Category: Aging (Page 4 of 8)

May 2024

By Richard Fleming

Photo courtesy of Gilberto Parada

My wife and I were awakened by a phone call at 6:03 am on Sunday, April 28. It was Cora, the manager of the care home where my younger brother lived. “I’m sorry to call so early, but Chris is not doing well,” she said. His oxygen level was dropping despite supplemental oxygen. He was not responding to people’s voices. His breathing had become a bit labored and he had been given a small dose of morphine a couple of hours earlier. We had enrolled Chris in hospice in early April because of recurrent aspiration pneumonia, dementia, and Down syndrome. While we knew his time was limited, we were not expecting this particular call at this particular time.

We should not have been surprised, since an omen appeared several hours before the phone rang. My wife’s bedside light turned on spontaneously in the middle of the night. That happened once before, 16 months ago, when another family member experienced a significant health problem. We should have known the light was turning on for Chris.

After the call, my wife and I got out of bed, braced ourselves for whatever may lie ahead, brewed coffee in to-go cups, and drove to the care home. Along the road, I called my sister, who lives in the area, to come as soon as she could.

When we arrived at Chris’ bedside, the sun was an hour above the horizon, the sky was cloudless, and the air was cool. Cora, her face grim, quickly ushered us in to Chris’ room. A hospice nurse sat at his bedside. She gave us a report on his status. He had another lung infection and it was clear his time on earth was drawing to a close. I texted our older brother in Colorado, who quickly responded he would fly out that afternoon.

Chris appeared serene. His eyes were closed and he was breathing slowly. We tried rousing him, but he made no movement. We spoke to him, telling him we were there, letting him know we loved him and that things would be OK. While he did not respond, we hoped our words would breach the barriers to the outside world which were quickly rising in his brain and provide him some sense of solace and security.

His breaths became raspy again and the hospice nurse gave another dose of morphine. His coarse breathing improved and his respirations slowed further, down to six breaths a minute for a while, then to four.

The nurse excused herself, since she had other patients to see that morning. The people left in the room with Chris were our sister, my wife, and myself. We sat surrounding him, hands resting on his shoulders and feet, periodically letting him know we were there. His breathing slowed to three breaths a minute. Then two. Then Chris took one last breath. It was deep and calm. Full but final. We waited. But he had no more breaths to take. After 61 years of a vibrant, challenging, and joyful life, Chris died.

We told him we loved him and to take care, and we asked him to say hello to mom and dad. Did Chris hear our words? Impossible to know, but they issued from our hearts more than from our minds, and had to be spoken aloud.

*    *    *

A commonly-held notion is that a person does not truly become an adult until both parents die. This concept makes sense. It is only after the protective parent figures in our lives are gone that we are fully on our own.

There is a corollary idea I’m beginning to embrace: a person does not fully enter old age until they lose a sibling. It is then that we truly appreciate what old means and what old feels like. (This corollary applies to people who are at least in their 60’s, since young people can tragically lose a sibling.) I’m in my early 70s, and I know that many people in my age range have lost a sibling. But it is the first time for me. And the impact has been profound.

Losing anyone – a parent, a spouse, a close friend – is incredibly painful. Losing a child is a pain beyond any possible measure.

Losing a sibling is different. It is painful, but in a unique way. The loss of a sibling makes a forceful statement about the brevity of life. When you lose a brother or sister, it transforms you. You had the same parents. You shared countless childhood experiences known only within your family. As you grew up together, you jointly wove a tapestry of life so rich and complex it is impossible to explain fully to anyone else, including your spouse and close friends. When you lose a sibling, you lose someone who played one or more important roles in your life – colleague, comrade-in-arms, crew member, peer, competitor, confidante, friend.

Chris’ death has precipitated much reflection. He was a brother, but having Down syndrome, he was much more than a sibling. It is hard to explain, but he was always present, always there, every day of my life, even though he mostly lived with other people. In the days after Chris died, my two remaining siblings and I, along with my wife, spent hours around the lunch and dinner tables, talking, ruminating, and deconstructing our family’s ups and downs over the six decades of Chris’ life, and even the years before he was born. Many things became clearer, though there is still much to sort out. Chris’ influence on our family was profound. His life largely governed where we lived. His life impacted what we thought and felt about our family and each other. It significantly influenced the way our parents treated us. Though small of stature, his presence in our lives was massive.

Chris’ death has closed the door on some important parts of my family’s evolution. It has impelled me to reconsider parts of my past and my future. I will continue living, hopefully for many more years, but it will be without my younger brother.

I feel more like a senior now than I did before Chris died.

*    *    *

All of Chris’ belongings are now sitting in our garage, in random sacks and boxes. Someday we will need to sort through them, but not today and not next week. One thing I retrieved was his eyeglasses, which I placed on top of the piano in our entryway. I see his glasses every time I walk by. Sometimes I touch them. They provide a small measure of comfort and remind me of times past, before the door closed, when Chris graced our home and our lives, smiling, and arguing, and joking, and crying, and walking, and breathing, and frequently saying, “I love you” for no apparent reason. Seeing his glasses makes me feel happy and sad. And they make me feel older, but not in a depressing way. It is hard to explain, but they help me feel more at peace with my place on the path as I navigate hesitantly into the future.

*    *    *

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April 2024

By Richard Fleming

I want to open with warm thanks for all the well wishes for my brother Chris, who recently entered hospice, and for our family. Your words are very meaningful.

