals and I was able to fill in the blanks. Between her minimal words, hand movements, and my interpretations, I learned about her life.

Lydia said she was not 85, but over 100 years old. She was brought up in a wealthy, cultured, Jewish family in Hungary. Her father was a lawyer. She had attended college and taught school both in Hungary and Austria. She had traveled all around Europe. Big smiles would light up her face while she remembered the places she visited: Paris, Vienna, Budapest, and London. She talked about traveling in ocean liners and on trains. She had fond recollections of going to Costa Rica and Panama. She relished in the pleasure of her memories. I’m not clear if she had come to the United States before or after the 1956 Soviet invasion of Hungary, or how the Holocaust affected her and her family. She did say her father lost everything when he came to this country and, stated sadly, that he never recovered. She was married twice and never had children. As we talked about her past, the topic of her clothes came up.

“Oh,” she said, “I was very elegant; I wore long white gloves, beautiful hats, and jackets with fur collars.” She has sparkling blue eyes, a wrinkled face, and remnants of reddish blond strands in her thick grey, shoulder-length hair. I imagined that she was quite a “looker” in her day.

Lydia said, “Life was good then, but now it is not so good,” and she expressed that she “wanted to die.” I was empathetic as I listened to her story unfold. I really do understand; once she had a full, independent life with choices and now she is infirmed and committed to a psychiatric ward. Her intellectual abilities are diminished and she spends many hours of each day sleeping in a chair. Everyone had died except for an indifferent nephew who had dropped her off at the hospital and hasn’t been back to visit since.

When Lydia talked about dying, in a philosophical moment I said, “The yogis say that we are given a certain amount of breaths in each lifetime, and when we have taken the last breath allocated, we are ready to die.” Her face brightened. “Yoga,” she said, “I studied yoga.” She made many hand motions when words did not come to her lips to express her excitement at the recognition of her past. I explained that I was also a yogi and demonstrated some simple postures; she smiled with glee and nodded her head in yes motions as she mimicked what I did from her chair. She was coming more and more to life. In attempting to recollect the yoga world of earlier days, I mentioned Krishnamurti and she acknowledged she had gone to Ojai to hear him speak many times. As synchronicity would have it, I realized that in the CD collection I brought to the ward there was a Donna DeLory CD of Sanskrit chants. I played it for her. The first track was the Gayatri:

Gayatri is  an ancient Sanskrit mantra that means: “Oh God, the giver of life, remover of pains and sorrows, bestower of happiness and creator of the universe You are most luminous, pure and adorable. We meditate on Thee. May you inspire and illumine our intellect that we may perform noble and virtuous actions.”

Bliss filled her face, “Oh, oh, oh,” she muttered and then she began uncontrollably weeping. We joined hands, smiled, looked each other in the eyes, and wept together. She mouthed the words to the chant and pointed to her heart. In trying to understand her she said something to the effect of, “This was what life was all about, the beauty, the knowledge, and now my life is meaningless.” She continued, “Look where she is (referring to the hospital and the other demented patients) and no one understood who she once was.”

As I remember this magical moment in time I again weep for the beauty of the prayer, the love of God, and the luminosity that we shared. The next day when I saw her, she was sleeping in a chair and it was difficult to arouse her. When she was able to again connect with me, she took my hand and we talked; she beamed, recalling the memory the day before. We had bypassed the aging brain that no longer functioned properly in real time, and, together, we found a connection to the “source.”

The late George Carlin wrote a humorous and poignant essay entitled “Views on Aging,” in which he ended his reflection with, “Life is not measured by the number of breaths we take, but by the moments that take our breath away.”

This magical moment in time took my breath away. As I get more involved in this work, it becomes more and more clear to me why I have such a passion for working with elders, even when I am overwhelmed by their confusion and suffering and recognize that these experiences also force me to come face to face with my own mortality. I realize I have a strong calling to help bring elders to the light. I pray that,whoever I am able to touch in my work, can carry this connection with them until they are ready to leave their bodies and pass into the next dimension.

“Death is one of two things… Either it is annihilation, and the dead have no consciousness of anything; or, as we are told, it is really a change: a migration of the soul from one place to another.” ~ Socrates

© Copyright 2009 by Ruth Subrin MFT ATR, therapist in Santa Monica, California. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Viera

    Viera

    November 19th, 2009 at 3:18 PM

    It must be so weird, and more importantly, so sad for older people to see that they are being considered non-productive…especially after the retirement convinces most of them that they are not worth doing anything anymore.

  • Grace

    Grace

    November 19th, 2009 at 5:00 PM

    It is so sad to see the state of many geriatric patients and the ways that they are mistreated not only by the system but also by their own family members. It is a good thing when there are those who care about their well being and who do the most that they can to make the limited time that they have left positive and uplifting. It is too bad that there are not more people out there who feel the need to give back to this community.

  • Katherine

    Katherine

    November 27th, 2009 at 12:26 PM

    I can relate. I was an administrator in a nursing home that had a secure unit within it. I saw new patients arrive that would literally fight tooth and nail with family, screaming all the way in the doors and refuse to ever see them again for dropping them off there. Then there were the arrivals that would have this terribly haunted desolate look about them and were terrified. Being able to chat with them one day and enjoy their company and for them to have no recollection of me or us doing so the next was something I never got used to. I can’t imagine how family must feel, to see a glimpse of who they were before dementia took them over, and then it be gone just as quickly. But those times when the residents were able to recall their lives with open hearts and eyes shining with clarity, those were some of the most precious and memorable of my life. I’ll never forget any of those wonderful souls that I shared those moments with.

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