I also want to acknowledge the many insightful comments you have made to my posts since I started this blog in August 2022. I have not been responding in the comments section, but I appreciate your thoughts and feedback and have learned much from your perspectives. I am inspired to see how we support each other on this journey into the ages. And it is helpful to learn the strategies people are using to chart their paths forward. Please continue sharing your ideas and experiences.

If you enjoy reading my blog posts, I would be honored if you encouraged your friends, family, and random strangers to subscribe. Subscriptions are free and will bring an email notification to your inbox whenever new posts appear. Subscribers will not be subjected to marketing or advertising.

Photo courtesy of Aaron Burden

Reminiscence is a common pastime for older folks. When we look back, it is gratifying when our memories yield more smiles than frowns. But it is common to see decisions we made in our youth that we would approach differently, if do-overs were an option. Some people see many things they would change. Others – the fortunate ones – see only a few. Of course, there is little point in dwelling on such matters. The past has passed. Not much can be accomplished by speculating on how we coulda, shoulda, woulda lived our lives differently.

At the same time, it can be an interesting exercise to reflect on decisions made earlier in life and how they impact us today. Doing so might help us understand ourselves better and inform the choices we are confronting today. After all, we old folks are still making decisions in the here and now that will impact who we become in the future. We may be old, cranky, and stiff, but we are still growing and developing. I expect I will be a different person when and if I reach my 80s. And I think that is true for many seniors.

In the spirit of learning and reflecting, I’ve recently been thinking what I would say in a letter to my 16-year-old self. What would I advise that young guy, standing on the threshold of adulthood? While some elements of my letter may be similar to what others would write to their younger selves, much of it is different. When I was young, my situation and my choices were unique to my situation, growing up in the 1950s and 60s in Topeka. For other seniors, their youthful years unfolded in very different situations with very different choices. Their letters sent back in time would reflect their upbringing and their reality.

So, here is what I’ve come up with.

*    *    *

Dear Richard,

I know you’re getting close to wrapping up your junior year at Topeka High, and you’ve got tests and papers to prepare for. But I hope you can take a few minutes to read this letter from your future. It is impossible for you to know what your life will be like five and a half decades from now. But I want to mention a few things to consider as your childhood wraps up.

Overall, you’re a good person. You’re doing well in school. You have a fair number of friends. You have close connections with some whom you will still be talking with regularly when you’re in your 70s. Be grateful for these friendships. Nurture them. Do not take them for granted.

An area you might want to work on is family connections. While your relationship with mom and dad is good, consider spending more time talking with them about their childhoods and early adult years. You know mom grew up in Baton Rouge and was the first in her family to go to college. But you’ve never talked with her about what it was like growing up in the South, how she decided to go to college, what her two siblings thought of this decision, and why she joined the Army during World War II.

Ditto with dad. His upbringing in New York City during the Great Depression was eventful, but you’ve never asked him much about it. You know he was a paratrooper during WW II and was in active combat zones in the Philippines. He parachuted onto Corregidor and brought back his parachute with a bullet hole in it. But you’ve never sat down with him on a cold Kansas winter night in front of a warm fireplace to ask him how he felt about his wartime experiences.

You should also spend time getting to know your grandparents, uncles, aunts, and cousins. You’ve had little contact with them. Write them letters. Call them on the phone.  As your 72-year-old future self, let me tell you I miss knowing more about our family. It is a sizable hole which can no longer be filled in.

Three last pieces of advice: (1) You should exercise more. You’ll feel better and be healthier 50 years from now. Plus it can be fun. (2) Please eat better. Less fast food. Bobo’s burgers are delicious, but they will linger on your frame for decades to come. You will feel better and look better 50 years from now with a healthier diet. (3) It’s probably too late for this last one, but I wish you had signed up for shop class at Roosevelt Junior High. Your life will be so much easier in the years ahead if you know what torx and hex screwdrivers are and understand how to use socket wrenches, ballpeen hammers, and other basic tools.

These suggestions might seem unnecessary or inappropriate. But please consider that your decisions in the next few years will reverberate and echo long into your future. Trust me on this, they will in large measure determine who you will be at age 72. No pressure, young man. Just choose wisely. I’ll be here waiting for you.

*    *    *

Well, writing this letter was mildly therapeutic. There are so many other things I should have done differently as a youth, but I’m not going to spend a lot of time thinking about them. If I’d lived a perfect life as a teenager, I would likely have become an incredibly boring adult. And, who knows, maybe I would not have ended up living in California and would have had a very different family. I must have made enough good choices as a young fella, since I am happy living in the Bay Area and have a wonderful family.

So, maybe there is little to be gained from writing a letter to my younger self. Perhaps in the spirit of sharing wisdom I should write a letter to my 85-year-old self? Naw, for a couple of reasons that would not be a useful way to spend my time. First of all, the garage still needs to be decluttered. And secondly, if I make it to 85, I’ll likely be even more crotchety and less willing to listen to advice from a young guy who’s only 72 years old. What could he possibly know?

*    *    *

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April 2024

By Richard Fleming

Photo by Richard Fleming

My younger brother Chris has Down syndrome and dementia, and he is rapidly growing old. Down syndrome individuals age more quickly and have shorter lifespans than other people. The past month has been particularly trying. Since turning 61 in March, Chris has been hospitalized twice with pneumonia. His throat muscles are weakening, making it hard for him to protect his airway. Saliva, food, and stomach contents can easily leak into his lungs and cause pneumonia. Because of these recent infections, his overall strength and stamina have declined significantly. He can no longer walk and he requires 24/7 help.

People with Down syndrome are prone to an array of medical problems. One particularly devastating condition is dementia, which tends to progress more rapidly in those with Down syndrome. My brother’s cognition is steadily declining. Three years ago, he handwrote a letter to President Biden with his ideas on how to stop the covid pandemic. He focused on how Biden should get rid of bats carrying the virus. Now, he can no longer write his own name on a piece of paper. Because of faltering muscle strength, he is at high risk for recurring episodes of pneumonia. Each infection will take more out of him. And they will become harder to treat because of antibiotic resistance and lung damage. Aspiration pneumonia is among the leading causes of death in Down syndrome.

It is very sad to witness my brother’s deteriorating health. Chris has had a remarkable life in many ways and has touched many people’s lives. In his 20s, he was a spokesperson for Special Olympics in San Jose. He worked at McDonald’s for 25 years. He developed a number of deep friendships over the years which continue to this day. Chris loves other people with no hesitation and no restrictions. As recently as six months ago, when our sister took him to a medical appointment, he went around to shake hands with each patient in the waiting room – all of whom were strangers – and said, “It’s nice to see you again.” When my wife and I took him to a fast food restaurant late last year, he wandered back to where people were preparing food to say hi to everyone and ask how they were doing.

His impact on our extended family has been profound.

But Chris is far older than his 61 years and his aging process is accelerating. It has become unavoidably clear over the past few months that he is approaching the end of his life. After much discussion within our family, we have just agreed to enroll him in hospice. No one can say how long he may have. Our primary hope is that his quality of life will be reasonably good, and that he will not suffer much physical discomfort or anxiety.

Fortunately, my brother has received excellent care since his health began faltering. His two recent hospitalizations were complex and challenging. More than 50 people helped him through his hospital stays and his out-of-hospital care: EMTs, hospital nurses, doctors in various specialties (emergency medicine, hospital medicine, radiology, psychiatry, pulmonary medicine, infectious diseases, neurosurgery), transport staff, physical therapists, speech therapists, nursing aides, phlebotomists, lab techs, radiology techs, environmental services staff, discharge planners, case managers, pharmacists, hospital unit clerks, the care home managers, the care home staff, the care home’s medical director, hospice nurses, the hospice music therapist, multiple staff members of the NorthBay Regional Center (which provides care for people with disabilities), staff at the durable medical equipment supply company, and others. These individuals treated Chris with compassion, respect, understanding, and expertise. Each had a specific role to play. And the coordination of their work was complicated, requiring scores of phone calls, emails, text messages, voicemails, and conference calls.

It was this intricate web involving so many people that enabled Chris to survive his pneumonias and return to living comfortably in his care home. My wife and I, while driving to see Chris after his second hospitalization, reflected on the vast number of people involved in providing him assistance and care over the past few weeks. It truly was remarkable.

It was also a bit concerning.

The amount of time, energy, and resources required to take care of this one older individual was, and still is, enormous. I am very glad our society is able to provide this level of support. Certainly my family would not have been able to manage his infections on our own. And it would be impossible for us to provide the 24/7 care he needs now. My brother has both Medicare and Medicaid, which fortunately cover the majority of his medical needs.

But my brother’s experience the past few weeks makes me wonder and worried about how other old people in our country will make out in the years ahead.

*    *    *

Our society is aging. When I was born in 1951, 8% of the population was over age 65. Today this group makes up more than 17% of the population. By 2040, old folks will be 22% of the population. Providing high quality care for the growing number of old people will require an increasing proportion of social resources, both financial and workforce. There are currently voices in the political sphere advocating reductions in spending and benefits on programs like Medicare and Medicaid, even before the silver tsunami washes ashore. Will these voices prevail? And will there be enough young people in the future willing to work in the organizations and systems which support old people?

Growing old is hard enough already. Having to contemplate whether our society will be willing to help us old folks navigate the vagaries of aging just adds to the stress.

I am grateful my brother’s final chapters will be relatively peaceful. He has all the support he needs, and it includes far more people and resources than a village could provide. His care home manager recently sent me a video of my brother lying in bed as the hospice music director strummed a guitar playing the Beatles classic “Good Day Sunshine.” The weather outside was gray and overcast, but Chris was smiling and singing along:

Good day sunshine
Good day sunshine
Good day sunshine

I need to laugh, and when the sun is out
I’ve got something I can laugh about
I feel good, in a special way
I’m in love and it’s a sunny day

*    *    *

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March 2024

By Richard Fleming

Photo courtesy of Nikoline Arns

“Me, myself, and I” is a well-known expression. It first appeared in a classic 1937 Billie Holiday song written by Allen Roberts and Alvin Kaufman. The song’s first two stanzas are:

Me, myself and I
Are all in love with you
We all think you’re wonderful
We do

Me, myself and I
Have just one point of view
We’re convinced there’s no one else like you

Holiday’s song is powerful and heartfelt. The phrasing shows how deeply her emotions run. Every part of her is in love.

But there are other ways to understand the words “me, myself, and I,” especially when considering seniors. For us, these three pronouns are not simply different representations of the same thing. Rather, they can be seen as symbolizing the three dimensions in which seniors’ lives unfold.

Here is how I see it: “Me” means my physical body. “Myself” refers to my mind and what is going on inside my thick skull. And “I” represents how society views me.

Let’s look at each pronoun – each dimension of growing old – in turn.

First, me. Me refers to my body. This body is clearly growing older. Though I am lucky to have dodged some serious ravages of time, the corpus is deteriorating. Whether it be my joints or my muscles, my hearing or my vision, my metabolism or my skin, all have seen better days. Which aspects of physical decline I find most bothersome varies from one season to the next. This spring, I dislike how quickly my stamina fails me, how easily I grow tired. In the past, I could accomplish multiple projects with energy to spare. Not anymore. Even completing a couple of chores like watering the plants and cleaning the garage can require a time out. When summer comes, perhaps I will be more bothered by my declining hearing. Hopefully a hearing aid tuneup at Costco will help. By the time autumn arrives, my irritation may turn towards my knees getting stiffer. The slowing down of the human body affects all old folks, including me.

Next, myself. While my body is declining, my mind still lingers under the illusion I’m much younger. Some days I feel I’m in my early 40s. Other days I’m in my late 50s. Rarely do I think of myself as being in my 70s. The brain is funny that way. It can play tricks on us. We live our lives day by day, year after year, and we move  forward through time. But our minds often fail to appreciate how far we have traveled and the toll it has taken. After spending five or six decades living vigorously and ignoring the prospect of growing old, it is hard to adopt a self-image of being gray haired, wrinkled, and slower of step. This disconnect between mind and body causes confusion and consternation as I move further into old age. Something does not seem right. My mind cannot fully grasp the reality of how many years I myself have lived on planet earth.

Lastly, I. This third pronoun puts focus on how society views me. When I am out in public, I am unmistakably viewed as a senior. And treated as one too. Often, when I’m in the hardware store, I’m the oldest person there. The clerks sometimes seem a bit surprised to see me foraging in drawers for the right sized screws I need for a home project. In the grocery, I am clearly viewed by young customers as a card-carrying member of the cohort of seniors shuffling down the aisles like a troupe of zombies. Though I feel no different than other customers, young folks are eager to briskly push past me. When I’m spending time deciding what type of pasta to purchase, youthful shoppers try not to show impatience as they quickly grab a box of organic whole wheat penne. And I can’t help but notice that young shoppers tend to avoid the checkout line I’m standing in, no doubt thinking I will have a hard time at the payment terminal, slowing things down interminably. No matter how young my brain feels, I find that society always treats me as an old person.

*    *    *

So “me, myself, and I” carries different meanings depending on one’s age. For the young, it serves as a statement of emphasis. For old folks, this trio of first-person pronouns can aptly characterize the complex levels on which we grow old: physical, mental, and social. Thus: Me. Myself. And I. The added periods are intentional.

With apologies to Billie Holiday, Allen Roberts, and Alvin Kaufman, I want to humbly offer a rephrasing of the first part of their song so it can appropriately be sung by an oldster:

Me. Myself. And I.
Are all in love with you
We all think you’re wonderful
We do

Me. Myself. And I
Have three points of view

For me, your love makes me young again

For myself, being with you makes my mind blossom anew

And I don’t care if society views us as two old turtle doves

Me. Myself. And I. We’re all convinced there’s no one else like you.

*    *    *

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March 2024

By Richard Fleming

Photo courtesy of Jeremy Wong

The human body is comprised of 78 remarkable organs which help sustain normal life. Five – the heart, brain, lungs, kidneys, and liver – are particularly crucial and are commonly referred to as “vital organs.” Other body parts, while important, are not as essential as our vital organs. We can live without our tonsils or appendix. Even our gall bladder is dispensable. But we cannot live without our heart.

In the hierarchy of importance, one internal organ gets short shrift. It is not labeled a vital organ in any medical textbook. I feel it is past time to give this body part more respect. The organ I am referring to is the lacrimal gland, commonly known as the tear gland. We have two of these magical organs, one above each eye. In my view, our lacrimal glands can make a viable claim to be vital organs. Granted, they may not be as important as our heart or lungs. But without functioning lacrimal glands, our quality of life would suffer. And this is especially true for seniors.

Why is tear production so important? And why is it especially valuable for old folks? Tears serve two principal functions, one physiologic, the other emotional.

Physiologically, tears lubricate our eyes. Maintaining moist eyes is crucial for normal vision and eye health. Our lacrimal glands work 24 hours a day to keep our eyes from drying out. If our eyes are not kept moist, we cannot clearly see the world around us and the road ahead.

And lacrimal glands serve an important role in our emotional well-being because they enable us to cry. Emotional crying is critical to healthy living. It is a uniquely human activity. Tears can express feelings of overwhelming joy or consuming sorrow. Crying can be a powerful affirmation of love or a plaintive request for support. Tears communicate with our fellow humans in ways that words alone cannot. Crying can release emotional tension. Without crying, we would tend to keep feelings bottled up inside, contributing to problems like hypertension, depression, and a weakened immune system.

*    *    *

People of all ages benefit from tear production, but this is especially true for seniors. Our lacrimal glands assume greater importance over time, both physiologically and emotionally.

As we age, our eyes also grow old. Our eyeballs stiffen and our vision becomes less sharp. Ironically, this happens at the same time that font sizes on medication bottles and food packages start shrinking. Tear production can help slow the anatomical decline of our eyes, so hopefully we know whether to take that blue capsule twice or three times a day.

And emotions frequently become more intense as we grow older. Aging can be accompanied by feelings of profound happiness. Children get married. Grandchildren are born. We witness the upcoming generations establishing themselves, leaving childhood behind, and taking the baton to work for a better future. Seniors often celebrate these happy milestones with tears of joy.

But a fundamental part of growing old is also the certainty of increasing loss. The toll of family members passing mounts. Friends fall by the wayside. The winding down of our bodies and the unavoidable truth of what lies ahead cannot be denied.

So we older folks also cry tears of sadness. Sometimes we cry in the presence of our family and friends. And sometimes we cry alone, sitting quietly in a bedroom or at the kitchen table. As our years accumulate and our horizons draw closer, tears tend to more frequently reflect grief than joy. But these tears of sadness can be therapeutic and help us deal with the mysterious and uncertain challenges of growing old.

*    *    *

As I think back on my years in medical practice, I recall many memories of old people crying. Rare was the clinic day untouched by tears. So many seniors feeling loss. So many seniors feeling lost.

And I remember the poignant tears of my own aging family members.

My father approaching death from cancer at age 68. He could barely move from bed, and on one visit I leaned in and gave him a long hug. When I finally sat back, he was crying and said, “This is what I am going to miss the most. Hugging.” I had to look away.

My mother-in-law sitting mutely on our family room sofa, unable to speak after a stroke. She sat stiffly, quietly, and then tears began to trickle down her cheeks. She must have known what was to come a few days later. Crying was the only way she could express herself.

My mother, lying in bed at a skilled nursing facility after a stroke left her so incapacitated she could not read. She could not watch TV. She could not bathe or dress herself. As tears ran down her face one day, she said, “Please make me the happiest mom in the world and help this end.”

A few months ago, my 60 year old brother with Down syndrome and dementia, sitting at our kitchen table drinking his morning coffee. After my wife asked him a question, he paused, hit the side of his head a few times, then started crying. “I can’t remember things so good,” he said. Then he took another sip of coffee and stared quietly into space.

*    *    *

We are all traveling further into the dappled light of the deep woods. We each take different paths and face unique challenges, though we share much. As we journey forward, it can become increasingly difficult to recall the beauty and to smile at the satisfactions of a life well lived. Loss envelops us more and more, year by year. Its grip grows tighter. The pain is real.

And our lacrimal glands respond as designed. The need to cry does not diminish. The production of tears is a necessary part of growing old. Crying provides validation, and confirmation, that our lives are filled with love. And with sadness. Love and sadness are interwined. If we did not know love, we would never feel sad. And if we did not know grief, we would never experience the magic of love. As we get older, the connection between love and loss grows deeper and tighter.

And so the tearfall of the old is a necessary part of coming to terms with life, helping us understand our past and accept our future.

Doesn’t it make sense to see our lacrimal glands as vital organs?

*    *    *

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February 2024

By Richard Fleming

Photo by Richard Fleming

Last September, my wife and I visited the Mendocino Coast Botanical Gardens, a beautiful 47-acre preserve south of Fort Bragg, California. It was midweek in autumn, and the gardens were peaceful and serene. While the park’s 13 collections remained lush, the flowers, shrubs, and other plants were clearly settling down for the winter ahead. The air was crisp and cool, and the wind found its way beneath our jackets as we walked along the Coastal Bluff Trail. Looking out over the Pacific Ocean, we saw occasional flocks of birds winging their way south in anticipation of the chilly weather to come.

After a gentle two-mile walk, we circled back to the entrance area and tucked into Rhody’s Garden Café for a light lunch. Rhody’s has an outdoor seating area surrounded by plants of all kinds. When we arrived, the dozen or so tables were occupied, but fortunately we were able to claim one just as an older couple was leaving. As we sat eating a turkey pesto sandwich and a soup-and-salad combo, we looked around and noticed that every table was occupied by seniors. Since it was a Wednesday and schools were in session, it should not have been surprising. But the complete absence of anyone young or even middle aged seemed a mite odd.

We also noted that almost no one was talking. Couples were focusing on their food. Groups of friends were silent. This too seemed a little strange. We were sitting in the midst of an open air plaza filled with old people who were not talking. It felt a bit bizarre, and it seemed we were out of place.

But we then realized that we were not talking with each other either. And we recognized that we too were just a couple of old folks, like everyone else there. We fit the mid-week, mid-September mold at Rhody’s Garden Café to a T. I’m sure no one eating lunch that day thought there was anything unusual about us.

We started chatting quietly and realized there was no reason to be surprised that it was exclusively old folks on the plaza. Most middle-aged and young adults were working and children were in school. So of course it was only seniors who had the freedom to relax in the botanical gardens on that autumn weekday.

But what about the eerie silence? Why was no one talking to their tablemates? I reflected on this and recalled the many times we’d been in restaurants where couples were sitting quietly, not saying much to each other. This seemed to occur more commonly among older couples. I had not previously given much thought to this phenomenon, but being surrounded that day by a group of quiet old people was a bit disconcerting. And thought-provoking.

I realized silence between couples does not necessarily imply an absence of communication. When two people have spent many decades together and know their partner better than they know themselves, their channels of communication run wide and deep. Nouns and verbs, adjectives and adverbs, are not always required to exchange thoughts, feelings, and ideas. Silence does not necessarily mean distance. It does not have to imply absence. Silence may convey closeness. And interconnection. And love.

And a similar phenomenon can apply to seniors who are with a group of friends. They often reach a point where they understand each other so well that sitting quietly is a source of warmth and comfort.

I think it is different for most young people. For them, communication relies more heavily on language. For the young, connections depend on words, spoken or texted. Silence is not a source of comfort. Rather, it is often a reflection of distance and disconnection.

But for many seniors, silence can speak louder than the human voice.

*    *    *

And so we finished our lunch. I got up to return our food trays to the cart. I looked around and nodded briefly at a couple of the old people sitting quietly at their tables. They nodded their heads in response, and faint smiles crossed their faces. In that moment, it seemed we were acknowledging each other’s situations. We were communicating a mutual understanding that we were just old folks, with no young’uns around, enjoying the peace and quiet of the California coast.

And it seemed we were quietly acknowledging, without needing to speak any words, that we were on the verge of entering deeper into autumn, with its golden sun, looming clouds, and falling leaves.

*    *    *

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February 2024

By Richard Fleming

Photo courtesy of Ricardo IV Tamayo

My wife and I recently saw two well-reviewed documentaries – one a TV series, the other a movie – showcasing seniors suffering serious health problems. The first focused on acute changes in old people’s health. The second explored the chronic downhill slide often experienced by seniors. They were interesting. But I also found them disquieting. They made me a bit uncomfortable, akin to fingernails scratching on a blackboard.

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The TV series is called 999: Critical Condition. Over 36 episodes, it presents an intimate look inside the Emergency Department and critical care units of Royal Stoke University Hospital in Staffordshire County, England. My wife is a retired ICU nurse and I am a retired internist, so we thought it would be an interesting series. We could relive some of the excitement without having to experience the very real stresses and pressures that kind of work entails.

The first installment of 999: Critical Condition offers a close-up view of old people being brought urgently into the hospital with possible strokes, heart attacks, and other serious medical problems. It also includes some younger patients coming in after traumatic injuries. The documentary features close-ups of not only the patients, but also their family members experiencing bewilderment, anxiety, and devastating grief. They are trying to come to terms with how their lives have abruptly transformed from familiarity and comfort to strangeness and heartache.

As the show progressed, I found myself shifting around on the sofa, not able to enjoy what I was seeing. Rather than remembering fondly the exciting days (earlier in my career) when I worked in an ER and an ICU, I could not stop imagining what it would be like if I was one of the patients coming in by ambulance. Or if it was my wife.

We only got through one episode. I don’t think I can watch any more.

The vignettes of younger patients did not generate as much angst. I found their experiences in the ER more interesting. I felt bad for these young patients and their families. But their stories were intriguing. And it was easier to maintain my distance from them. I don’t imagine myself falling off a ladder or being hit by a car while crossing the street.

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The movie is a Chilean documentary called The Eternal Memory. Nominated for Best Documentary Feature Film this year, it tells the story of an older couple, Augusto and Paulina, who have been married for 25 years. Eight years ago Augusto developed Alzheimer’s, and it has been steadily progressing. Rather than suddenly changing a person’s life forever, as can happen with a stroke or heart attack, Alzheimer’s slowly robs people of their memories. And losing memories means losing part of oneself. The changes do not happen over days or weeks. They progress over a period of years.

The movie portrays Augusto’s gradual loss of himself in very human and relatable terms. And it tenderly shows his wife Paulina doing her best to support him during his slow downward spiral. The challenges she faces are hard to fathom. She alternates between optimism and pessimism, love and frustration, patience and anger, denial and acceptance. But letting him decline without her is never an option.

This movie also was a bit disconcerting to view. I have one family member experiencing dementia, and fortunately we have an excellent support system in place to help. But the idea of my wife or myself possibly succumbing to Alzheimer’s is too painful to contemplate. If it happens, we will deal with it, of course. But witnessing the difficulties of that challenge in this movie was quite uncomfortable.

Fortunately this film lasted only 85 minutes. I don’t think I could have watched much longer.

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Seeing these two shows was both engrossing and repelling.

In the old days, I used to enjoy programs and movies like these. Stories of old people experiencing the maladies of aging and the ways their families supported them were heartwarming. Not anymore. Now I find these stories heartrending. They’re no longer warm and fuzzy. Now they seem a bit ominous.

Simply put, they hit too close to home.

If I am lucky enough to continue growing older, I wonder whether I will reach a point when these movie and TV themes will again become enjoyable to watch. But this would require a level of maturity and acceptance I’ve not yet reached. For the next few years, I think it’s best if I put myself on a timeout from watching shows about the tribulations and capriciousness of old age. Actually living through the process of growing old provides more than enough emotional stimulation.

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January 2024

By Richard Fleming

Photo courtesy of Nigel Tadyanehondo

Many of us seniors don’t feel as ancient as our birth certificates proclaim. For those who have so far avoided devastating health problems, we typically collect aging’s components slowly. The ailments sneak up on us. Minor joint aches accumulate. The aging of our skin and hair unfolds over years. Stamina dissipates almost imperceptibly. Our trouble recalling names is easy to dismiss, because those people’s names weren’t all that important, right?

And because our physical and mental capacities erode gradually, we can be fooled for a while. But at some point reality intervenes. The mirage fades as the maladies amass. And society puts a stamp on it by highlighting how differently we approach life than everyone else.

What activities mark us as unequivocally old? What features set us apart from the younger generations? I will mention several that I experience, but there are many others. Your results may vary. (Please feel free to add more in the comments section.)

• I do not go out in public wearing pants that are torn and ripped. I would find that embarrassing. While I may sometimes wear articles of clothing that have a hole or two, it’s only because I didn’t realize the holes were there. Young folks wear ripped clothing as a styling statement.
• I often write checks when I need to pay for something. My parents taught me how to write checks carefully and accurately. Knowing there is a clean paper trail for where our cash is going provides a sense of security. Today, though, it seems many young people do not own a checkbook and don’t know what they could possibly be used for.
• I am not very good or efficient with those new-fangled payment methods the rest of society seems to use, like Venmo and ApplePay. I find it intriguing that a person can twist their wrist over the payment terminal at the grocery store and then push their cart out the door. They pay without reaching for their credit card. I’ve just recently learned how to tap my credit card on payment terminals, but paying from my watch is a bridge too far.
• I usually communicate using email. Email still amazes me. It is so quick, so efficient, so useful. But when I email my kids, I rarely hear back from them. If I text, they respond quickly. They tell me no one uses email anymore. Young people appear to view email as a dinosaur, akin to snail mail or corded land line phones. (My wife and I still have those phones.)
• When a person I’m calling does not answer their phone, I tend to leave a voicemail message. Most seniors are very comfortable using voicemail. Answering machines became common household devices when we were growing up, so we became very familiar with this technology (though we didn’t call it voicemail). For some reason, younger generations dislike voicemail and often won’t even listen to it. If I get no response to a voicemail I left a few days earlier, I can safely assume the recipient is under age 50.
• Over the past ten years, I’ve learned to embrace the utility of texting. But I use my dominant hand’s index finger to type one letter at a time. I’m still mystified how young people can type using two thumbs. How can a person enter words correctly that way? When we were growing up, the phrase “I’m all thumbs” meant I was awkward and clumsy. Today, I suppose this phrase refers to a person who can text quickly.
• When I text, I write words in complete sentences. I might text “Are you coming over later?”, while young folks will text “r u coming l8r”. And I always put punctuation marks at the end of sentences. (I still remember the lessons from Mr. McKinney’s 9th grade grammar class at Roosevelt Junior High.) But many young people seem to feel punctuation is superfluous. In their view, putting a  period at the end of a sentence conveys hostility or passive-aggressiveness.
• I don’t participate in what seems to be called… um… chat groups. Did I get that term right? Cognitively, I find it hard enough to keep individual text communications organized. If I had to keep track of what group chat each text belonged to, my mind would implode.
• I still watch cable television. I have listened to young people try to explain to me that cable is outdated. Evidently you can now plug a thumb drive into the back of your TV and watch whatever you want. No thanks. When I want to watch television, I prefer to sit down and relax. I don’t want to be challenged to remember which buttons to push and which menus to navigate through to be able to watch NBC News or Survivor. With cable, it is easy. You turn on the TV and enter the channel number. Done and done.

I’ve barely scratched the surface on the list of traits which mark me as undeniably, fully, and wholly old. I don’t understand most modern slang. I’ve never heard of most of the hosts on Saturday Night Live. I don’t know the musical groups topping the charts on Spotify. I don’t follow any influencers and don’t understand how they are any different from advertisers. I don’t get my news from Facebook or the Gram. I could go on, but…

Mind you, my aim here is not to complain. And I certainly do not mean to disrespect young people. Rather, I just want to acknowledge how gob smacked I sometimes feel about how far today’s younger generations have evolved beyond the Boomers and the Silents. In my younger years, I used to pride myself on being in touch with culture, trends, and social norms. Nowadays I often just feel lost in time and space.

This phenomenon is not unique to the 21^st Century. Generation gaps are timeless. When Boomers were young, we knew it all. And we lamented the fact our elders were stodgy, rigid, and didn’t understand music, lifestyle, politics, and culture. Now we have grown old and can no longer avoid the reality that we too are aging out of many currents of modern life.

But we should not see the novel habits of younger folks as problematic. Indeed, it is reassuring to see the vitality and innovation of the younger generations. They have taken the baton and are now the ones shaping today’s world. I hope beyond hope they succeed in creating a society with fewer problems than the world they are inheriting from us.

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January 2024

By Richard Fleming

Photo courtesy of Stephanie McCabe

For most people, birthdays are important markers of their progress through life. They offer an opportunity for family and friends to celebrate. But some birthdays are considered more significant and are referred to as milestone birthdays. Though their importance is more symbolic than real, they nonetheless are often occasions for larger gatherings and more elaborate parties.

An interesting facet of aging is that our feelings about milestone birthdays change over time. When we are young, they are joyful occasions. As we mature into adulthood, they remain notable, but their importance tends to lessen. And as we grow into old age, those milestone birthdays often evolve into what may be more appropriately called millstone birthdays.

Let me explain.

For children, milestone birthdays are very important. Of course the first birthday is always a cause for partying, even though the celebrant is clueless about why people are wearing funny hats and singing a silly song. First birthdays are milestones more for the parents and grandparents than for the child. The fifth birthday marks the time the child will be starting school. Turning 10 is significant because the person has attained double digits. Three years on, they officially become a teenager. A few years later, they become eligible to drive. Then they become old enough to vote. And before long they can buy alcohol. These are indeed milestone birthdays, marking greater maturation, more opportunities, and expanded responsibilities.

Attaining age 21 is an important marker of becoming officially an adult. A young adult, certainly, but a true grownup. 21-year-olds are viewed by society as more mature than 19- or 20-year olds. Thereafter, milestone birthdays are generally considered to be those when a person moves into a new decade of life. People turning 30 or 40 often have large birthday celebrations. Arriving at an older decade represents a notable achievement. People who like to party often include the five year birthdays – 35, 45, etc. – as milestones and opportune times for large celebrations.

Then comes age 50. Fifty is a big one. It symbolizes the person wrapping up the first stage of adulthood. It signifies a person stands on the threshold of middle age. And 50 is often the birthday where friends and family start cracking jokes about creaking joints. About the difficulty staying up late to party. And about the myriad realms in which vitality is declining.

Sixty is another significant occasion. Even more jokes about aging are offered, but they seem less humorous when we turn 60. The birthday celebrant may force a smile when they read birthday card comments about sagging skin and bowel problems, but what they are really thinking is these statements are too accurate to be funny.

It is when we turn 65 or 70 that the implications of milestone birthdays start to sink in. These celebrations, while joyful, can take on a somber undertone. This is the time of life when moving into another decade begins to feel more like a millstone than a milestone. During our birthday parties, we may chuckle as family and friends tease us about how hard it is for us to blow out the candles on our cake, but is this really so funny? And when we reach 75 or 80, the millstone character of birthdays is hard to deny. We can’t avoid reflecting on the reality we are getting ever closer to sundown.

My next major birthday, my 75^th, will come in a couple of years. I’m sure when that day comes, assuming I make it to then, I will think back fondly on how much more energy I had when I was only 68 years old. And I will recall how much more youthful I felt at age 59. Those were the days, my friend, but I did know they would end.

Mind you, I’m not trying to come across as a curmudgeonly old fella, but I suspect that is exactly how I sound. Truthfully, I hope my luck holds so I can be around for more millstone birthdays. But the uncertainty of not knowing how many I still have gives me pause. I know, on an intellectual level, I should appreciate each and every one.

In the years ahead, whenever I celebrate another millstone birthday, I will smile. I won’t begrudge the young folks – anyone under 60 – who will josh me about the accumulating frailties of old age. I will chuckle faintly when I open birthday cards pointing out I have less hair, worse hearing, and a sketchy memory. I will tell myself that at least I’m lucky enough to still be alive, still spend time with my family, and still be fortunate enough to grow even older. I will think of the increasing number of friends who no longer have millstone birthdays, or any birthdays for that matter.

As I move further down the path into the deep woods, perhaps I will eventually get to the point where I no longer consider milestone birthdays to be millstones. If so, I will have finally made peace with my personal reality of growing old. But I’m not quite there yet.

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December 2023

By Richard Fleming

Photo courtesy of Juliane Liebermann

As the end of a year approaches, people commonly reflect back on the past and look forward to the future. I try not to dwell on looking backward, but instead try to contemplate – with a measure of optimism and realism – what the future may hold. This December, for some reason, I’m spending more time pondering what the future will hold for our grandchildren and their generation. What will their lives be like long after we are gone? And I especially wonder how growing old will unfold for them, a half century from now. How will their journey into old age differ from the road we Boomers are currently traveling?

It can seem hard to imagine our grandchildren growing old. During this holiday season, their enthusiasm, excitement, and energy is boundless. But their youthful vigor belies the reality they too will one day face the challenges every preceding generation had to confront – how to navigate the awkwardness and myriad booby traps of old age.

As I think about our grandchildren’s generation aging into senior status, I feel apprehensive. My concern stems from serious and evolving problems they will likely face as they age. While the impact of these difficulties will not be limited to the elderly – all of society will feel the effects – they will hit seniors especially hard.

Before mentioning these problems, I want to reflect on how growing old today compares to what it was like for our grandparents to grow old. The aging process today is not vastly different from the aging process then. Our grandparents had to manage the same adversities faced by seniors throughout the ages: health issues, cognitive challenges, finding living situations appropriate for their needs, loneliness, and oftentimes financial insecurity.

People’s ability to navigate these problems is always greatly impacted by the social context of the time. Our grandparents grew old in a society with a new and moderately effective safety net. Medicare and Medicaid were established in 1965 and these programs significantly improved access to health care for seniors. Social Security, originally established in 1935, was expanded in the 1960s and helped with financial security for seniors. Society was moving in the direction of expanding people’s rights, with the passage of the Civil Rights Act and the Voting Rights Act. Growing old was not easy for our grandparents, but it was a bit less stressful than it had been for their grandparents.

Today, the societal context in which we are growing old is fairly similar to that of our grandparents. The challenges we Boomers face with aging are roughly comparable to those they encountered a half century ago.

But for today’s youngest generation – Generation Alpha – society might be radically different when they grow old. There are worrisome trends which could adversely impact the process of aging later this century. Two of the most concerning are climate change and artificial intelligence.

On the problem of climate change, unless we significantly reduce greenhouse gas emissions, global warming will be much worse in 50 years. The environment will be more difficult to live in for everyone, but especially for seniors. Extreme weather events will become even more frequent than today. Heat-related illnesses and infectious diseases will likely be more widespread. Old people’s bodies are less resilient. We are less mobile. We are more dependent on an intact medical care system. These realities make seniors more vulnerable to global warming. International and domestic climate migration (away from coastal areas and intolerable heat) will almost certainly divert resources and attention away from the needs of old people.

We already are living with the impacts of climate change today. But the damage will vastly increase in the decades ahead unless there is widespread adoption of renewable energy.

As far as artificial intelligence (AI), the potential risks are enormous. Little seems to be standing in the way of AI’s expanding role in society. While societal control today already rests in fewer hands than was the case previously, AI could well lead to a further concentration of power. The spread of AI in our economy and political system could yield a further erosion of democratic input and popular voice in how society should function. AI can exacerbate social divisions, racial inequality, and stereotyping of marginalized groups, including seniors.

Very alarming is the possibility that machines may one day become “smarter” than humans. If this happens, there will be little reason for machine-controlled societies to value old people. Supporting seniors is a costly endeavor, since we consume more societal resources than we add back. For seniors to be accepted and respected members of the social order, large doses of empathy and love are required. Artificial intelligence is the mortal enemy of emotional intelligence. And compassion cannot be coded into a computer.

Any number of other issues could threaten old folks later this century. Without elaborating on how they might affect seniors, these hazards include rising authoritarianism, wealth inequality, food shortages, and more virulent pandemics. The bottom line is that successful aging may be a vastly bigger challenge for our grandchildren than it is for us.

We Boomers already have a difficult time aging gracefully. Do we really want to make growing old even harder for future generations?

We have the knowledge and wherewithal to reduce these risks to our grandchildren. With a new year dawning, perhaps it is an appropriate time to consider whether we have the will to do so.

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